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

Abstract

BACKGROUND AND AIMS: The possible association between psoriatic/psoriatic arthritis (PsA) and bone loss has been observed; however, studies have yielded inconclusive results. This meta-analysis aimed to assess whether there is an increase in the risk of osteoporosis, osteopenia and fractures in patients with psoriasis/PsA, compared with healthy individuals. METHODS: PubMed and Scopus were systematically searched from their inception to September 2020 to identify relevant studies. Relative risk, hazard ratio or odds ratio (OR), with their corresponding 95 confidence intervals (95 CI) were calculated and pooled using a random-effects model. RESULTS: A total of 12 different studies, with a total of 199 389 296 participants, were included. Overall, no significant relationship was observed between psoriasis/PsA and the risk of osteoporosis (psoriasis: OR = 1.28, 95CI = 0.86-1.90; PsA: OR = 1.32, 95CI = 0.79-2.19) and osteopenia (psoriasis: OR = 1.50, 95CI = 0.75-3.02; PsA: OR = 1.61, 95CI = 0.67-3.85). However, in the subgroup analysis, psoriasis was significantly associated with an increased risk of osteoporosis in men (OR = 1.27, 95CI = 1.02-1.59) and studies with cohort design (OR = 1.04, 95CI = 1.003-1.09). Psoriasis was also related to the risk of osteopenia in studies on a combination of both genders (OR = 2.86, 95CI = 2.70-3.02). The pooled analysis demonstrated a significantly higher risk of fractures among patients with psoriasis (OR = 1.29, 95CI = 1.02-1.63) and PsA (OR = 2.88, 95CI = 1.51-5.48), compared with participants without psoriasis/PsA. CONCLUSIONS: Patients with psoriasis/PsA have an increased risk of fractures. There is little evidence supporting the relation of psoriasis to osteoporosis/osteopenia.