A case-control study based on the National Health and Nutrition Examination Survey to evaluate the effects of human papilloma virus on bone health in women

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However, the impact of HPV infection on bone health remains uncertain. Methods This case-control study utilized data from the National Health and Nutrition Examination Survey (NHANES). Comparable datasets were created using nearest neighbor propensity score matching (PSM) at a ratio of 1:1. The association between HPV infection and bone mineral density (BMD) was analyzed using the Welch two-sample t-test. Furthermore, linear mixed models were employed for validation purposes. Restricted cubic spline (RCS) analysis and Kendall's tau-b tests were performed to explore the effect of different types of HPV infection on BMD. Results Individuals with HPV infection had lower BMD in the lower limbs and lumbar spine compared to uninfected individuals. RCS analysis revealed that an increasing number of cooccurring HPV types in women was associated with lower BMD. Specifically, four HPV types were negatively associated with lower limb BMD, while 14 HPV types were negatively associated with lumbar spine BMD. Additionally, HPV types 53, 59, and 89 exhibited effects on both lower limb and lumbar spine BMD. Conclusions HPV infection is associated with a decrease in BMD, and co-infection with multiple types of HPV implies even lower BMD. Appropriately designed trials are needed to determine if interventions targeted at preventing HPV infection can have a protective effect on BMD. Women Human papilloma virus Bone mineral density Figures Figure 1 Figure 2 1. Introduction Osteoporosis (OP) is a prevalent chronic skeletal disease characterized by reduced bone mineral density (BMD) and deterioration of bone structure[ 1 , 2 ]. OP is of significant clinical importance as it is a major risk factor for fractures and has a substantial impact on human health and quality of life[ 3 , 4 ]. Worldwide, there are over 200 million individuals affected by OP[ 5 , 6 ], with an approximate 40% prevalence rate in elderly populations in certain regions[ 7 – 9 ]. The economic and social burdens imposed by OP and its associated fractures are substantial. Due to its multifactorial nature, it is crucial to gain a better understanding of emerging risk factors associated with the disease in order to develop effective prevention and treatment strategies for high-risk individuals. Human papillomavirus (HPV) is one of the most well-known viruses affecting humans, with a relatively high infection rate ranging from 2–44%[ 10 – 12 ]. The majority of individuals will encounter HPV infection at some point in their lives. HPV has become the most common sexually transmitted infection worldwide and is recognized as a causal factor for cervical cancer[ 13 , 14 ]. It has also been implicated as a risk factor for other malignancies such as laryngeal carcinoma, anal squamous cell cancer, lung cancer, and colorectal cancer[ 15 – 20 ]. The rate of HPV infection is significantly higher in women than in men[ 21 , 22 ]. Similarly, being female is an independent risk factor for OP[ 23 – 25 ]. However, the association between HPV and BMD has not been confirmed. This has sparked our interest in investigating the impact of HPV on bone health in women. Thus, we conducted a comprehensive case-control study utilizing data from the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between HPV infection and BMD. By elucidating the strength and nature of this association, we aim to provide evidence to guide targeted public health interventions. 2. Subjects and methods 2.1 General information about the NHANES The National Center for Health Statistics of the Centers for Disease Control and Prevention in the United States conducted a multistage, large-scale, nationally representative study named the NHANES[26]. This cross-sectional survey gathered comprehensive demographic, dietary, examination, and questionnaire data. Detailed information regarding the NHANES protocol can be found elsewhere[27]. The data utilized in this study were obtained from the 2009-2014 NHANES database. 2.2 Definition of variables 2.2.1 HPV infection All eligible female participants underwent vaginal swab collection. The collected samples were analyzed using the Roche linear array HPV genotyping test to identify the presence and specific type of HPV infection. This method allowed for the detection of 37 HPV types, including 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89, and IS39. Subjects who tested negative for HPV were grouped into group A, while those who tested positive for any HPV type were placed in group B. Subjects with missing data were excluded from the analysis. 2.2.2 Measurement of BMD Dual-energy X-ray absorptiometry (DXA) was utilized to measure bone mineral density (BMD) in eligible female subjects. The scanning procedure encompassed the entire body, but our study concentrated specifically on the BMD of the lower limbs and lumbar spines. The BMD of the lower limbs was determined by averaging the BMD values of the bilateral total femur, while the BMD of the lumbar spine was calculated by averaging the BMD values of L1-4. If the BMD measurement for one lower limb was missing, the average BMD of the legs was used in place of the missing value. Subjects whose BMD measurements for the lower limbs or lumbar spine could not be computed were excluded from the analysis. Raw BMD values in gm/cm2 units were employed for subsequent analyses. 2.2.3 Covariates We included various covariates of interest in our study. These covariates include age, race, education level, marital status, poverty-to-income ratio, smoking status, alcohol consumption status, presence of diabetes, depression score, sleeping difficulty, intake of calcium and vitamin D, sun exposure, and human immunodeficiency virus (HIV) infection. To ensure consistency and accuracy in our measurements, we defined smoking as having smoked ≥ 100 cigarettes in a lifetime[28]. We defined alcohol consumption as having 4/5 or more drinks every day[29, 30]. Subjects were considered to have diabetes if they met any of the following criteria: being told by doctors or other health professionals they had diabetes, using insulin, or using diabetes medication to lower their blood sugar[31]. We deemed subjects to have clinically relevant depression if they had a Patient Health Questionnaire (PHQ)-9 total score of ≥ 10[8, 32]. Additionally, subjects who answered "yes" to the question "Have you ever been told by a doctor that you have a sleep disorder?" were considered to have sleeping difficulty. To investigate the intake of calcium and vitamin D, we conducted dietary interviews and examined total nutrient intakes on the first and second day. We used the average value of the intake for downstream analysis. For sun exposure, we obtained data from the dermatology questionnaire section. Subjects who answered "always," "most of the time," or "don't go out in the sun" to the question "When you go outside on a very sunny day, for more than one hour, how often do you stay in the shade?" or "Wear a long-sleeved shirt?" or "Use sunscreen?" were considered to have insufficient sun exposure[33]. Finally, to determine the HIV infection status, we collected serum samples from the subjects and conducted tests to detect the presence of HIV antibodies. 