Associated factors of osteoporosis in Chinese rheumatoid arthritis patients: A systematic review and meta-analysis.

Abstract

The aim of this systematic review and meta-analysis was to analyze the associated factors of osteoporosis in patients with rheumatoid arthritis RA in China. PubMed, Embase, Web of Science, Cochrane Library, CINAHL and four Chinese electronic databases were searched for observational studies without language restrictions that reported the associated factors from inception to February 2023. A modified Newcastle-Ottawa Scale evaluated the risk of bias. Statistical heterogeneity among the included studies was analysed using Cochran's Q and I2 tests. Begg's and Egger's tests were used to assess the publication bias. A total of 15 studies were finally included. The meta-analysis showed that 10 factors were grouped into three themes with statistical significance: (1) demographics theme: age≥50 [OR=1.161; 95% CI: (1.111,1.231); p<0.001], low BMI [OR=1.248; 95% CI: (1.192. 1.312); p<0.001], female [OR=5.174; 95% CI: (3.058,7.290); p<0.001], and menopause[OR=4.917; 95%CI: (1.558, 15.523); I2=0.0%; p=0.007]; (2) RA-related factor theme: disease duration [OR=1.083; 95% CI: (1.038, 1.127); p<0.001], and glucocorticoids [OR=2.740; 95% CI: (2.000,3.750); p<0.001]; (3) relevant physiological indicators or scores theme: low 25(OH)D3 [OR=1.009; 95% CI: (1.003,1.016); p<0.001], ESR [OR=1.489; 95% CI: (1.041,2.130); p=0.029], high DAS28 score [OR=2.5991; 95% CI: (1.094,6.138); p<0.001] and β-CTx [OR=1.009; 95% CI: (1.003,1.016); p=0.005]. Osteoporosis in patients with rheumatoid arthritis is associated to various factors. Therefore, patients with rheumatoid arthritis should be monitored in a timely manner and targeted interventions should be taken. In addition, further longitudinal studies are needed to confirm the direct link between multiple factors and osteoporosis.