Atopic dermatitis and bone health: a systematic review

Abstract

Atopic dermatitis (AD) is associated with systemic inflammation and systemic corticosteroid use which can lead to poor bone health. The aim of this systematic review is to investigate the relationship between AD and bone mineral density (BMD), osteoporosis and fractures. We searched Web of Science, Cochrane Database of Systematic Reviews, MEDLINE and Embase. Title, abstract and full‐text screening, and data extraction were done in duplicate. Quality appraisal was performed using the Agency for Healthcare Research and Quality Methodology Checklist (cross‐sectional studies) and Newcastle‐Ottawa Scale (cohort studies). We screened 3800 abstracts and included fifteen studies (twelve cross‐sectional, three cohort). In cross‐sectional studies, AD was associated with decreased BMD and increased fractures. In cross‐sectional studies and a cohort study, AD was associated with a higher prevalence of osteoporosis compared to controls. There was inconsistency across studies, with some finding no association. In a large cohort study, AD was associated with increased risk of fractures of the hip (HR: 1.06, 95% CI: 1.02 to 1.11), spine (HR: 1.14, 95% CI: 1.06 to 1.23) and wrist (HR: 1.06, 95% CI: 1.01 to 1.10), with further increased risk with more severe AD. Differences between studies precluded quantitative synthesis. There is some evidence supporting an association between AD and poor bone health. Research is needed to clarify this association, underlying mechanisms and develop strategies to improve bone health of individuals with AD.

ESDR059 - Atopic-eczema-associated fracture risk and oral corticosteroids: a population-based cohort study

“…Using detailed definitions of oral corticosteroid use allowed us to address to what degree oral corticosteroid use might explain the previously observed relationship between atopic eczema and fracture risk. 5 The results of our study are likely to be generalizable to the general population of England because CPRD covers a population that is broadly representative of the English general population in terms of age, sex, and ethnicity. 18 The association we saw between atopic eczema and fracture could be explained by mediation through other potential observed (ie, harmful alcohol use, smoking, BMI) and unobserved mediators (Figure 2), potentially including physical activity, osteoporosis, sleep impairment, and fatigue or daytime sleepiness (owing to nighttime itching or the use of sedating antihistamines to manage the sleep problems associated with the itch of atopic eczema).…”

“…Whereas a number of other studies describe an association between atopic eczema and worse bone health, insight into the impact of oral corticosteroids on the relationship, until now, has been limited, as described in a recent systematic review. 5 Of the studies included in the review, only our previous study 6 and 1 other population-based cohort study from Taiwan 2 adjusted analyses for oral corticosteroid use, both using definitions that classified steroid use into categories of never or ever.…”

“…Evidence indicates people with atopic eczema have increased fracture risk. [2][3][4][5] Our previous study showed that people with atopic eczema have 10% higher fracture risk than those without, and risk increases substantially in people with severe atopic eczema (eg, the spinal fracture risk in people with severe atopic eczema was more than twice that in people without). 6 Understanding the mechanisms behind the association between atopic eczema and fracture is important given the high morbidity and mortality associated with fractures.…”

Atopic Eczema–Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study

“…While a number of other studies describe an association between atopic eczema and worse bone health, insight into the impact of oral corticosteroids on the relationship, until now, has been limited, as described in a recent systematic review. 5 Of the studies included in the review, only our previous study 6 and one other population-based cohort study from Taiwan 2 adjusted analyses for oral corticosteroid use, both using definitions that classified steroid use into categories of never or ever.…”

“…Evidence indicates people with atopic eczema have increased fracture risk. 2 – 5 Our previous study showed that people with atopic eczema have 10% higher fracture risk than those without, and risk increases substantially in people with severe atopic eczema (e.g., spinal fracture risk in people with severe atopic eczema was more than twice that in people without). 6 Understanding the mechanisms behind the association between atopic eczema and fracture is important given the high morbidity and mortality associated with fractures.…”