2.3 Ethical statement The National Center for Health Statistics Research Ethics Review Board had approved the NHAHES. Therefore, NHANES data could be accessed without ethical or administrative permission. 2.4 Statistical analyses Normal Q-Q plots were utilized to assess the distribution of the data. Continuous variables were analyzed using either Welch two-sample t tests or nonparametric Mann–Whitney U tests. Categorical variables were compared using either chi-square tests or Fisher’s exact tests. Previous studies have demonstrated the effectiveness of propensity score matching (PSM) in reducing selection bias in retrospective studies[7, 34, 35]. In our study, we employed PSM with the 1:1 nearest neighbor matching algorithm to match subjects. Subsequently, linear mixed models were utilized to further investigate the association between HPV infection and BMD. BMD was treated as a continuous variable in this analysis. HPV infection was treated as categorical and set as a fixed effect. The remaining parameters used their default settings. For nonlinear a priori associations, we employed restricted cubic spline (RCS) models to describe the dose‒response relationships between the continuous exposure and outcomes[36, 37]. In this study, RCS models with five knots were utilized to further explore the association between HPV infection and BMD. Lastly, Kendall's tau-b test was employed to analyze the association between HPV type and BMD. Only the individual effects of each HPV type were calculated in this test, without considering interactions between different types. The effects of HPV types 26, 64, and 82 could not be analyzed as there were no subjects infected with only these types. A significance level of P < 0.05 was applied, and all tests were one-sided. Data extraction, merging, statistical analyses, and figures were conducted using R (version 4.1.1) and SPSS (version 22). The study design is presented in Supplemental Figure 1. 3. Results 3.1 Participant characteristics before matching A total of 4673 female subjects were included in this study after screening. Group A (n = 2614) had a mean age of 39.00 ± 11.97 years, while group B (n = 2059) had a mean age of 36.67 ± 12.29 years. Supplementary File 1 presents the comparisons of baseline characteristics between the two groups. The results revealed statistically significant differences in the vast majority of characteristics, including age and education level (P < 0.001). This indicated the presence of significant selection bias between the two groups of subjects. Consequently, propensity score matching (PSM) was conducted to mitigate this phenomenon. 3.2 Construction of matched datasets Following 1:1 matching, datasets containing BMDs in the legs and lumbar spine were obtained. A total of 753 subjects were included in both group A and group B. Analysis of baseline characteristics revealed the absence of selection bias (P > 0.05). Further details can be found in Supplementary File 2. Figure 1A depicts the BMD values of the lower limbs and lumbar spine across different age groups. Figures 1B-D demonstrate that BMD follows a significant normal distribution according to the Normal Q-Q plots. 3.3 Lower BMD in subjects with HPV infection Subjects infected with HPV exhibited lower BMD in both the lower limbs and lumbar spine, as indicated by Welch two-sample t tests (P < 0.001). There was a greater decrease in BMD in the lumbar spine compared to the lower limbs (Table 1). Linear mixed models revealed that subjects infected with HPV had a mean decrease of 0.015 (P = 0.015) in lower limb BMD compared to HPV-negative subjects. Additionally, a mean decrease of 0.017 (P = 0.006) was observed in lumbar spine BMD. These findings corroborated the results obtained from PSM and Welch two-sample t tests. Detailed data can be found in Table 2. RCS analysis was performed to gain a clearer understanding of the association between HPV infection and BMD. Figure 2 demonstrates a nonlinear association (P < 0.001) between the number of cooccurring HPV types and BMD. As the number of cooccurring HPV types increased, BMD decreased. Subsequently, we performed an analysis on individual HPV types to identify those that had the most significant impact on BMD. The data revealed that four HPV types (06, 53, 59, and 89) exhibited a negative correlation with lower limb BMD (P < 0.05). Notably, type 89 exhibited the strongest correlation (r = -0.060). Fourteen HPV types demonstrated a negative correlation with lumbar spine BMD, with type 53 showing the strongest correlation (r = -0.085). Specifically, three HPV types (53, 59, and 89) had a significant effect on both lower limb and lumbar spine BMDs. Additional detailed data can be found in Tables 3 and 4. 4. Discussion The current literature regarding the association between viral infection and osteoporosis (OP) is limited. Viruses such as HIV, hepatitis B virus, hepatitis C virus, and severe acute respiratory syndrome coronavirus 2 have been found to be associated with OP[38-42]. By integrating the findings from the PSM, linear mixed models, and RCS analyses, we established a negative correlation between HPV infection and BMD. Additionally, a higher number of co-occurring HPV types was associated with decreased BMD. As mentioned earlier, we confirmed the association between HPV and BMD. However, it is more important to determine the causal relationship between them. The decline in BMD and its progression to OP often occur over an extended period of time. In contrast, HPV infection can be regarded as an immediate occurrence. We posit that the decline in BMD is more likely caused by HPV infection rather than the other way around. Furthermore, the results after statistical adjustment provide support for our hypothesis. PSM eliminated selection bias, safeguarded our findings from confounding factors, and