Rheumatology International

, Volume 37, Issue 4, pp 617–622 | Cite as

Bone mineral density is decreased in fibromyalgia syndrome: a systematic review and meta-analysis

  • Sikarin Upala
  • Wai Chung Yong
  • Anawin Sanguankeo
Observational Research


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 2. 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 2 = 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 2 = 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


Meta-analysis Bone mineral density Fibromyalgia Osteoporosis Osteopenia 


Compliance with ethical standards

Conflict of interest

Sikarin Upala, Wai Chung Yong, and Anawin Sanguankeo declare that they have no conflict of interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

296_2016_3625_MOESM1_ESM.docx (12 kb)
Supplemental Fig. 1: Search methodology and selection process. (DOCX 12 kb)
296_2016_3625_MOESM2_ESM.tif (193 kb)
Supplemental Materials and methods (TIFF 193 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Internal MedicineBassett Medical Center and Columbia University College of Physicians and SurgeonsCooperstownUSA
  2. 2.Department of Preventive and Social Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand

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