Abstract
Bone health in psoriasis and psoriatic arthritis has been emphasized in recent years. Novel imaging modalities allow investigations into volumetric bone mineral density (vBMD) and bone microstructure in psoriatic patients. However, literature regarding vBMD measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) is inconclusive. We conducted a systematic review and meta-analysis to evaluate vBMD in patients with psoriatic disease. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for relevant observational studies. A random-effects meta-analysis with trial sequential analysis (TSA) was performed. The pooled mean difference (MD) and 95% confidence interval (CI) were calculated. Five studies with 780 patients were included. Patients with psoriatic disease showed a lower average vBMD than controls (MD −14.90; 95% CI −22.90 to −6.89; TSA-adjusted CI −23.77 to −6.03; I2 = 41%). Trabecular vBMD and cortical vBMD results were inconclusive because of the small sample size. Patients recruited in Asia and those whose vBMD were measured at the distal radius exhibited a lower average vBMD than controls. Further research should clarify the association of psoriasis with bone microstructure and the underlying pathophysiology.
Highlights
Psoriasis is a chronic inflammatory disorder characterized by papulosquamous lesions with variable morphology, severity, and clinical course [1,2]
The authors hypothesized that low volumetric bone mineral density, which is related to low bone quality, is associated with a higher risk of fracture in psoriatic patients
Two investigators (YWH and JWL) independently selected relevant studies according to the following criteria: (1) observational studies including adults diagnosed with psoriasis or psoriatic arthritis (PsA) according to clinical or histopathologic information, (2) study involving adult controls without psoriasis or PsA, and (3) studies comprising clinical outcomes of interest, i.e., average volumetric bone mineral density (vBMD), trabecular vBMD, or cortical vBMD, measured by highresolution peripheral quantitative computed tomography (HR-pQCT)
Summary
Psoriasis is a chronic inflammatory disorder characterized by papulosquamous lesions with variable morphology, severity, and clinical course [1,2]. A previous study concluded that psoriatic patients have a higher fracture risk than non-psoriatic controls, without necessary association with lower bone mineral density (BMD) [11]. The authors hypothesized that low volumetric bone mineral density (vBMD), which is related to low bone quality, is associated with a higher risk of fracture in psoriatic patients. With the recent developments in imaging modalities, high-resolution peripheral quantitative computed tomography (HR-pQCT) has been introduced to measure bone microarchitecture, bone erosions, and vBMD [14,15]. HR-pQCT provides threedimensional images with high resolution, with only low levels of radiation exposure [18], enabling studies to investigate vBMD and bone microstructure in psoriatic patients. This systematic review and meta-analysis aimed to assess vBMD measured by HR-pQCT in patients with psoriatic disease
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