enhanced the strength of evidence. Nevertheless, prospective studies are essential to establish the causal relationship between HPV infection and BMD. However, the biological mechanisms responsible for the decline in BMD due to HPV infection are still unclear. Persistent HPV infection is known to elicit various responses, such as immunosuppression and abnormal cell destruction[43]. In a prospective study, Scott et al. discovered elevated IL-12 concentrations in cervicovaginal lavage fluid specimens from women with persistent HPV infection[44]. This might indicate the activation of macrophages induced by IL-12 and the ensuing chronic inflammation[45]. The tissue damage resulting from inflammation is self-evident. Furthermore, cervical HPV infection leads to the infiltration of macrophages and dendritic cells. Activation of these cells also results in the release of TNF, IL-8, and IL-12[[46, 47]. Additionally, HPV infection-induced oxidative stress and lipid peroxidation contribute to cellular damage that may result in cell death[48]. While these effects are primarily observed in locally infected tissues, prolonged effects can lead to systemic damage, including bone damage. We also noted a larger decline in BMD in the lumbar spine than in the lower limbs in HPV-infected individuals. Fourteen HPV types showed an inverse association with lumbar spine BMD, a significantly higher number compared to the lower limbs (four types). This finding indicates that lumbar spine BMD is more responsive than lower limb BMD. This finding aligns partially with the results of previous studies. or instance, Snyder et al. discovered that testosterone was associated with increased BMD in older men, with a greater increase observed in the spine compared to the hip[49]. Currently, more than 20 types of HPV are known to infect the genital tract. These types have been classified as either 'high-risk' or 'low-risk' based on their probability of causing cancer. A study identified fifteen high-risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82[50]. Among them, HPV-16 is considered to have the highest risk for carcinogenicity, followed by HPV-18[51]. On the other hand, types 6 and 11 are commonly found in benign lesions and are therefore classified as low-risk. However, based on epidemiological evidence and molecular research, types 26, 53, and 66 might also be considered high-risk[52]. In our study, we analyzed data on all 37 types of HPV included in NHANES, which included the aforementioned types. Our findings revealed a negative association between three types of HPV (53, 59, and 89) and BMDs in both the lumbar spine and lower limbs. Therefore, public HPV preventive measures and the detection of HPV infection should prioritize these three types. Further research focusing on these types could help elucidate the biological mechanisms underlying the association between HPV and BMD. Although our statistical analysis minimized selection bias, there are still some limitations in the present study. Firstly, to truly establish a causal association between HPV infection and BMD decline, prospective evidence is necessary. Secondly, additional molecular experiments are required to better understand the biological mechanisms linking HPV and BMD. Lastly, our study only included 37 types of HPV, and it remains unknown whether other types not detected in NHANES have an impact on bone health in women. 5. Conclusions In conclusion, our analysis of data from a nationally representative database of US adults revealed a negative association between HPV infection and BMD in female subjects. Additionally, we observed that a higher number of cooccurring HPV types was associated with lower BMD levels. Declarations Funding: This research was supported by the Natural Science Foundation of Shandong Province (ZR2021MH293). Declaration of interests: The authors state that they have no conflicts of interest. Acknowledgments: Not applicable. Data sharing statement: The raw data of this study is deposited in the Dryad (DOI:10.5061/dryad.4b8gththb). Funding: This research was supported by the Natural Science Foundation of Shandong Province (ZR2021MH293). References Zhu, X., W. Bai, and H. Zheng, Twelve years of GWAS discoveries for osteoporosis and related traits: advances, challenges and applications. Bone Res, 2021. 9 (1): p. 23. Bellavia, D., et al., Non-flavonoid polyphenols in osteoporosis: preclinical evidence. Trends Endocrinol Metab, 2021. 32 (7): p. 515-529. Yong, E.L. and S. Logan, Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J, 2021. 62 (4): p. 159-166. Yu, X.H., et al., Birth weight is positively associated with adult osteoporosis risk: observational and Mendelian randomization studies. J Bone Miner Res, 2021. 36 (8): p. 1469-1480. Khatib, J., K. Stote, and A.R. 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Clin Infect Dis, 2017. 64 (9): p. 1228-1235. Backes, D.M., et al., Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control, 2009. 20 (4): p. 449-57. Lizano, M., J. Berumen, and A. García-Carrancá, HPV-related Carcinogenesis: Basic Concepts, Viral Types and Variants. Archives of Medical Research, 2009. 40 (6): p. 428-434. Tables Table 1. Comparison of BMD between the two groups after matching. Characteristics Group A Group B P value N = 753 N = 753 a BMD of lower limbs 1.057±0.143 1.026±0.146 < 0.001 a BMD of lumbar spine 1.051±0.138 1.035±0.139 0.032 BMD, bone mineral density. a The values were given as the mean and standard deviation. P value was calculated by Welch two-sample t test. Table 2. Linear mixed model of BMD, with HPV infection as a categorical variable. Dependent variable Predictor variable Estimate Standard error 95% Confidence interval P value lower-bound upper-bound BMD of lower limbs HPV infection -0.015 0.006 -0.026 -0.003 0.015 BMD of lumbar spine -0.017 0.006 -0.028 -0.005 0.006 BMD, bone mineral density. HPV, Human papilloma virus. Table 3. The correlation between HPV types and BMD of lower limbs. BMD, bone mineral density. HPV, Human papilloma virus. P values were calculated by Kendall's tau-b correlation test. Statistically significant HPV types were marked in blue. Since there were no subjects infected with only HPV types 11, it was not applicable to calculate their effects on the BMD of leg. Table 4. The correlation between HPV types and BMD of lumbar spine. BMD, bone mineral density. HPV, Human papilloma virus. P values were calculated by Kendall's tau-b correlation test. Statistically significant HPV types were marked in blue. Additional Declarations No competing interests reported. Supplementary Files SupplementalFigure1.doc