Chronic urticaria and osteoporosis: a longitudinal, community‐based cohort study of 11 944 patients

Abstract

Background Chronic urticaria (CU) carries many risk factors for osteoporosis, but data on the relationships between CU and osteoporosis are lacking. Objectives To evaluate the association between CU and osteoporosis in a large community-based study. Methods A nationwide observational longitudinal cohort study was conducted. CU was defined as four pairs of urticaria diagnoses; each pair was recorded within a period of 6 weeks and was registered by physicians in a primary-care setting. Patients with CU and their age-and sex-matched controls were followed for the incidence of osteoporosis and other laboratory data between 2002 and 2017. Data regarding systemic steroid exposure and other relevant risk factors for osteoporosis were obtained. Analyses of risk for osteoporosis were performed in Cox regression models adjusted for age, sex, exposure to systemic corticosteroids, obesity, smoking and hyper-and hypothyroid disease. Results The study included 11 944 patients with CU and 59 829 controls. During the study's observation period, 1035 (8Á7%) patients with CU were diagnosed with osteoporosis, compared with 4046 (6Á8%) controls. The adjusted multivariate analysis demonstrated that CU was significantly associated with a higher risk for osteoporosis (hazard ratio 1Á23, 95% confidence interval 1Á10-1Á37, P < 0Á001). Conclusions CU may impose a risk for osteoporosis. Appropriate targeted screening should be considered.

Osteoporosis in Skin Diseases

“…In fact, in patients with OP and osteopenia, mast cells produce bone cytokines capable of directing remodeling towards bone loss [62]. In that study, it is shown that patients with CU have a higher rate of OP and hypocalcemia, as well as lower levels of parathyroid hormone (PTH) and vitamin D. In fact, the levels of PTH are significantly lower in patients with OP and CU, compared to patients diagnosed with OP alone [61,62]. In patients with CU, the presence of risk factors, which include female sex, exposure to systemic corticosteroids, changes in thyroid function, smoking, and obesity, increases the risk of OP [62].…”

“…Several pathogenetic mechanisms, including the dysregulation of intracellular signaling pathways in basophils and mast cells, an abnormal innate immunity response, and the simultaneous activation of inflammatory response and coagulation system, are involved [59,60]. In the active phase of CU, especially in the spontaneous form, increased circulating levels of inflammatory markers including interleukin IL-6, fibrin degradation products, D-dimer, and C-reactive protein (CRP) are found [61]. CU has been associated with a low-grade or persistent inflammation over time with an increase in inflammatory markers in relation to the severity of the disease.…”

Does Allergy Break Bones? Osteoporosis and Its Connection to Allergy

“…Epidemiological evidence is reported on the association between chronic urticaria (CU) and osteoporosis [76]. CU as a low grade inflammatory condition [77][78][79] is a potential risk factor for osteoporosis, to which the female predisposition and the exposure to systemic corticosteroids is added.…”

Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous urticaria - A real-life experience

“… 1 This chronic condition is associated with various co-morbidities, decreased quality of life, and reduced ability to maintain normal activities. 2 , 3 , 4 Two immune mechanisms were linked with CSU pathogenesis. “Type I″ response that is mediated by IgE antibodies, but unlike classic allergy, these IgE antibodies are directed at auto-antigens (e.g.…”