Effect of fibromyalgia on bone mineral density in patients with fibromylagia and rheumatoid arthritis

Associations Between Bone Mass in Women With Fibromyalgia and Widespread Pressure Pain Hypersensitivity, Tenderness, Perceived Pain Level, and Disability

This study aimed to evaluate the impact of fibromyalgia syndrome (FMS) on bone mass assessed by calcaneal quantitative ultrasound (QUS) in pre- and postmenopausal women and determine whether there are associations between bone status and pressure pain thresholds (PPTs), tender point counts (TPCs), self-reported global pain, or disease severity. Ninety-five women with a diagnosis of FMS and 108 healthy controls matched on menopause status were included in this cross-sectional study. PPT and TPC were measured by algometry pressure. Self-reported global pain and disease severity were evaluated by Visual Analogue Scale and Fibromyalgia Impact Questionnaire, respectively. Bone mass was assessed with calcaneus QUS. Broadband ultrasound attenuation (BUA; dB/MHz) and speed of sound (SOS; m/s) were significantly lower in the FMS patients compared with controls ( p = .027 and p = .003, respectively). Linear regression analysis revealed that all PPTs were significantly associated with the BUA parameter after adjustments for body mass index (BMI), menopause status, and physical activity in women with FMS ( p < .05). TPC was also significantly associated with BUA after adjustments for covariables (β = .241, 95% confidence interval [0.333, 3.754], p = .020). No significant differences were found between any QUS measurements and global pain or disease severity. Calcaneal BUA and SOS values were lower in women with FMS compared to healthy controls, and decreased pain thresholds and higher TPCs were associated with lower calcaneal BUA values. Low pain thresholds might be independent predictors for low bone mass in FMS women.

Concomitant fibromyalgia complicating chronic inflammatory arthritis: a systematic review and meta-analysis

Objectives

This systematic review and meta-analysis will describe the prevalence of concomitant FM in adults with inflammatory arthritis and quantify the impact of FM on DAS.

Methods

Cochrane library, MEDLINE, Psychinfo, PubMed, Scopus and Web of Science were searched using key terms and predefined exclusion criteria. As appropriate, proportional and pairwise meta-analysis methods were used to pool results.

Results

Forty articles were identified. In RA the prevalence of FM ranged from 4.9 to 52.4% (21% pooled). In axSpA the range was 4.11–25.2% (13% pooled in AS only). In PsA the range was 9.6–27.2% (18% pooled). The presence of concomitant FM was related to higher DAS in patients with RA and AS (DAS28 mean difference 1.24, 95% CI: 1.10, 1.37 in RA; BASDAI mean difference 2.22, 95% CI: 1.86, 2.58 in AS). Concomitant FM was also associated with higher DAS in existing PsA studies. Self-reported, rather than objective, components of DAS appear to be raised in the presence of FM (e.g. tender joint count and Visual Analogue Scale (VAS) pain scores).

Conclusion

FM is common in RA, AxSpA and PsA. Comorbid FM appears to amplify DAS and could therefore influence management of these rheumatic conditions.

Association between low bone mineral density and fibromyalgia: a meta-analysis

We aimed to evaluate the relationship between bone mineral density (BMD) and fibromyalgia (FM). Meta-analyses were performed comparing BMD in FM patients and healthy controls, and in FM patients in subgroups based on ethnicity, BMD site, age, sex, and measurement method. Twelve studies including 695 FM patients and 784 controls were selected. Meta-analysis by ethnicity revealed a significantly lower BMD in the FM group in Caucasian populations [standardized mean difference (SMD) = -0.144, 95% CI = -0.271-(-0.017), p = 0.026], but not in Turkish populations. Subgroup analysis by BMD site showed that BMD was significantly lower in the FM group than in the control group in the lumbar spine [SMD = -0.588 (medium), 95% CI = -1.142-(-0.033), p = 0.038], but not in the femur neck and hip. Stratification by measurement method revealed a significantly lower BMD in the FM group by dual X-ray absorptiometry and dual-photon absorptiometry [SMD = -0.531 (medium), 95% CI = -1.040-(-0.023), p = 0.041; SMD = -0.315 (small), 95% CI = -0.544-(-0.085), p = 0.007, respectively], but not by quantitative ultrasound, but not by quantitative ultrasound. Subgroup analysis by sex, menopause status, and age revealed a significantly lower BMD in the female FM group [SMD = -0.588 (medium), 95% CI = -1.142-(-0.033), p = 0.038], but not in the pre-menopausal group and the group greater than mean age 50 years old. Our meta-analysis demonstrated that BMD was significantly lower in FM patients in Caucasian and female populations.

Bone mineral density is decreased in fibromyalgia syndrome: a systematic review and meta-analysis

Previous studies have shown that fibromyalgia syndrome (FMS) is associated with low level of physical activity and exercise, which may lead to an increased risk of osteoporosis. However, studies of bone mineral density (BMD) in fibromyalgia have shown conflicting results. Thus, we conducted a systematic review and meta-analysis to better characterize the association between FMS and BMD. A comprehensive search of the databases MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies' assessment of the association between fibromyalgia and bone mineral density in adult subjects. Fibromyalgia was diagnosed in accordance with the American College of Rheumatology criteria for the diagnosis of fibromyalgia syndrome. BMD was measured at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry. Pooled mean difference (MD) of BMD at each site and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I ². Data were extracted from four observational studies involving 680 subjects. At lumbar spine (L2-L4), BMD is significantly decreased in patients with FMS compared with controls with pooled MD of -0.02 (95% CI -0.03 to -0.01, P value = 0.003, I ² = 0%) (Fig. 1). At femoral neck, BMD is not significantly decreased in patients with FMS compared with controls with pooled MD of 0.01 (95% CI -0.02 to 0.01, P value = 0.23, I ² = 0%) (Fig. 2). In this meta-analysis, we observe that BMD at lumbar spine is decreased in FMS compared with normal individuals. Patients with FMS should be assessed for risk of osteoporosis. Fig. 1 Forest plot of bone mineral density at the lumbar spine, for patients with and without fibromyalgia syndrome. CI-confidence interval Fig. 2 Forest plot of bone mineral density at the femoral neck, for patients with and without fibromyalgia syndrome. CI-confidence interval.