Fassio Angelo, Berti Alvise, Mantovani Alessandro, Adami Giovanni, Pollastri Francesco, Gatti Davide, Bixio Riccardo, Messina Valeria, Rossini Maurizio, Bertelle Davide, Bertoldo Eugenia, Galvagni Isotta, Bortolotti Roberto, Viapiana Ombretta
Rheumatology Unit, University of Verona, Verona, Italy.
Center for Medical Sciences (CISMed), Department of Cellular, Computational, and Integrative Biology (CIBIO), University of Trento, Trento, Italy.
Front Immunol. 2025 Mar 17;16:1545546. doi: 10.3389/fimmu.2025.1545546. eCollection 2025.
BACKGROUND/AIM: We performed a systematic review and meta-analysis of observational studies aimed at investigating the prevalence of osteoporosis and osteoporotic fractures in subjects affected by systemic vasculitides (SVs) as well as to explore their risk of osteoporosis and osteoporotic fractures when compared to healthy controls.
Scopus, Web of Science and PubMed were systematically searched from inception to February 2024 for observational studies investigating the prevalence of osteoporosis and fragility fractures in adults with SVs. In addition, when available, we assessed the odd ratios (OR) of prevalent osteoporosis and fragility fractures amongst subjects with SVs vs. healthy controls. Data from eligible studies were extracted, and meta-analysis was performed using a random effects model to obtain ORs with 95% confidence intervals (CIs). Subgroup analyses and meta-regressions were also performed. This study was registered in Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/3G7RJ).
Forty studies with 23,358 individuals affected by SVs were included. The overall prevalence of osteoporosis and fragility fractures in the SV patients were respectively 14.64% (95%CI 12.21-18.89), and 17.08% (95%CI 11.42-24.78). The ORs for osteoporosis and fragility fractures in SV patients when compared with healthy controls were 2.92 (95%CI 1.72-4.98) and 2.39 (95%CI 1.34-4.26) respectively. The univariable meta-regression analysis showed a significant association between cumulative glucocorticoids' dosage (total grams) and risk of prevalent osteoporosis (estimate = 0.0995, R = 0.24, p=0.0194).
SVs are associated with an increased risk for osteoporosis and fragility fractures, suggesting that active vigilance and pre-emptive screening are recommended.
背景/目的：我们对观察性研究进行了系统评价和荟萃分析，旨在调查系统性血管炎（SVs）患者中骨质疏松症和骨质疏松性骨折的患病率，并探讨与健康对照相比，他们患骨质疏松症和骨质疏松性骨折的风险。
从Scopus、Web of Science和PubMed数据库建库至2024年2月，系统检索关于调查成人SVs患者骨质疏松症和脆性骨折患病率的观察性研究。此外，如有可用数据，我们评估了SVs患者与健康对照相比，患现患骨质疏松症和脆性骨折的比值比（OR）。提取符合条件的研究数据，并使用随机效应模型进行荟萃分析，以获得具有95%置信区间（CIs）的OR。还进行了亚组分析和荟萃回归分析。本研究已在开放科学框架（DOI：https://doi.org/10.17605/OSF.IO/3G7RJ）注册。
纳入了40项研究，共23358名受SVs影响的个体。SVs患者中骨质疏松症和脆性骨折的总体患病率分别为14.64%（95%CI 12.21 - 18.89）和17.08%（95%CI 11.42 - 24.78）。与健康对照相比，SVs患者骨质疏松症和脆性骨折的OR分别为2.92（95%CI 1.72 - 4.98）和2.39（95%CI 1.34 - 4.26）。单变量荟萃回归分析显示，累积糖皮质激素剂量（总克数）与现患骨质疏松症风险之间存在显著关联（估计值 = 0.0995，R = 0.24，p = 0.0194）。
SVs与骨质疏松症和脆性骨折风险增加相关，提示建议进行积极监测和预防性筛查。
