The association between psoriasis and psoriatic arthritis with the risk of osteoporosis, osteopenia and bone fractures: A systematic review and meta‐analysis

Sepehri, Nazanin Zahra; Raeisi, Tahereh; Razi, Bahman; Janmohammadi, Parisa; Darand, Mina; Alizadeh, Shahab

doi:10.1111/ijcp.14630

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…Further, patients with Ps did not have a higher risk of OP than the controls; but, interestingly, did have an increased OR of sustaining fractures unrelated to lower BMD/OP. Similar findings were reported by Sepehri et al., 31 demonstrating an increased risk of fracture but not OP/OPe in psoriatic disease. Chandran et al., 32 showed a possible association between various factors and low BMD in PsA, but with inconsistent findings.…”

Section: Discussionsupporting

confidence: 90%

The risk of osteopenia/osteoporosis and psoriatic disease: A systematic review

Schauer

Uthayakumar

Boardman

et al. 2022

Skin Health and Disease

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Background Psoriasis (Ps) is a multisystem inflammatory disease associated with several comorbidities; however, its effect on bone health remains uncertain. This systematic review aimed to evaluate the risks of osteopenia (OPe) and osteoporosis (OP) in psoriasis. Methods A systematic search was performed for published studies evaluating cutaneous Ps and psoriatic arthritis (PsA) compared with healthy control groups utilizing a validated bone mineral density (BMD) assessment score. Meta‐analysis was performed using a random‐effects model; pooled estimates and their confidence intervals (CIs) were calculated. For analysis, Ps and PsA groups were combined due to the small number of studies. Results Twenty‐one studies were included for final analysis; three Ps only, 15 PsA and three both. There was a significant difference between psoriatic disease (combination Ps and PsA group) compared with controls relating to an association with OP/OPe, with an overall odds ratio (OR) of 1.71 (95% CI 1.07–2.74: p‐value = 0.026). The Ps group had significantly lower BMD than the control group at both the lumbar spine and femoral neck (mean difference −0.04; 95% CI −0.090 to 0.002 and −0.03; 95% CI −0.059 to 0.003 respectively). Conclusion Putative risks of OPe and OP in both Ps and PsA are supported but not confirmed. Significant heterogeneity of reported data limits definitive conclusions in this meta‐analysis. This review contributes to the further understanding of Ps as a multisystem disease and future management of potential comorbidities, but highlights key gaps in the literature. Further studies addressing standardised OP reporting, specific disease group characteristics comparing Ps with PsA, patient characteristics and medication use, are required in order to make more certain conclusions with greater clinical impact.

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Section: Discussionsupporting

confidence: 90%

The risk of osteopenia/osteoporosis and psoriatic disease: A systematic review

Schauer

Uthayakumar

Boardman

et al. 2022

Skin Health and Disease

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“…Studies have yielded inconclusive results on the association between psoriatic/PsA and bone loss (180)(181)(182), a systematic review and meta-analysis including 12 studies concluded that patients with psoriasis/PsA have an increased risk of fractures (psoriasis: OR = 1.29, 95%CI = 1.02-1.63; PsA: OR = 2.88, 95%CI = 1.51-5.48). However there is little evidence supporting the association between psoriasis and osteoporosis/osteopenia (osteoporosis, psoriasis: OR, 1.28, 95%CI 0.86-1.90; PsA: OR, 1.32, 95%CI: 0.79-2.19; osteopenia, psoriasis: OR, 1.50, 95%CI: 0.75-3.02; PsA: OR, 1.61, 95%CI: 0.67-3.85) (183). Psoriasis increased the risk of osteoporosis in patients aged ≥ 40 years in Korea (182).…”

Section: Osteoporosis and Fracturementioning

confidence: 99%

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

et al. 2022

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Psoriasis is a chronic autoimmune inflammatory disease that remains active for a long period, even for life in most patients. The impact of psoriasis on health is not only limited to the skin, but also influences multiple systems of the body, even mental health. With the increasing of literature on the association between psoriasis and extracutaneous systems, a better understanding of psoriasis as an autoimmune disease with systemic inflammation is created. Except for cardiometabolic diseases, gastrointestinal diseases, chronic kidney diseases, malignancy, and infections that have received much attention, the association between psoriasis and more systemic diseases, including the skin system, reproductive system, and oral and ocular systems has also been revealed, and mental health diseases draw more attention not just because of the negative mental and mood influence caused by skin lesions, but a common immune-inflammatory mechanism identified of the two systemic diseases. This review summarizes the epidemiological evidence supporting the association between psoriasis and important and/or newly reported systemic diseases in the past 5 years, and may help to comprehensively recognize the comorbidity burden related to psoriasis, further to improve the management of people with psoriasis.

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“…We observed that psoriasis also evaluated the risk of CKD ( 46 ), end-stage CKD ( 46 ), uveitis ( 47 ), fracture ( 48 ), geographic tongue ( 49 ), multiple sclerosis ( 50 ), erectile dysfunction ( 51 ), aortic aneurysm ( 52 ), schizophrenia ( 53 ), prevalence and incidence of depression ( 54 ), and prevalence of anxiety ( 54 ). However, meta-analyses also reported the lack of significant correlation between psoriasis and osteoporosis ( 55 ), osteopenia ( 55 ), suicide ( 56 ), suicide attempt ( 56 ), and venous thromboembolism (VTE) ( 57 ) ( Figure 8 ).…”

Section: Resultsmentioning

confidence: 99%

Psoriasis and medical ramifications: A comprehensive analysis based on observational meta-analyses

et al. 2022

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PurposeBased on a large number of systematic reviews and meta-analyses exploring the relationship between psoriasis and various health outcomes, we conducted an comprehensive analysis to assess the strength and evidence for the association between psoriasis and medical end-point ramifications in patients.MethodsWe searched related meta-analyses, investigating the links between psoriasis and medical ramifications from three databases. All summary effect sizes, 95% CIs, heterogeneity, and small-study effects in the included meta-analyses were recalculated. We assessed the methodological quality of included articles with the AMSTAR 2 tool and graded the epidemiological evidence. Subgroup analysis based on the severity of psoriasis and study design were also performed.ResultsA total of 38 articles comprising 85 unique meta-analyses were included in this study. Although 69 outcomes were statistically significant, only 8 outcomes (nonvascular dementia, ulcerative colitis, pediatric dyslipidemia, gestational diabetes, gestational hypertension, fracture, multiple sclerosis, and schizophrenia) showed a high quality of epidemiological evidence.ConclusionWe found that psoriasis increased the risk of 69 health outcomes, and 8 outcomes were graded as high-quality evidence. No evidence was found that psoriasis was beneficial for any medical end point. However, to verify our results, more large-sample, multi-center prospective cohort studies are needed.

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The association between psoriasis and psoriatic arthritis with the risk of osteoporosis, osteopenia and bone fractures: A systematic review and meta‐analysis

Cited by 6 publications

References 36 publications

The risk of osteopenia/osteoporosis and psoriatic disease: A systematic review

The risk of osteopenia/osteoporosis and psoriatic disease: A systematic review

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

Psoriasis and medical ramifications: A comprehensive analysis based on observational meta-analyses

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