SupplementaryFile1.docx SupplementaryFile2.docx Cite Share Download PDF Status: Published Journal Publication published 07 Feb, 2025 Read the published version in BMC Medicine → Version 1 posted Editorial decision: Revision requested 11 Nov, 2024 Reviews received at journal 31 Oct, 2024 Reviewers agreed at journal 18 Oct, 2024 Reviews received at journal 08 Oct, 2024 Reviewers agreed at journal 26 Sep, 2024 Reviewers agreed at journal 05 Apr, 2024 Reviewers invited by journal 03 Apr, 2024 Editor assigned by journal 28 Mar, 2024 Submission checks completed at journal 28 Mar, 2024 First submitted to journal 27 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4178709","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285040696,"identity":"fe67382e-85b5-4859-9b64-761afc85cda6","order_by":0,"name":"Xiang Li","email":"","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Xiang","middleName":"","lastName":"Li","suffix":""},{"id":285040697,"identity":"133bed6f-08b7-41ef-b943-d472a40f45c6","order_by":1,"name":"Guangjun Jiao","email":"","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Guangjun","middleName":"","lastName":"Jiao","suffix":""},{"id":285040699,"identity":"bb5de973-a1cf-4a5a-884f-973918401b12","order_by":2,"name":"Yunzhen Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYDACZuYGECUHxGzEamEEazGGaZEgQg9ES2ID0Vr4jjO2Sfxsq0vfcLz52QPGHTZ1BLVIHmZsk+xtY8vdcOaYuQHjmTTCthgAtUgztvHkbriRYCbB2HaYaC0S6Qb3n38DavlPtBaDBIMbPCBbDhDWAvRLs2XPuQTDmWdyyiQS25IlGwhp4Tt/+OCNH2V18nzHj2+T+Nhmx0/QFoYDQMwIjBEFECOBsHqoFoY/DAzyBB00CkbBKBgFIxYAAD+lO3K5EkTSAAAAAElFTkSuQmCC","orcid":"","institution":"Qilu Hospital of Shandong University","correspondingAuthor":true,"prefix":"","firstName":"Yunzhen","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-03-28 01:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4178709/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4178709/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12916-025-03909-2","type":"published","date":"2025-02-07T15:57:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53961092,"identity":"4e7873b0-ec1d-4fa1-899c-23fc6bc86229","added_by":"auto","created_at":"2024-04-02 18:01:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":216155,"visible":true,"origin":"","legend":"\u003cp\u003eAfter matching, the bone mineral density (BMD) of lower limbs and\u003c/p\u003e\n\u003cp\u003elumbar spine in different age groups (A). The normal Q-Q plots of BMD in\u003c/p\u003e\n\u003cp\u003egroup A (B, C) and group B (D, E).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4178709/v1/7b7d6d548bcd38c1dccc0a7d.png"},{"id":53959890,"identity":"861a359a-8677-4f92-bfbe-45373e12878a","added_by":"auto","created_at":"2024-04-02 17:53:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":266671,"visible":true,"origin":"","legend":"\u003cp\u003eRestricted cubic spline models for the relationship between the\u003c/p\u003e\n\u003cp\u003enumber of infected human papilloma virus (HPV) types and bone mineral\u003c/p\u003e\n\u003cp\u003edensity (BMD) after matching.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4178709/v1/2fc2aa141ce80d50f90cc1aa.png"},{"id":75929968,"identity":"f53898c8-b49e-45bf-8eed-dc3b513f2137","added_by":"auto","created_at":"2025-02-10 16:08:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1193605,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4178709/v1/0f42d1ac-9909-4d6a-9dd3-0ca7ff7815b8.pdf"},{"id":53959889,"identity":"feab1b12-5627-4f7c-9288-e60d3fd1ec01","added_by":"auto","created_at":"2024-04-02 17:53:39","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10752,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigure1.doc","url":"https://assets-eu.researchsquare.com/files/rs-4178709/v1/999b03fdaec7f878fd94ca32.doc"},{"id":53959891,"identity":"157de501-b77f-4893-8204-52052f06c707","added_by":"auto","created_at":"2024-04-02 17:53:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18368,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4178709/v1/2689b0c49063c54f2976e36a.docx"},{"id":53959887,"identity":"2948fd73-7f2d-44fb-8a0e-c90d5296f012","added_by":"auto","created_at":"2024-04-02 17:53:39","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":18514,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4178709/v1/5210a7c5e9949c45b5cdd3ff.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A case-control study based on the National Health and Nutrition Examination Survey to evaluate the effects of human papilloma virus on bone health in women","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eOsteoporosis (OP) is a prevalent chronic skeletal disease characterized by reduced bone mineral density (BMD) and deterioration of bone structure[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. OP is of significant clinical importance as it is a major risk factor for fractures and has a substantial impact on human health and quality of life[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Worldwide, there are over 200\u0026nbsp;million individuals affected by OP[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], with an approximate 40% prevalence rate in elderly populations in certain regions[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The economic and social burdens imposed by OP and its associated fractures are substantial. Due to its multifactorial nature, it is crucial to gain a better understanding of emerging risk factors associated with the disease in order to develop effective prevention and treatment strategies for high-risk individuals.\u003c/p\u003e \u003cp\u003eHuman papillomavirus (HPV) is one of the most well-known viruses affecting humans, with a relatively high infection rate ranging from 2\u0026ndash;44%[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The majority of individuals will encounter HPV infection at some point in their lives. HPV has become the most common sexually transmitted infection worldwide and is recognized as a causal factor for cervical cancer[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It has also been implicated as a risk factor for other malignancies such as laryngeal carcinoma, anal squamous cell cancer, lung cancer, and colorectal cancer[\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The rate of HPV infection is significantly higher in women than in men[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, being female is an independent risk factor for OP[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, the association between HPV and BMD has not been confirmed. This has sparked our interest in investigating the impact of HPV on bone health in women.