Volumetric Bone Mineral Density Measured by HR-pQCT in Patients with Psoriasis or Psoriatic Arthritis: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

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.

Osteoimmunology of Spondyloarthritis

“…In the same study, patients with mild psoriasis were reported to have similar risk for VF, or even higher when patients with severe psoriasis were considered (mild psoriasis, 1.07, 1.05; 1.10, and severe psoriasis, HR 95% CI 1.26, 1.15; 1.39) [172]. Finally, in two recent meta-analyses, Chen et al showed that, while the DXA-assessed BMD seems not to be significantly reduced in PsA patients compared to controls [173], when a more sophisticated imaging technique such as HR-pQCT is adopted, PsA show a lower average volumetric BMD (total, trabecular, and cortical) [174]. Furthermore, the increased OR for fracture was confirmed: OR 95% CI 1.09, 1.06; 1.12 [173].…”

Effects of Biological/Targeted Therapies on Bone Mineral Density in Inflammatory Arthritis

“…However, this higher risk of fractures may not necessarily correlate with lower BMD or a higher risk of osteoporosis [96]. Another meta-analysis provided more in-depth evidence about the bone microstructure and bone strength in psoriatic disease [97]. Psoriatic patients had lower volumetric BMD than non-psoriatic controls.…”