Psoriatic Disease Linked to Higher Risk of Pathological Fractures


Pso and PsA are associated with higher rates of pathological fractures.

Psoriasis (Pso) and psoriatic arthritis (PsA) are associated with higher rates of pathological fractures, including those of the vertebrae, pelvis, femur, tibia, and fibula, researchers at Northwestern University have found.

These types of fractures also resulted in more hospitalizations, prolonged the length of hospitalizations, and increased the costs of care.

The researchers, led by Jonathan Silverberg, MD, PhD, MPH, concluded that, “patients with psoriatic disease pose a substantial public health burden with respect to their increased risk for low BMD [bone mineral density] and fractures.” Their study was published on the Journal of the American Academy of Dermatology website; the article is in press.

Osteoporotic fractures have an increased risk of morbidity and mortality, making an association with psoriatic disease a reason for concern. While mortality rates in the present study were low in patients with psoriatic disease, the authors stressed that future studies are needed to assess their impact on long-term mortality rates.

Patients with Pso are already at risk for a number of comorbid conditions, including cardiovascular disease and rheumatologic disorders, such as rheumatoid arthritis and ankylosing spondylitis (AS). In this study, the researchers looked for a link between Pso and PsA and osteoporosis and pathological fractures, and analyzed data from the 2006-2012 Nationwide Emergency Department Sample (NEDS).

Out of nearly 200 million emergency department (ED) visits included in the NEDS for the study period, more than 183,000 visits involved patients with Pso, and more than 28,000 visits involved patients with PsA. Patients with Pso were more likely to be older and male. The disease was found to be significantly linked to the bone disorders of osteopenia, osteoporosis, osteomalacia, and AS.

PsA was also linked to significantly higher odds of osteopenia, osteoporosis, and AS. In fact, there was a higher prevalence of osteopenia in patients with PsA—both men and women—compared with individuals without PsA throughout the entire 7 years of data examined; the prevalence of AS was also higher in both male and female patients with PsA compared with healthy individuals for 6 of the 7 years studied.

Both conditions were associated with pathological fractures of the vertebrae, pelvis, and femur in all 7 years studied. Pso was further associated with fractures of the tibia and fibula.

When patients with Pso presented to the ED either with or without fractures, they had higher rates of inpatient admission compared with individuals without Pso (range, 50% to 80% vs 15% to 25% over the 7 years of the study), and their mean length of stay ranged from 5.09 to 5.97 days. The mean adjusted cost of care for patients with Pso who presented to an ED with fractures was $2445, compared with $2237 for patients with Pso who presented without fractures.

“It appears that women, older patients, and those with PsA and AS are at highest risk,” the authors concluded. “A cursory assessment of osteoporosis risk can be achieved by asking patients about their personal history of fractures, systemic corticosteroid use, rheumatoid or psoriatic arthritis, and AS.”

The study, “Association of Psoriasis and Psoriatic Arthritis with Osteoporosis and Pathological Fractures,” was published in the Journal of the American Academy of Dermatology.

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