Bone mineral density, osteopenia, osteoporosis, and fracture risk in patients with atopic dermatitis: a systematic review and meta- analysis

Abstract

Background: The relationship between atopic dermatitis (AD) and abnormal bone metabolism remains unclear. We performed a systematic review and meta-analysis to determine whether patients with AD were associated with increased risks of low bone mineral density (BMD), osteopenia, osteoporosis, and related fractures.Methods: We searched PubMed, Embase, and the Cochrane Library through December 2019 to identify studies that investigated the association between AD and abnormal bone metabolism (including BMD, osteopenia, osteoporosis, and related fractures). The predefined primary outcome was related fractures; secondary outcomes included osteoporosis, osteopenia, and BMD. We calculated the summary odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model.Results: Ten studies were included in this systematic review. In children and adolescents, four studies investigated the association between AD and BMD; three studies indicated that children and adolescents with AD were associated with an increased risk of low BMD; one study found similar BMD between AD and control groups. In adults, three studies assessed the risk of fracture and were included in the meta-analysis, comprising 562,405 AD patients among 3,171,268 participants. Adults with AD were associated with an increased risk of fracture (OR 1.13; 95% CI, 1.05-1.22; P=0.001). Three studies investigated the association between AD and osteoporosis, which suggested that patients with AD were associated with an increased risk of osteoporosis (OR 1.95; 95% CI, 1.18-3.23; P=0.009). Further, patients with AD were associated with increased risks of osteopenia (OR 1.90; 95% CI, 1.51-2.38; P<0.001) and low BMD at the femur and spine.Conclusions: Patients with AD were associated with increased risks of low BMD, osteopenia, osteoporosis, and related fractures. Both clinical studies and basic research are needed to clarify the mechanisms of association between AD and abnormal bone metabolism.

Associations of Sex Hormone-binding Globulin with Bone Mineral Density Among US Adults, NHANES 2013–2016

“…Osteoporosis is a systemic skeleton disease characterized by an imbalance of bone metabolism and high risk of fractures, whose clearly fundamental pathophysiological is mechanical microenvironment. 1 , 2 As an age-related disease, osteoporosis has multiple similar characteristics with diabetes, cardiovascular disease and fractures that affects an estimated 44 million Americans over the age of 50 years, leading to significant morbidity, mortality, and disability all over the world. 3 , 4 However, the clear understanding of associated characteristics between osteoporosis and body metabolism has not been fully revealed.…”

Effect of Disease Severity on Comorbid Conditions in Atopic Dermatitis: Nationwide Registry-Based Investigation in Finnish Adults

“…Considering the more frequent use of systemic corticosteroids in severe AD in the past, it is not surprising that, in the current study, severe AD increased the risk of osteoporosis and drug-induced cataract. Both conditions are previously reported comorbidities of AD and known adverse effects of systemic corticosteroids (29,30). How ever, an earlier study by Haeck et al (31) found that lower bone density in patients with AD was independent of corticosteroid use within the previous 5 years; hence other explanations are possible.…”

Higher cumulative dose of topical corticosteroids is associated with osteoporosis and major osteoporotic fracture: A nationwide case–control study

“…The possible mechanisms may involve inflammation-induced bone loss, corticosteroid exposure, dietary restrictions due to food allergies, etc. 25 A nationwide population-based study in Taiwan also showed that the incidence of osteoporosis was 4.72-fold greater in AD patients than in non-AD patients. 26 Another example is psoriasis.…”

“…A systematic review and meta‐analysis demonstrated that patients with atopic dermatitis (AD) are at increased risk of osteoporosis and related fractures. The possible mechanisms may involve inflammation‐induced bone loss, corticosteroid exposure, dietary restrictions due to food allergies, etc 25 . A nationwide population‐based study in Taiwan also showed that the incidence of osteoporosis was 4.72‐fold greater in AD patients than in non‐AD patients 26 .…”