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High prevalence and risk factors for osteoporosis in 1839 patients with systemic sclerosis: a systematic review and meta-analysis

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Abstract

Objectives

Osteoporosis is prevalent in patients with systemic sclerosis (SSc). Updated evidence is required to complement the previous systematic review on this topic to provide best practices. This systematic review and meta-analysis aimed to quantitatively synthesize data from studies concerning the prevalence and risk factors for osteoporosis among patients with SSc.

Methods

We searched PubMed, EMBASE, Web of Science, and ScienceDirect databases for potential studies published from inception to May 31, 2022. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Then meta-analyses were performed to determine osteoporosis prevalence and risk factors in patients with SSc. Meta-regression analysis was conducted to explore the sources of heterogeneity.

Results

The pooled prevalence of osteoporosis in patients with SSc was 27% (95% CI, 24–31), with moderate heterogeneity (I2 = 61.6%). Meta-regression revealed no significant difference among all variables. And the presence of SSc increased the likelihood of having osteoporosis (OR = 3.05, 95% CI, 2.32–4.01) compared to controls. These significant risk factors for osteoporosis in SSc patients were age > 50 years (OR = 2.94, 95% CI, 1.52–5.68), menopause (OR = 3.90; 95% CI, 1.94–7.84), aging (MD = 8.40; 95% CI,6.10–10.71) and longer disease duration (MD = 4.78; 95% CI,1.83–7.73). However, female (OR = 1.45; 95% CI, 0.75–2.77), pulmonary arterial hypertension (OR = 0.50; 95% CI, 0.17–1.54), and diffuse cutaneous SSc (OR = 1.05; 95% CI, 0.75–1.48) were not significant risk factors for osteoporosis in SSc patients.

Conclusions

Osteoporosis was highly prevalent in patients with SSc, and the prevalence seemed to be high and similar in many countries. The age > 50 years, menopause, aging, and longer disease duration were identified as risk factors for osteoporosis in patients with SSc.

Key Points

• The pooled prevalence of osteoporosis in patients with SSc was 27% based on 22 included studies.

• SSc patients had an increased prevalence and risk of osteoporosis as compared to the healthy control population.

• Age > 50 years, menopause, aging, and longer disease duration might be associated with osteoporosis in SSc.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We appreciated the support from the National Natural Science Foundation of China (82273710) and the National Innovation and Entrepreneurship Training Program for College Students (202010366046). We were grateful to the Medical Data Processing Center of the School of Public Health, which provided the data analysis in this study.

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  1. Xinhua Tu and Chengcheng Li contributed equally to this work and should be considered as the co-first author.

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China

    Xinhua Tu, Chengcheng Li, Meng Zhuang, Lian Liu, Chengwei Xu & Jing Wang

  2. Medical Data Processing Center of School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China

    Jing Wang

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  1. Xinhua Tu
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Contributions

Xinhua Tu, Chengcheng Li, and Jing Wang contributed to conceptualizing the study and the design, drafting the manuscript, and analyzing and interpreting the data. Meng Zhuang, Lian Liu, and Chengwei Xu contributed to the collection, integration, and interpretation of the data. All authors contributed substantially to the review of the manuscript before submission. All authors critically evaluated and revised the manuscript and approved the version submitted.

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Correspondence to Jing Wang.

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Tu, X., Li, C., Zhuang, M. et al. High prevalence and risk factors for osteoporosis in 1839 patients with systemic sclerosis: a systematic review and meta-analysis. Clin Rheumatol 42, 1087–1099 (2023). https://doi.org/10.1007/s10067-022-06460-0

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