title: Vitamin D and skeletal health in autoimmune bullous skin diseases: a case control study.
abstract: BACKGROUND
  The presence of hypovitaminosis D in patients with autoimmune bullous skin diseases, such as pemphigus vulgaris (PV) and bullous pemphigoid (BP), is debated. In a previous study we found an increased prevalence of vertebral fractures (VFx) and hypovitaminosis D in PV and BP patients. The present study extends the sample size of the previous one, for investigating the 25-hydroxyvitamin D (25OHVitD) levels in relation with the skeletal health and disease intensity in these patients.
  
  
  METHODS
  The previous study was performed in 13 PV and 15 BP patients and 28 controls. Data from 39 additional patients (22 PV and 17 BP) were now added. Eventually, we studied 67 patients (35 PV, 32 BP, 51 females), aged 64.7 ± 16.9 years and 67 age- gender- and body mass index-matched controls. In all subjects, serum 25OHVitD, calcium and alkaline phosphatase (ALP) levels were measured, bone mineral density (BMD) was evaluated by Dual-energy X-ray. Absorptiometry at lumbar spine (LS) and femoral neck (FN) and the presence of VFx were ascertained by visual assessment from spinal radiographs. In patients, the disease intensity was evaluated by the autoimmune bullous skin disorder intensity score (ABSIS).
  
  
  RESULTS
  As compared with controls, both PV and BP patients showed lower 25OHVitD (22.2 ± 11.1 vs 13.9 ± 8.3 ng/mL, p < 0.001 and 22.4 ± 14.9 vs 9.5 ± 7.7 ng/mL, p < 0.0001, respectively) and higher prevalence of severe hypovitaminosis D (22.9 vs 48.6%, p < 0.02 and 31.1 vs 75.0%, p < 0.0001, respectively) and VFx (28.6 vs 57.1%, p = 0.03 and 34.4 vs 62.5%, P = 0.02, respectively). In both PV and BP patients, LS and FN BMD did not differ from controls. In the whole patients' group, ABSIS score was inversely associated with 25OHVitD levels (R = -0.36, p < 0.005), regardless of age (β = -3.2, P = 0.009).
  
  
  CONCLUSIONS
  PV and BP patients have an increased prevalence of hypovitaminosis D and VFx. The extended study shows, for the first time, that the 25OHVitD levels are inversely associated with disease intensity and that VFx occur in spite of a not reduced BMD.
authors: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, Unit of Dermatology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. angelovalerio.marzano@policlinico.mi.it.
authors: Angelo Valerio
authors: AV
authors: Marzano
authors: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, Unit of Dermatology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. dott.vtrevisan@gmail.com.
authors: Valentina
authors: V
authors: Trevisan
authors: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. elisa.cairoli@live.it.|Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. elisa.cairoli@live.it.
authors: Elisa
authors: E
authors: Cairoli
authors: Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. eller.vainicher@gmail.com.
authors: Cristina
authors: C
authors: Eller-Vainicher
authors: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. morellivale@yahoo.it.|Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. morellivale@yahoo.it.
authors: Valentina
authors: V
authors: Morelli
authors: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. anna.spada@unimi.it.|Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. anna.spada@unimi.it.
authors: Anna
authors: A
authors: Spada
authors: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, Unit of Dermatology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. carlo.crosti@unimi.it.
authors: Carlo
authors: C
authors: Crosti
authors: Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. iacopo.chiodini@policlinico.mi.it.
authors: Iacopo
authors: I
authors: Chiodini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications / Q000473:pathology*; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000150:complications*; D010392:Pemphigus / Q000150:complications*; D014807:Vitamin D; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D014807:Vitamin D
references: Endocr Rev. 2001 Aug;22(4):477-501
references: 11493580
references: BMC Res Notes. 2014;7:536
references: 25128193
references: J Neuroimmunol. 2003 Jan;134(1-2):128-32
references: 12507780
references: Br J Dermatol. 2003 Nov;149(5):926-37
references: 14632796
references: J Clin Invest. 2005 Apr;115(4):825-8
references: 15841169
references: Lancet. 2005 Jul 2-8;366(9479):61-73
references: 15993235
references: Arch Dermatol Res. 2006 Jun;298(1):38-45
references: 16583210
references: Eur J Dermatol. 2007 Jan-Feb;17(1):4-11
references: 17324820
references: Dermatology. 2007;214(4):310-8
references: 17460402
references: N Engl J Med. 2007 Jul 19;357(3):266-81
references: 17634462
references: Nat Clin Pract Endocrinol Metab. 2008 Feb;4(2):80-90
references: 18212810
references: BMJ. 2008;337:a180
references: 18614511
references: Arch Dermatol Res. 2009 Jan;301(1):57-64
references: 18815800
references: Br J Dermatol. 2009 Feb;160(2):266-72
references: 18945300
references: Ann Rheum Dis. 2009 Mar;68(3):446-7
references: 19213751
references: Arch Biochem Biophys. 2010 Nov 1;503(1):41-53
references: 20599675
references: Arch Dermatol. 2010 Oct;146(10):1126-31
references: 20956645
references: Autoimmun Rev. 2011 Oct;10(12):733-43
references: 21621002
references: J Am Acad Dermatol. 2012 Mar;66(3):479-85
references: 22056920
references: Arch Dermatol. 2012 Mar;148(3):307-14
references: 22105813
references: Nat Rev Rheumatol. 2012 Jul;8(7):379-89
references: 22664836
references: J Invest Dermatol. 2012 Aug;132(8):1998-2004
references: 22418872
references: Br J Dermatol. 2012 Sep;167(3):688-91
references: 22486251
references: Lancet. 2013 Jan 26;381(9863):320-32
references: 23237497
references: Br J Dermatol. 2013 Apr;168(4):873-4
references: 22963014
references: Eur J Endocrinol. 2013 Aug;169(2):225-37
references: 23735901
references: Autoimmun Rev. 2013 Aug;12(10):976-89
references: 23542507
references: Curr Mol Med. 2014 Jan;14(1):69-95
references: 24160488
references: Autoimmun Rev. 2014 Apr-May;13(4-5):477-81
references: 24424192
references: Ann N Y Acad Sci. 2014 May;1317:39-46
references: 24739090
references: J Eur Acad Dermatol Venereol. 2014 Jul;28(7):859-63
references: 23659586
references: Osteoporos Int. 2001 Dec;12(12):1026-30
references: 11846328