\u003c/p\u003e \u003cp\u003eThus, we conducted a comprehensive case-control study utilizing data from the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between HPV infection and BMD. By elucidating the strength and nature of this association, we aim to provide evidence to guide targeted public health interventions.\u003c/p\u003e"},{"header":"2. Subjects and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 General information about the NHANES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe National Center for Health Statistics of the Centers for Disease Control and Prevention in the United States conducted a multistage, large-scale, nationally representative study named the NHANES[26]. This cross-sectional survey gathered comprehensive demographic, dietary, examination, and questionnaire data. Detailed information regarding the NHANES protocol can be found elsewhere[27]. The data utilized in this study were obtained from the 2009-2014 NHANES database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Definition of variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1 HPV infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll eligible female participants underwent vaginal swab collection. The collected samples were analyzed using the Roche linear array HPV genotyping test to identify the presence and specific type of HPV infection. This method allowed for the detection of 37 HPV types, including 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89, and IS39.\u003c/p\u003e\n\u003cp\u003eSubjects who tested negative for HPV were grouped into group A, while those who tested positive for any HPV type were placed in group B. Subjects with missing data were excluded from the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2 Measurement of BMD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDual-energy X-ray absorptiometry (DXA) was utilized to measure bone mineral density (BMD) in eligible female subjects. The scanning procedure encompassed the entire body, but our study concentrated specifically on the BMD of the lower limbs and lumbar spines.\u003c/p\u003e\n\u003cp\u003eThe BMD of the lower limbs was determined by averaging the BMD values of the bilateral total femur, while the BMD of the lumbar spine was calculated by averaging the BMD values of L1-4. If the BMD measurement for one lower limb was missing, the average BMD of the legs was used in place of the missing value. Subjects whose BMD measurements for the lower limbs or lumbar spine could not be computed were excluded from the analysis. Raw BMD values in gm/cm2 units were employed for subsequent analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.3 Covariates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; We included various covariates of interest in our study. These covariates include age, race, education level, marital status, poverty-to-income ratio, smoking status, alcohol consumption status, presence of diabetes, depression score, sleeping difficulty, intake of calcium and vitamin D, sun exposure, and human immunodeficiency virus (HIV) infection.\u003c/p\u003e\n\u003cp\u003eTo ensure consistency and accuracy in our measurements, we defined smoking as having smoked ≥ 100 cigarettes in a lifetime[28]. We defined alcohol consumption as having 4/5 or more drinks every day[29, 30].\u003c/p\u003e\n\u003cp\u003eSubjects were considered to have diabetes if they met any of the following criteria: being told by doctors or other health professionals they had diabetes, using insulin, or using diabetes medication to lower their blood sugar[31].\u003c/p\u003e\n\u003cp\u003eWe deemed subjects to have clinically relevant depression if they had a Patient Health Questionnaire (PHQ)-9 total score of ≥ 10[8, 32].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, subjects who answered \"yes\" to the question \"Have you ever been told by a doctor that you have a sleep disorder?\" were considered to have sleeping difficulty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo investigate the intake of calcium and vitamin D, we conducted dietary interviews and examined total nutrient intakes on the first and second day. We used the average value of the intake for downstream analysis.\u003c/p\u003e\n\u003cp\u003eFor sun exposure, we obtained data from the dermatology questionnaire section. Subjects who answered \"always,\" \"most of the time,\" or \"don't go out in the sun\" to the question \"When you go outside on a very sunny day, for more than one hour, how often do you stay in the shade?\" or \"Wear a long-sleeved shirt?\" or \"Use sunscreen?\" were considered to have insufficient sun exposure[33].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, to determine the HIV infection status, we collected serum samples from the subjects and conducted tests to detect the presence of HIV antibodies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Ethical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe National Center for Health Statistics Research Ethics Review Board had approved the NHAHES. Therefore, NHANES data could be accessed without ethical or administrative permission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNormal Q-Q plots were utilized to assess the distribution of the data. Continuous variables were analyzed using either Welch two-sample t tests or nonparametric Mann–Whitney U tests. Categorical variables were compared using either chi-square tests or Fisher’s exact tests.\u003c/p\u003e\n\u003cp\u003ePrevious studies have demonstrated the effectiveness of propensity score matching (PSM) in reducing selection bias in retrospective studies[7, 34, 35]. In our study, we employed PSM with the 1:1 nearest neighbor matching algorithm to match subjects. Subsequently, linear mixed models were utilized to further investigate the association between HPV infection and BMD. BMD was treated as a continuous variable in this analysis. HPV infection was treated as categorical and set as a fixed effect. The remaining parameters used their default settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor nonlinear a priori associations, we employed restricted cubic spline (RCS) models to describe the dose‒response relationships between the continuous exposure and outcomes[36, 37]. In this study, RCS models with five knots were utilized to further explore the association between HPV infection and BMD.