Low bone mineral density in adult patients with moderate to severe atopic dermatitis.
BACKGROUND
Atopic dermatitis (AD) is a chronic inflammatory skin disease commonly treated with topical corticosteroids. The inflammatory nature of this disorder and the use of topical corticosteroids represent potential risk factors for bone loss.


OBJECTIVE
The aim was to assess the prevalence of osteoporosis and osteopenia in adult patients with moderate to severe AD. In addition, the associations between topical/oral corticosteroid use and bone mineral density (BMD) and between disease activity and BMD were studied.


METHODS
We studied 125 adult patients with moderate to severe AD. Using dual-energy X-ray absorptiometry, BMD was measured at lumbar spine and hips. The cumulative dose of topical and oral corticosteroids was calculated from pharmacy prescription records. Lifestyle parameters were collected by a questionnaire. Biochemical parameters of bone metabolism and disease activity [serum concentration of thymus and activation-regulated chemokine (TARC) levels] were also measured.


RESULTS
Osteoporosis was documented in six patients (4.8%) and osteopenia in 41 patients (32.8%); 30.4% of the patients had a Z-score <or= -1 (low BMD), with more men (43.8%) than women (16.4%) affected. There was no significant association between low BMD and biochemical parameters of bone metabolism, serum TARC levels and cumulative dose of topical and oral corticosteroids during the 5 years prior to inclusion.


CONCLUSIONS
We document a Z-score <or= -1 in about one-third of predominantly male patients with moderate to severe AD, being independent of the cumulative dose of topical and corticosteroids used within 5 years prior to study. Whether the relatively high prevalence of low BMD is due to the cumulative dose of topical corticosteroids beyond 5 years prior to the study or the chronicity of the underlying inflammatory process or a combination of these, remains to be established.
Haeck
I M
IM
Department of Dermatology and Allergology, University Medical Center Utrecht, Inhouse postnumber G02.124, Utrecht, the Netherlands. i.haeck@umcutrecht.nl
Hamdy
N A T
NA
Timmer-de Mik
L
L
Lentjes
E G W M
EG
Verhaar
H J J
HJ
Knol
M J
MJ
de Bruin-Weller
M S
MS
Bruijnzeel-Koomen
C A F M
CA
D015502:Absorptiometry, Photon / Q000379:methods*; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D003876:Dermatitis, Atopic / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
D000305:Adrenal Cortex Hormones