<i>Helicobacter pylori</i> Management During Alendronate Therapy, Cell-Free DNA Levels, and Gastrointestinal Safety in Osteoporosis

Helicobacter pylori infection contributes to chronic gastric inflammation, yet evidence is limited on whether infection management around alendronate initiation is associated with early biological or gastrointestinal outcomes. We therefore conducted a prospective, single-center, routine-care-based cohort study in 90 patients aged 50–85 years: 34 H. pylori-positive patients receiving eradication management, 26 H. pylori-positive patients with delayed, declined, incomplete, or unconfirmed management, and 30 H. pylori-negative reference patients.

Plasma cfDNA was measured at baseline and week 24, and gastrointestinal adverse events, alendronate administration behavior, treatment interruption, and eradication confirmation were assessed during follow-up. Valid week-24 cfDNA data were available for 81 participants. Mean cfDNA change was −5.2 ± 3.5 ng/mL in the eradication-management cohort, −0.8 ± 4.0 ng/mL in the delayed-management cohort, and −1.7 ± 3.6 ng/mL in the reference cohort (overall P < 0.001).