A meta-analysis, conducted by Nazanin Zahra Sepehri, MD, and colleagues, investigated a possible association between psoriatic arthritis (PsA) and bone loss. Their article, published in the International Journal of Clinical Practice, suggested an increased risk of fractures in patients with psoriasis and PsA, relative to healthy individuals. However, their study uncovered insufficient evidence to support an association between psoriasis and osteoporosis and osteopenia.
Relevant studies for meta-analysis were identified with searches on the PubMed and Scopus databases from their inception to September 2020. Reported relative risk, hazard ratio, or odds ratio (OR) with 95% confidence intervals (CI) from the studies were calculated and pooled using a random-effects model.
The final meta-analysis included 12 different studies, with a total of 199,389,296 participants. Investigators found no significant relationship between psoriasis and PsA and the risk of osteoporosis (psoriasis: OR = 1.28, 95% CI, 0.86-1.90, PsA: OR = 1.32, 95% CI, 0.79-2.19), and osteopenia (psoriasis: OR = 1.50, 95% CI, 0.75-3.02, PsA: OR = 1.61, 95% CI, 0.67-3.85).
In subgroup analysis, however, researchers related psoriasis to a significantly increased risk of osteoporosis in men (OR = 1.27, 95% CI, 1.02-1.59) and studies with cohort design (OR = 1.04, 95% CI, 1.003-1.09). In studies on both genders, psoriasis was also related to the risk of osteopenia (OR = 2.86, 95% CI, 2.70-3.02).
In their pooled analysis, the researchers observed a significantly higher risk of fractures among patients with psoriasis (OR = 1.29, 95% CI, 1.02-1.63) and PsA (OR = 2.88, 95% CI, 1.51-5.48), compared to participants without psoriasis and PsA.
The authors concluded that while that patients with psoriasis and PsA did have increased risk of fractures, insufficient evidence was found during the meta-analysis to support the association of psoriasis to increased risk of osteoporosis or osteopenia.