title: Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review.
abstract: Prevalence and impact of low bone mineral density (BMD) in psoriatic arthritis (PsA) is not well understood. We aimed to synthesize current evidence regarding the prevalence, impact, and risk factors for low BMD and fractures in PsA.
  
  
  
  A systematic literature search limited to human studies was conducted without language restriction. Data on BMD, prevalence of osteoporosis, osteopenia and fractures, risk factors, morbidity, and mortality due to low BMD in PsA patients were collected.
  
  
  
  A total of 21 studies (16 case-control, 4 cross-sectional, and 1 prospective cohort) were reviewed after screening 639 titles and abstracts. In all, 17 studies compared PsA patients with one or more control group (four normal controls, five psoriasis, and eight other rheumatic diseases with or without healthy controls). The number of PsA patients in the studies ranged from 8 to 2212 with a mean (standard deviation) age of 35 (10) to 63.4 (6.2), and mean PsA duration of 2.25-13.65 years. Reported prevalence of osteoporosis varied from 1.4% to 68.8%. Low BMD was identified as a significant problem in 13 of the 21 studies. Age, female sex, postmenopausal status, PsA duration, presence of erosions, and cumulative steroid dose were associated with lower BMD. Fractures (12-40%) were associated with postmenopausal status and axial disease. No studies reported on hospitalization and mortality due to low BMD.
  
  
  
  This systematic review synthesizes current evidence on BMD and its impact in PsA. High likelihood of bias and inconsistent results suggest a need for well-designed longitudinal studies on bone health in PsA.
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Shelly
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Aldei
authors.affiliation: Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sindhu R
authors.initials: SR
authors.lastname: Johnson
authors.affiliation: Centre of Excellence in Skeletal Health Assessment, University of Toronto, University Health Network, Toronto, Ontario, Canada.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.affiliation: Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Salonen
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada; Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. Electronic address: dafna.gladman@utoronto.ca.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
mesh_terms: D015535:Arthritis, Psoriatic / Q000453:epidemiology*; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D010024:Osteoporosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors
keywords: Bone loss; Epidemiology; Fractures; Inflammation; Osteoporosis; Spondyloarthritis