Yong Wai Chung, Upala Sikarin, Sanguankeo Anawin
Arch Rheumatol. 2018 Sep 5;34(2):130-140. doi: 10.5606/ArchRheumatol.2019.6883. eCollection 2019 Jun.
This meta-analysis aims to investigate the possibility of bone mineral loss and fracture in sarcoidosis.
A comprehensive search of the MEDLINE and Embase databases was performed from inception through August 2017. The inclusion criterion was observational studies evaluating the association between sarcoidosis and bone mineral density (BMD) or fracture. The pooled odds ratio (OR) of fracture, standardized mean difference (SMD) of volumetric BMD and areal BMD, and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between sarcoidosis and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2.
Data were extracted from 10 studies involving a total of 6,448 sarcoidosis patients and 77,857 controls. The pooled result demonstrated no significant increased risk of fracture in sarcoidosis patients compared with controls (OR=1.68; 95% CI: 0.85-3.31, p value=0.14, I2=72%). There were no differences between the patients and controls in areal BMD (SMD= 0.21 g/cm2; 95% CI: -0.12-0.54, p value= 0.22, I2=0%) or volumetric BMD (SMD= 0.04 mg/cm3; 95% CI: -0.51-0.58, p value=0.89, I2=83%).
Our study has not shown an increased risk of fracture or bone mineral loss in sarcoidosis. However, based on the currently available studies with heterogeneity in between, the conclusion for the osteoporosis screening and fracture risk assessment of patients with sarcoidosis cannot be drawn until more studies are available.
本荟萃分析旨在研究结节病患者骨矿物质流失和骨折的可能性。
对MEDLINE和Embase数据库从创建至2017年8月进行全面检索。纳入标准为评估结节病与骨密度（BMD）或骨折之间关联的观察性研究。采用随机效应荟萃分析计算骨折的合并比值比（OR）、体积骨密度和面积骨密度的标准化均数差（SMD）及其95%置信区间（CI），以比较结节病患者与对照组之间的风险。使用Q统计量和I²对效应量的研究间异质性进行量化。
从10项研究中提取数据，共纳入6448例结节病患者和77857例对照。汇总结果显示，与对照组相比，结节病患者骨折风险未显著增加（OR = 1.68；95% CI：0.85 - 3.31，p值 = 0.14，I² = 72%）。患者与对照组在面积骨密度（SMD = 0.21 g/cm²；95% CI： - 0.12 - 0.54，p值 = 0.22，I² = 0%）或体积骨密度（SMD = 0.04 mg/cm³；95% CI： - 0.51 - 0.58，p值 = 0.89，I² = 83%）方面无差异。
我们的研究未显示结节病患者骨折风险增加或骨矿物质流失。然而，基于目前研究存在的异质性，在有更多研究之前，无法得出关于结节病患者骨质疏松筛查和骨折风险评估的结论。
