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Estrogen deficiency due to menopause results in accumulation of the transcription factor hypoxia inducible factor 1 alpha (HIF1) in osteoclasts, in turn promoting osteoclast activation and bone loss 5

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High SDI (sociodemographic index) regions generally have more developed endoscopic screening programs and early diagnostic capabilities, while limited healthcare resources in low-to-middle SDI regions lead to a higher proportion of late-stage diagnoses 28

27: Tobacco use

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