Abstract
Introduction: Awareness of psoriasis-related comorbidities has been established in the current guidelines; however, evidence regarding the association of bone density or bone fragility with psoriatic disease remains inconclusive. Methods: We conducted a systematic review and meta-analysis to assess bone mineral density and the risk of osteoporosis and fractures in patients with psoriatic disease, including those with cutaneous psoriasis and psoriatic arthritis. We searched electronic databases for published observational studies. A meta-analysis was performed using the random-effect model. Pooled estimates and their confidence intervals (CIs) were calculated. Small-study effects were examined using the Doi plot and Luis Furuya–Kanamori index. Results: The analysis of the standardized mean difference in the absolute value of bone mineral density at different measuring sites (lumbar spine, femoral neck, and total hip) revealed no significant difference between patients with psoriatic disease and non-psoriatic controls. The pooled results of the adjusted odds ratios (ORs) demonstrated no increased risk of osteoporosis in patients with psoriatic disease. Notably, patients with psoriatic disease had a higher OR of developing bone fractures (adjusted OR: 1.09; 95% CI: 1.06 to 1.12; I2: 0%). Conclusion: Patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls. This higher risk for fracture may not necessarily be associated with lower bone mineral density nor a higher risk for osteoporosis.
Highlights
Awareness of psoriasis-related comorbidities has been established in the current guidelines; evidence regarding the association of bone density or bone fragility with psoriatic disease remains inconclusive
Cutaneous psoriasis and psoriatic arthritis (PsA) are chronic inflammatory disorders recognized on the spectrum of psoriatic disease [1,2,3]
Our results indicate that patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls
Summary
Awareness of psoriasis-related comorbidities has been established in the current guidelines; evidence regarding the association of bone density or bone fragility with psoriatic disease remains inconclusive. Methods: We conducted a systematic review and meta-analysis to assess bone mineral density and the risk of osteoporosis and fractures in patients with psoriatic disease, including those with cutaneous psoriasis and psoriatic arthritis. Conclusion: Patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls This higher risk for fracture may not necessarily be associated with lower bone mineral density nor a higher risk for osteoporosis. The current guidelines on psoriatic comorbidities do not include bone health [13] recent studies have indicated that patients with psoriatic disease may be at an increased risk of osteoporosis and fractures [14]. The evidence regarding the association of psoriatic disease and bone fragility remains inconclusive
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