\u003c/p\u003e\n\u003cp\u003eLastly, Kendall's tau-b test was employed to analyze the association between HPV type and BMD. Only the individual effects of each HPV type were calculated in this test, without considering interactions between different types. The effects of HPV types 26, 64, and 82 could not be analyzed as there were no subjects infected with only these types. A significance level of P \u0026lt; 0.05 was applied, and all tests were one-sided. Data extraction, merging, statistical analyses, and figures were conducted using R (version 4.1.1) and SPSS (version 22). The study design is presented in Supplemental Figure 1.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Participant characteristics before matching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 4673 female subjects were included in this study after screening. Group A (n = 2614) had a mean age of 39.00 ± 11.97 years, while group B (n = 2059) had a mean age of 36.67 ± 12.29 years. Supplementary File 1 presents the comparisons of baseline characteristics between the two groups. The results revealed statistically significant differences in the vast majority of characteristics, including age and education level (P \u0026lt; 0.001). This indicated the presence of significant selection bias between the two groups of subjects. Consequently, propensity score matching (PSM) was conducted to mitigate this phenomenon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Construction of matched datasets\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing 1:1 matching, datasets containing BMDs in the legs and lumbar spine were obtained. A total of 753 subjects were included in both group A and group B. Analysis of baseline characteristics revealed the absence of selection bias (P \u0026gt; 0.05). Further details can be found in Supplementary File 2. Figure 1A depicts the BMD values of the lower limbs and lumbar spine across different age groups. Figures 1B-D demonstrate that BMD follows a significant normal distribution according to the Normal Q-Q plots.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Lower BMD in subjects with HPV infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubjects infected with HPV exhibited lower BMD in both the lower limbs and lumbar spine, as indicated by Welch two-sample t tests (P \u0026lt; 0.001). There was a greater decrease in BMD in the lumbar spine compared to the lower limbs (Table 1). Linear mixed models revealed that subjects infected with HPV had a mean decrease of 0.015 (P = 0.015) in lower limb BMD compared to HPV-negative subjects. Additionally, a mean decrease of 0.017 (P = 0.006) was observed in lumbar spine BMD. These findings corroborated the results obtained from PSM and Welch two-sample t tests. Detailed data can be found in Table 2.\u003c/p\u003e\n\u003cp\u003eRCS analysis was performed to gain a clearer understanding of the association between HPV infection and BMD. Figure 2 demonstrates a nonlinear association (P \u0026lt; 0.001) between the number of cooccurring HPV types and BMD. As the number of cooccurring HPV types increased, BMD decreased.\u003c/p\u003e\n\u003cp\u003eSubsequently, we performed an analysis on individual HPV types to identify those that had the most significant impact on BMD. The data revealed that four HPV types (06, 53, 59, and 89) exhibited a negative correlation with lower limb BMD (P \u0026lt; 0.05). Notably, type 89 exhibited the strongest correlation (r = -0.060). Fourteen HPV types demonstrated a negative correlation with lumbar spine BMD, with type 53 showing the strongest correlation (r = -0.085). Specifically, three HPV types (53, 59, and 89) had a significant effect on both lower limb and lumbar spine BMDs. Additional detailed data can be found in Tables 3 and 4.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe current literature regarding the association between viral infection and osteoporosis (OP) is limited. Viruses such as HIV, hepatitis B virus, hepatitis C virus, and severe acute respiratory syndrome coronavirus 2 have been found to be associated with OP[38-42]. By integrating the findings from the PSM, linear mixed models, and RCS analyses, we established a negative correlation between HPV infection and BMD. Additionally, a higher number of co-occurring HPV types was associated with decreased BMD.\u003c/p\u003e\n\u003cp\u003eAs mentioned earlier, we confirmed the association between HPV and BMD. However, it is more important to determine the causal relationship between them. The decline in BMD and its progression to OP often occur over an extended period of time. In contrast, HPV infection can be regarded as an immediate occurrence. We posit that the decline in BMD is more likely caused by HPV infection rather than the other way around. Furthermore, the results after statistical adjustment provide support for our hypothesis. PSM eliminated selection bias, safeguarded our findings from confounding factors, and enhanced the strength of evidence. Nevertheless, prospective studies are essential to establish the causal relationship between HPV infection and BMD.\u003c/p\u003e\n\u003cp\u003eHowever, the biological mechanisms responsible for the decline in BMD due to HPV infection are still unclear. Persistent HPV infection is known to elicit various responses, such as immunosuppression and abnormal cell destruction[43]. In a prospective study, Scott et al. discovered elevated IL-12 concentrations in cervicovaginal lavage fluid specimens from women with persistent HPV infection[44]. This might indicate the activation of macrophages induced by IL-12 and the ensuing chronic inflammation[45]. The tissue damage resulting from inflammation is self-evident. Furthermore, cervical HPV infection leads to the infiltration of macrophages and dendritic cells. Activation of these cells also results in the release of TNF, IL-8, and IL-12[[46, 47]. Additionally, HPV infection-induced oxidative stress and lipid peroxidation contribute to cellular damage that may result in cell death[48]. While these effects are primarily observed in locally infected tissues, prolonged effects can lead to systemic damage, including bone damage.\u003c/p\u003e\n\u003cp\u003eWe also noted a larger decline in BMD in the lumbar spine than in the lower limbs in HPV-infected individuals. Fourteen HPV types showed an inverse association with lumbar spine BMD, a significantly higher number compared to the lower limbs (four types). This finding indicates that lumbar spine BMD is more responsive than lower limb BMD. This finding aligns partially with the results of previous studies. or instance, Snyder et al. discovered that testosterone was associated with increased BMD in older men, with a greater increase observed in the spine compared to the hip[49].