Upala Sikarin, Yong Wai Chung, Sanguankeo Anawin
Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, 1 Atwell Road, Cooperstown, NY, 13326, USA.
Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Rheumatol Int. 2017 Apr;37(4):617-622. doi: 10.1007/s00296-016-3625-x. Epub 2016 Dec 5.
Previous studies have shown that fibromyalgia syndrome (FMS) is associated with low level of physical activity and exercise, which may lead to an increased risk of osteoporosis. However, studies of bone mineral density (BMD) in fibromyalgia have shown conflicting results. Thus, we conducted a systematic review and meta-analysis to better characterize the association between FMS and BMD. A comprehensive search of the databases MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies' assessment of the association between fibromyalgia and bone mineral density in adult subjects. Fibromyalgia was diagnosed in accordance with the American College of Rheumatology criteria for the diagnosis of fibromyalgia syndrome. BMD was measured at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry. Pooled mean difference (MD) of BMD at each site and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I . Data were extracted from four observational studies involving 680 subjects. At lumbar spine (L2-L4), BMD is significantly decreased in patients with FMS compared with controls with pooled MD of -0.02 (95% CI -0.03 to -0.01, P value = 0.003, I = 0%) (Fig. 1). At femoral neck, BMD is not significantly decreased in patients with FMS compared with controls with pooled MD of 0.01 (95% CI -0.02 to 0.01, P value = 0.23, I = 0%) (Fig. 2). In this meta-analysis, we observe that BMD at lumbar spine is decreased in FMS compared with normal individuals. Patients with FMS should be assessed for risk of osteoporosis. Fig. 1 Forest plot of bone mineral density at the lumbar spine, for patients with and without fibromyalgia syndrome. CI-confidence interval Fig. 2 Forest plot of bone mineral density at the femoral neck, for patients with and without fibromyalgia syndrome. CI-confidence interval.
以往研究表明，纤维肌痛综合征（FMS）与身体活动和锻炼水平较低有关，这可能会导致骨质疏松风险增加。然而，关于纤维肌痛患者骨密度（BMD）的研究结果却相互矛盾。因此，我们进行了一项系统评价和荟萃分析，以更好地描述FMS与BMD之间的关联。从数据库建立至2016年5月，我们对MEDLINE和EMBASE数据库进行了全面检索。纳入标准为观察性研究对成年受试者中纤维肌痛与骨密度之间关联的评估。纤维肌痛根据美国风湿病学会纤维肌痛综合征诊断标准进行诊断。采用双能X线吸收法测量腰椎和股骨颈的骨密度。使用随机效应、通用逆方差法计算每个部位骨密度的合并平均差（MD）和95%置信区间（CI）。使用Q统计量和I²对研究间效应大小的异质性进行量化。数据来自四项涉及680名受试者的观察性研究。在腰椎（L2-L4），与对照组相比，FMS患者的骨密度显著降低，合并MD为-0.02（95%CI -0.03至-0.01，P值=0.003，I²=0%）（图1）。在股骨颈，与对照组相比，FMS患者的骨密度没有显著降低，合并MD为0.01（95%CI -0.02至0.01，P值=0.23，I²=0%）（图2）。在这项荟萃分析中，我们观察到与正常个体相比，FMS患者腰椎的骨密度降低。FMS患者应评估骨质疏松风险。图1有和没有纤维肌痛综合征患者腰椎骨密度的森林图。CI-置信区间 图2有和没有纤维肌痛综合征患者股骨颈骨密度的森林图。CI-置信区间。
