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

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.

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.

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).

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.