\u003c/p\u003e\n\u003cp\u003eCurrently, more than 20 types of HPV are known to infect the genital tract. These types have been classified as either \u0026apos;high-risk\u0026apos; or \u0026apos;low-risk\u0026apos; based on their probability of causing cancer. A study identified fifteen high-risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82[50]. Among them, HPV-16 is considered to have the highest risk for carcinogenicity, followed by HPV-18[51]. On the other hand, types 6 and 11 are commonly found in benign lesions and are therefore classified as low-risk. However, based on epidemiological evidence and molecular research, types 26, 53, and 66 might also be considered high-risk[52]. In our study, we analyzed data on all 37 types of HPV included in NHANES, which included the aforementioned types. Our findings revealed a negative association between three types of HPV (53, 59, and 89) and BMDs in both the lumbar spine and lower limbs. Therefore, public HPV preventive measures and the detection of HPV infection should prioritize these three types. Further research focusing on these types could help elucidate the biological mechanisms underlying the association between HPV and BMD.\u003c/p\u003e\n\u003cp\u003eAlthough our statistical analysis minimized selection bias, there are still some limitations in the present study. Firstly, to truly establish a causal association between HPV infection and BMD decline, prospective evidence is necessary. Secondly, additional molecular experiments are required to better understand the biological mechanisms linking HPV and BMD. Lastly, our study only included 37 types of HPV, and it remains unknown whether other types not detected in NHANES have an impact on bone health in women.\u0026nbsp;\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn conclusion, our analysis of data from a nationally representative database of US adults revealed a negative association between HPV infection and BMD in female subjects. Additionally, we observed that a higher number of cooccurring HPV types was associated with lower BMD levels.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Natural Science Foundation of Shandong Province (ZR2021MH293).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors state that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sharing statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data of this study is deposited in the Dryad (DOI:10.5061/dryad.4b8gththb).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Natural Science Foundation of Shandong Province (ZR2021MH293).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhu, X., W. Bai, and H. Zheng, \u003cem\u003eTwelve years of GWAS discoveries for osteoporosis and related traits: advances, challenges and applications.\u003c/em\u003e Bone Res, 2021. \u003cstrong\u003e9\u003c/strong\u003e(1): p. 23.\u003c/li\u003e\n \u003cli\u003eBellavia, D., et al., \u003cem\u003eNon-flavonoid polyphenols in osteoporosis: preclinical evidence.\u003c/em\u003e Trends Endocrinol Metab, 2021. \u003cstrong\u003e32\u003c/strong\u003e(7): p. 515-529.\u003c/li\u003e\n \u003cli\u003eYong, E.L. and S. 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Franceschi, \u003cem\u003eCarcinogenicity of Human Papillomavirus (HPV) Types in HIV-Positive Women: A Meta-Analysis From HPV Infection to Cervical Cancer.\u003c/em\u003e Clin Infect Dis, 2017. \u003cstrong\u003e64\u003c/strong\u003e(9): p. 1228-1235.\u003c/li\u003e\n \u003cli\u003eBackes, D.M., et al., \u003cem\u003eSystematic review of human papillomavirus prevalence in invasive penile cancer.\u003c/em\u003e Cancer Causes Control, 2009. \u003cstrong\u003e20\u003c/strong\u003e(4): p. 449-57.\u003c/li\u003e\n \u003cli\u003eLizano, M., J. Berumen, and A. Garc\u0026iacute;a-Carranc\u0026aacute;, \u003cem\u003eHPV-related Carcinogenesis: Basic Concepts, Viral Types and Variants.\u003c/em\u003e Archives of Medical Research, 2009. \u003cstrong\u003e40\u003c/strong\u003e(6): p. 428-434.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Comparison of BMD between the two groups after matching.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"550\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45454545454545%\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003eGroup A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.363636363636363%\" valign=\"top\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.545454545454545%\" rowspan=\"2\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.40909090909091%\" valign=\"top\"\u003e\n \u003cp\u003eN = 753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.59090909090909%\" valign=\"top\"\u003e\n \u003cp\u003eN = 753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45454545454545%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eBMD of lower limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.636363636363637%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.057\u0026plusmn;0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.363636363636363%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.026\u0026plusmn;0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.545454545454545%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.45454545454545%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eBMD of lumbar spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.636363636363637%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.051\u0026plusmn;0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.363636363636363%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.035\u0026plusmn;0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.545454545454545%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMD, bone mineral density.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eThe values were given as the mean and standard deviation.\u003c/p\u003e\n\u003cp\u003eP value was calculated by Welch two-sample t test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Linear mixed model of BMD, with HPV infection as a categorical variable.