Abstract
IntroductionThe aim of the present study was to compare bone mineral density (BMD) and body composition (BC) measurements as well as identify risk factors for low BMD and osteoporotic fractures in postmenopausal women with psoriasis (Ps) and psoriatic arthritis (PsA).MethodsA cross-sectional study was carried out in 45 PsA women, 52 Ps women and 98 healthy female controls (HC). Clinical risk factors for low bone density and osteoporotic fracture were evaluated by a specific questionnaire. An X-ray absorptiometry (DXA) at the lumbar spine, total femur and total body was performed on all patients. Skin and joint outcomes were measured by specific tools (PASI, HAQ and DAS28). Morphometric vertebral fractures were evaluated by lumbar and thoracic spine X-ray, according to Genant's method.ResultsThere were no significant differences in age, body mass index (BMI), total lean mass and bone mineral density among the groups. However, the PsA group had a significantly higher body fat percentage (BF%) than the Ps and HC groups. Osteoporotic fractures were more frequently observed in PsA and Ps groups than in the HC group (P = 0.01). Recurrent falls and a longer duration of disease increased the risk of fracture (odds ratio (OR) = 18.3 and 1.08, respectively) in the PsA group (P = 0.02). Disability was the main factor related to osteoporotic fracture in the Ps group (odds ratio (OR) = 11.1) (P = 0.02).ConclusionsPs and PsA patients did not present lower BMD. However, they had a higher prevalence of osteoporotic fractures and higher risk of metabolic syndrome. Patients with a longer duration of disease, disability and recurrent falls need preventive measures.
Highlights
The aim of the present study was to compare bone mineral density (BMD) and body composition (BC) measurements as well as identify risk factors for low BMD and osteoporotic fractures in postmenopausal women with psoriasis (Ps) and psoriatic arthritis (PsA)
Psoriasis (Ps) and psoriatic arthritis (PsA) are chronic, immuno-mediated inflammatory diseases characterized by abnormal expressions of keratinocytes, with actions of interferon (IFN)-g, tumor necrosis factor (TNF)-a, TNF-b, transforming growth factor (TGF)-b, interleukin (IL)-1, IL-6, IL-8 and IL-17 [1,2,3] or activation of Th2 inflammatory response, releasing TNF-a, IL-1 and IL-6, as well as proliferation and neovascularization of the synovial [4,5]
Clinical risk factors to low bone density and osteoporotic fracture were evaluated by a specific questionnaire based on the European Vertebral Osteoporosis Study (EVOS) that included details about anthropometric data, personal and medical history, gynecological information, concomitant medications, diet, smoking and physical activity [23]
Summary
The aim of the present study was to compare bone mineral density (BMD) and body composition (BC) measurements as well as identify risk factors for low BMD and osteoporotic fractures in postmenopausal women with psoriasis (Ps) and psoriatic arthritis (PsA). According to Colucci et al, there is greater in vitro expression of TNF-a and receptor activator of nuclear factor-kappa ligand (RANKL) in T and B cells of the Higher release of IL-1, IL-2, IL-6, IFN-g and TNF-a is associated with lean mass loss in patients with AIDS, cancer, chronic obstructive pulmonary disease, kidney failure, RA, acute myocardial infarction [13,14]. Inflammatory cytokines activate the muscle proteolytic system, stimulate the release of cortisol and catecholamines, induce lipolysis and b-oxidation, as well as higher synthesis of very low density lipoprotein (VLDL) and triglycerides and an increase of fat mass [15]. Westhovens et al found a significant reduction of total body BMD and lean mass as well as an increase of fat mass in RA patients when compared to HC [17]. Saraceno and Gisondi demonstrated an increase of body weight in Ps and PsA patients treated with etanercept, adalimumab and infliximab [20,21]
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