Association Between Vitamin D Deficiency And Osteoporosis In Systemic Sclerosis: A Metaanalysis

초록

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease associated with high morbidity and mortality. Its pathogenesis remains poorly understood, but vitamin D deficiency has been implicated as a contributing factor. Given the established link between vitamin D deficiency and osteoporosis, SSc patients may also be at increased risk of compromised bone health. This meta-analysis aimed to quantify serum vitamin D levels in SSc patients compared to healthy controls, evaluate differences between diffuse and limited SSc subtypes, and explore associations with clinical phenotypes, including those with potential implications for osteoporosis, such as gastrointestinal (GI) and lung involvement, digital ulcers, and anti-Scl-70 antibody positivity. Methods: This meta-analysis evaluated serum vitamin D levels in 12 studies comprising 836 SSc patients and 537 healthy controls. Subgroup analyses examined differences by SSc subtype and clinical phenotypes. Serum 25(OH)D levels were used as the marker for vitamin D status. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated with funnel plots.Results: SSc patients exhibited significantly lower vitamin D levels than healthy controls (mean difference [MD]: - 9.44, 95% confidence interval [CI]: - 12.07 to - 6.80, P \0.00001). Subgroup analyses revealed no significant differences in vitamin D levels between diffuse and limited SSc subtypes or among patients with complications such as gastrointestinal (GI) involvement, lung involvement, digital ulcers, or anti-Scl-70 antibody positivity. The high prevalence of vitamin D deficiency in SSc patients suggests a potential exacerbation of osteoporosis risk, particularly given the systemic nature of the disease and its impact on bone metabolism. Conclusion: Vitamin D deficiency is frequently observed in SSc patients and may not only play a role in disease pathogenesis but also contribute to secondary complications, such as osteoporosis. These findings underscore the importance of addressing vitamin D deficiency in clinical practice, particularly to mitigate the potential burden of osteoporosis, and highlight the need for further research to clarify its therapeutic potential.