Psoriatic Disease and Fracture Risk

Recent research conducted at the Buddhist Tzu Chi Medical Foundation, Taiwan has highlighted that patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls. The study is published in the Journal of Clinical Medicine.

Awareness of psoriasis-related comorbidities has been established in the current guidelines; however, evidence regarding the association of bone density or bone fragility with psoriatic disease remains inconclusive. Reduction in bone mineral density (BMD) in patients with psoriatic disease has been reported in a previous systematic review. The prevalence of osteoporosis in patients with psoriatic disease was reported to be 1.4–68.8% in some studies. Moreover, patients with psoriatic disease were shown to have a higher risk of developing bone fractures. In contrast, other studies reported negative results.

Therefore, Tai-Li Chen and colleagues carried out this systematic review and meta-analysis to assess bone mineral density and the risk of osteoporosis and fractures in patients with psoriatic disease, including those with cutaneous psoriasis and psoriatic arthritis.

A meta-analysis was performed using the random-effect model. Pooled estimates and their confidence intervals (CIs) were calculated. Small-study effects were examined using the Doi plot and Luis Furuya–Kanamori index.

Results

• The analysis of the standardized mean difference in the absolute value of bone mineral density at different measuring sites (lumbar spine, femoral neck, and total hip) revealed no significant difference between patients with psoriatic disease and non-psoriatic controls.
• The pooled results of the adjusted odds ratios (ORs) demonstrated no increased risk of osteoporosis in patients with psoriatic disease.
• Notably, patients with psoriatic disease had a higher OR of developing bone fractures (adjusted OR: 1.09; 95% CI: 1.06 to 1.12; I²: 0%).

Hence, the authors concluded that "Patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls. This higher risk for fracture may not necessarily be associated with lower bone mineral density nor a higher risk for osteoporosis."