BACKGROUND/AIMS The relationship between Helicobacter pylori (HP) eradication and osteoporosis development remains inadequately elucidated. This study aimed to ascertain whether HP eradication therapy confers protective effects against osteoporosis progression.

METHODS Subjects without osteoporosis who underwent esophagogastroduodenoscopy with concurrent HP testing were prospectively recruited between May 2003 and February 2023 at Seoul National University Bundang Hospital. Participants were stratified into two cohorts: those with successful HP eradication and those without. Osteoporosis was diagnosed using dual-energy X-ray absorptiometry, and the risk of osteoporosis was assessed using Cox proportional hazards regression analysis.

RESULTS The successfully eradicated cohort comprised 730 individuals (mean age, 56.4 years; 67.5% female), compared with 116 individuals (mean age, 56.2 years; 74.1% female) in the non-eradicated cohort. Osteoporosis occurred in 179 subjects (24.5%) in the eradicated group and in 40 subjects (34.5%) in the non-eradicated group. Significant risk factors for osteoporosis included female sex (hazard ratio [HR], 3.12; 95% confidence interval [CI], 1.93 to 5.05; p<0.001), advanced age (HR, 1.08; 95% CI, 1.06 to 1.10 per year; p<0.001), and persistent HP infection (HR, 1.60; 95% CI, 1.13 to 2.28; p=0.009). In subgroup analyses according to sex and age, HP eradication demonstrated a significant reduction in osteoporosis risk in females (p=0.005) than in males, especially among females aged ≥50 years (p=0.003). However, this change was not pronounced in males.

CONCLUSIONS HP eradication may serve as a preventive intervention against osteoporosis development, particularly among female subjects (ClinicalTrials.gov: NCT06818591).