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 Eczema, which is marked by red, swollen, itchy skin, can be caused
by other diseases, irritants or allergies. It is usually treated
with topical corticosteroids or oral antihistamines.
“There are a number of reasons why people with eczema may be at
higher risk for osteoporosis,” said Dr. Jonathan I. Silverberg of
the departments of dermatology, preventive medicine and medical
social sciences at Northwestern University in Chicago.
“It may be that chronic inflammation occurring in eczema may
directly impact upon bone mineral density,” Silverberg told Reuters
Health by email.
People with eczema tend to be more sedentary and exercise less since
sweating can worsen the itch, he said. Weight bearing exercise helps
maintain bone density.
Silverberg and his coauthor Dr. Nitin K. Garg used the 2005-2006
National Health and Nutrition Examination Survey to analyze national
levels of fractures among people with eczema. The surveys include
questions about doctor diagnoses of eczema, osteoporosis and
fractures of the hip, spine, wrist or other bones. Respondents also
underwent bone mineral density tests.
Of the nearly 5,000 people included in the study, seven percent
reported a diagnosis of eczema. Nearly a third of the total group
had suffered a bone fracture.
For those without eczema, 32 percent had suffered a fracture,
compared to 41 percent of those with eczema, according to the
results published in the Journal of Allergy and Clinical Immunology.
Almost four percent of the group without eczema had suffered a hip
or spine fracture compared to more than six percent of the eczema
group.
“Systemic corticosteroid medications, such as oral prednisone and
steroid injections, have been shown to decrease bone mineral
density,” Silverberg said. “In our study, however, few if any
patients were actively using systemic steroids. This suggests that
there are additional factors at play.”
Steroids applied to the skin have not been found to decrease bone
mineral density, he noted.
The distraction of itchiness, mental health issues associated with
eczema and even sleep disturbances that go along with the condition
might also contribute to increased risk of injuries, the authors
write.
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Osteoporosis is a hefty burden on the aging population. For U.S.
women over age 55, one study found that bone fractures due to
osteoporosis lead to more hospitalizations and greater healthcare
costs than heart attack, stroke or breast cancer (see Reuters story
of December 12, 2014 here: http://reut.rs/1qTxb96).
Quitting smoking, reducing alcohol consumption, increasing
weight-bearing activity, vitamin D and calcium supplementation, and
bisphosphonate drugs can all help reduce the risk of osteoporosis
and fracture, the authors write, but osteoporosis is generally
underdiagnosed.
In the present study, people with eczema had lower bone density of
the femur (thigh bone), trochanter (part of the femur that connects
to the hip) and spine.
They were also more likely to qualify as osteoporotic than those
without the condition. Five percent of those with eczema had
osteoporotic bone density in the femur, compared to 2.6 percent of
those without eczema. Most had not been diagnosed with osteoporosis,
however.
“While there are no guidelines on this matter, it is advisable that
patients with longstanding moderate to severe eczema, especially
those who have taken multiple courses of systemic steroids and tend
to have a sedentary lifestyle, should have bone density testing,”
Silverberg said.
People with eczema can increase their level of weight bearing
activity, avoid repeated courses of systemic steroids and try to
better control the condition with topical medications, he said.
“If needed, there are other systemic treatment options available and
in development that will improve their eczema without affecting
their bones,” he said.
SOURCE: http://bit.ly/1tHwRvM Journal of Allergy and Clinical
Immunology, online December 13, 2014.
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