Psoriatic Arthritis and Risk of Vertebral Fracture: A Systematic Review and Meta-Analysis

Objective: This study was conducted in order to determine the association between psoriatic arthritis and the risk of vertebral fracture by pooling the evidence from previous studies. Methods: Potentially eligible studies were identified from MEDLINE and EMBASE databases from inception to March 2020 using a search strategy that comprised of terms “Psoriatic Arthritis” and “Vertebral Fracture”. Studies were eligible for the meta-analysis if they were cohort studies that included psoriatic arthritis and individuals without psoriasis and followed them for incident vertebral fracture. Studies were also required to report standardized incidence ration, hazard risk ratio or relative risk with related 95% confidence intervals (CI) comparing the incidence of vertebral fracture between the two cohorts. The retrieved point estimates with standard errors from each study were pooled into the final result by the random-effect model and generic inverse variance method. Results: A total of 26,090 articles were identified. After two rounds of independent review by three investigators, we included five cohort studies that met the eligibility criteria in the meta-analysis. PsA is significantly associated with VF with a pooled odds ratio of 2.09 (95% CI, 1.11 – 3.96; I2 70%). The funnel plot was fairly asymmetric, thus the publication bias in favor of studies may present. Conclusion: This systematic review and meta-analysis indicates that psoriatic arthritis patients have a significantly elevated risk of developing a vertebral fracture.