Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Department of Experimental and Clinical Medicine, University of Florence & Division of Rheumatology AOUC, Florence, Italy.
Autoimmun Rev. 2021 Apr;20(4):102782. doi: 10.1016/j.autrev.2021.102782. Epub 2021 Feb 17.
To review the extant literature relating to bone health in the idiopathic inflammatory myopathies (IIM) including both adult and juvenile patients.
A PubMed search® identified relevant studies from 1966 to 2020 in accordance with PRISMA guidelines. Two independent reviewers screened and extracted the abstracts/full manuscripts, and a third author was consulted in the case of disagreement.
We identified 37 articles (3 review articles, 2 RCTs, 9 cross-sectional, 16 cohort and 7 case-control studies). The prevalence of osteopenia (n = 7) ranges from 7 to 75% and osteoporosis (n = 7) between 13% to 27%. The prevalence of vertebral fractures ranged from 11 to 75%. Systemic inflammation likely contributes to reduced bone mineral density (BMD) in children with IIM but data is currently lacking in adult patients. Association between with impaired BMD and Vitamin D or calcium intake and physical activity has not been demonstrated in IIM. There is no clear consensus regarding the impact of age, menopause or BMI on bone health. Gender, smoking status, disease activity and inflammatory markers are not obvious independent predictors of low BMD. Several studies have demonstrated that glucocorticoids are associated with an increased risk of low BMD. There are no specific guidelines relating to the management of bone health in adult and juvenile patients with IIM.
Both adult and juvenile patients with IIM are at high risk of impaired bone health and fracture. The mechanisms behind this are likely multifactorial including systemic inflammation, glucocorticoid treatment, reduced mobility and impaired calcium/vitamin D homeostasis. There are a lack of guidelines and studies relating to the screening, prevention and treatment of impaired bone health in adult and juvenile patients with IIM. Future research is required to understand the complexity of bone health in IIM including to develop much needed disease-specific management recommendations.
综述特发性炎性肌病（IIM）患者骨骼健康的相关文献，包括成人和青少年患者。
根据 PRISMA 指南，通过 PubMed 搜索从 1966 年至 2020 年的相关研究。两位独立评审员筛选和提取摘要/全文，如有分歧则咨询第三位作者。
共确定了 37 篇文章（3 篇综述、2 项 RCT、9 项横断面研究、16 项队列研究和 7 项病例对照研究）。骨量减少（n=7）的患病率为 7%至 75%，骨质疏松症（n=7）的患病率为 13%至 27%。椎体骨折的患病率为 11%至 75%。全身炎症可能导致儿童 IIM 患者的骨矿物质密度（BMD）降低，但目前缺乏成人患者的数据。在 IIM 中，维生素 D 或钙摄入和体力活动与 BMD 受损之间的关联尚未得到证实。目前尚无明确共识认为年龄、绝经或 BMI 对骨骼健康有影响。性别、吸烟状况、疾病活动度和炎症标志物并非 BMD 降低的明显独立预测因素。几项研究表明，糖皮质激素与 BMD 降低的风险增加相关。目前没有针对 IIM 成人和青少年患者骨骼健康管理的具体指南。
成人和青少年 IIM 患者的骨骼健康和骨折风险均较高。其机制可能是多因素的，包括全身炎症、糖皮质激素治疗、活动减少和钙/维生素 D 稳态失调。目前缺乏关于成人和青少年 IIM 患者骨骼健康筛查、预防和治疗的指南和研究。需要进一步研究以了解 IIM 中骨骼健康的复杂性，包括制定急需的疾病特异性管理建议。