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"579\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.586206896551722%\" rowspan=\"2\"\u003e\n \u003cp\u003eDependent variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.03448275862069%\" rowspan=\"2\"\u003e\n \u003cp\u003ePredictor variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.206896551724139%\" rowspan=\"2\"\u003e\n \u003cp\u003eEstimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.03448275862069%\" rowspan=\"2\"\u003e\n \u003cp\u003eStandard\u0026nbsp;error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.79310344827586%\" colspan=\"2\"\u003e\n \u003cp\u003e95% Confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.344827586206897%\" rowspan=\"2\"\u003e\n \u003cp\u003eP\u0026nbsp;value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003elower-bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eupper-bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.616580310880828%\"\u003e\n \u003cp\u003eBMD of lower limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\" rowspan=\"2\"\u003e\n \u003cp\u003eHPV infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.226252158894646%\"\u003e\n \u003cp\u003e-0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.335060449050086%\"\u003e\n \u003cp\u003e-0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.335060449050086%\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.362694300518134%\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.987654320987655%\"\u003e\n \u003cp\u003eBMD of lumbar spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.37448559670782%\"\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.135802469135804%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.078189300411523%\"\u003e\n \u003cp\u003e-0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.078189300411523%\"\u003e\n \u003cp\u003e-0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.345679012345679%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMD, bone mineral density. HPV, Human papilloma virus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e The correlation between HPV types and BMD of lower limbs.\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eBMD, bone mineral density.\u0026nbsp;HPV, Human papilloma virus.\u003c/p\u003e\n\u003cp\u003eP values were calculated by Kendall\u0026apos;s tau-b correlation test.\u003c/p\u003e\n\u003cp\u003eStatistically significant HPV types were marked in blue.\u003c/p\u003e\n\u003cp\u003eSince there were no subjects infected with only HPV types 11, it was not applicable to calculate their effects on the BMD of leg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e The correlation between HPV types and BMD of lumbar spine.\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eBMD, bone mineral density.\u0026nbsp;HPV, Human papilloma virus.\u003c/p\u003e\n\u003cp\u003eP values were calculated by Kendall\u0026apos;s tau-b correlation test.\u003c/p\u003e\n\u003cp\u003eStatistically significant HPV types were marked in blue.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmed","sideBox":"Learn more about [BMC Medicine](http://bmcmedicine.biomedcentral.com/)","snPcode":"12916","submissionUrl":"https://submission.nature.com/new-submission/12916/3","title":"BMC Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Women, Human papilloma virus, Bone mineral density","lastPublishedDoi":"10.21203/rs.3.rs-4178709/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4178709/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuman papillomavirus (HPV) infection and osteoporosis (OP) are global health concerns, with higher prevalence observed in women compared to men. However, the impact of HPV infection on bone health remains uncertain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case-control study utilized data from the National Health and Nutrition Examination Survey (NHANES). Comparable datasets were created using nearest neighbor propensity score matching (PSM) at a ratio of 1:1. The association between HPV infection and bone mineral density (BMD) was analyzed using the Welch two-sample t-test. Furthermore, linear mixed models were employed for validation purposes. Restricted cubic spline (RCS) analysis and Kendall's tau-b tests were performed to explore the effect of different types of HPV infection on BMD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividuals with HPV infection had lower BMD in the lower limbs and lumbar spine compared to uninfected individuals. RCS analysis revealed that an increasing number of cooccurring HPV types in women was associated with lower BMD. Specifically, four HPV types were negatively associated with lower limb BMD, while 14 HPV types were negatively associated with lumbar spine BMD. Additionally, HPV types 53, 59, and 89 exhibited effects on both lower limb and lumbar spine BMD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHPV infection is associated with a decrease in BMD, and co-infection with multiple types of HPV implies even lower BMD. Appropriately designed trials are needed to determine if interventions targeted at preventing HPV infection can have a protective effect on BMD.\u003c/p\u003e","manuscriptTitle":"A case-control study based on the National Health and Nutrition Examination Survey to evaluate the effects of human papilloma virus on bone health in women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 17:53:34","doi":"10.21203/rs.3.rs-4178709/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-11T12:28:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-31T08:16:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163259511120355162996770590358196800482","date":"2024-10-18T21:01:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-08T06:04:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44184045750749773654867480979590789370","date":"2024-09-26T05:19:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4acc3d73-1844-4b02-958e-db2ce5ff5ffe_SNPRID","date":"2024-04-05T12:12:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-03T11:17:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-28T09:46:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-28T09:28:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medicine","date":"2024-03-28T01:07:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmed","sideBox":"Learn more about [BMC Medicine](http://bmcmedicine.biomedcentral.com/)","snPcode":"12916","submissionUrl":"https://submission.nature.com/new-submission/12916/3","title":"BMC Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"76a8f091-0a18-4e71-97c4-d565217b811e","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T15:59:25+00:00","versionOfRecord":{"articleIdentity":"rs-4178709","link":"https://doi.org/10.1186/s12916-025-03909-2","journal":{"identity":"bmc-medicine","isVorOnly":false,"title":"BMC Medicine"},"publishedOn":"2025-02-07 15:57:02","publishedOnDateReadable":"February 7th, 2025"},"versionCreatedAt":"2024-04-02 17:53:34","video":"","vorDoi":"10.1186/s12916-025-03909-2","vorDoiUrl":"https://doi.org/10.1186/s12916-025-03909-2","workflowStages":[]},"version":"v1","identity":"rs-4178709","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4178709","identity":"rs-4178709","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}