Atopic dermatitis, or eczema, is a common, lifelong skin condition that affects slightly more than 10 percent of adult and children in the United States. Recently, research findings have found that people with eczema, including children, have a higher rate of bone fractures (broken bones) compared to people without eczema.
Scientists are still trying to understand if there is a connection between eczema and bone fractures, and if so, what could cause it. But they suspect there are several different ways eczema — and/or medications taken for its symptoms — may contribute to the increased risk. One idea is that chronic inflammation from eczema could weaken bones, which would raise the risk of bone fractures.
If you have eczema, your overall risk of bone fractures is still very low. There are many other factors that work together to determine a person’s overall risk of fractures. If you have atopic dermatitis and some of these other fracture risk factors, talk to your dermatologist — or other health care provider — about ways to lower your risk of broken bones.
Curious about any potential connection? Here’s what to know about the general risk factors of bone fractures and reports about possible associations of broken bones and eczema.
Bone fractures are usually caused by falls or injuries that put enough pressure on bones that they break. Fractures present a large public health burden, and scientists are interested in identifying groups of people at higher risk of fractures in order to help prevent these injuries.
Certain conditions and lifestyle factors affect your bone mineral density, a measure of the strength of your bones. When your bone mineral density is low, you are considered to have a condition called osteoporosis.
Common risk factors for both osteoporosis and bone fractures include:
Bone mineral density, osteoporosis, and fracture risk could also be affected by conditions that cause systemic inflammation, like rheumatoid arthritis, systemic lupus erythematosus, and psoriasis. Given that atopic dermatitis is both an inflammatory condition and also frequently treated with steroids, scientists have questioned if eczema and/or its treatment could impact someone’s risk of fractures.
Through studies, researchers have found that people with eczema tend to have decreased bone mineral density, a higher prevalence of osteoporosis, and an increased risk of fractures as compared to groups of those without the condition. Specifically, researchers found that those with eczema had an increased risk of hip fractures, spinal fractures, and wrist fractures. People with severe atopic dermatitis, the researchers shared, had even higher risks of fracture.
There are several different theories scientists believe could explain the relationship between a person having eczema and their risk of fractures.
Having eczema could affect someone’s risk of osteoporosis. A cohort study published in PLOS ONE examined the medical records of more than 70,000 Taiwanese adults, half with atopic dermatitis and half without. The group with atopic dermatitis, the study’s authors reported, had more than four times the amount of osteoporosis diagnoses than that noted in those without atopic dermatitis. Although the researchers did not know exactly why those with eczema would have more osteoporosis, they had several ideas.
The Taiwanese team of researchers pointed out that those in the study with eczema had higher rates of depression, as compared to the others without eczema. Because other research studies have connected depression with a risk of low bone density, the authors questioned if depression may be a factor connecting low bone density with eczema.
The results of a U.S. survey conducted by the National Center for Health Statistics considered answers from some 34,000 people with eczema in the United States. Researchers found that, compared to the general population, people who had both eczema and psychiatric and behavioral disorders showed a higher rate of risk of fracture and bone or joint injuries. However, the medical community agrees there is still no known cause for any potential association.
Another way the Taiwanese authors suggested that eczema could be connected to osteoporosis was through vitamin D levels. Vitamin D is an important vitamin for bone health and the prevention of osteoporosis. Research suggests that low vitamin D levels might increase the likelihood of a person developing atopic dermatitis.
An additional idea the Taiwanese authors mentioned was that perhaps the inflammation caused by eczema could affect bone density. Other inflammatory diseases like rheumatoid arthritis are associated with bone loss, so scientists have suggested that inflammation produced by eczema may play a role in bone loss, osteoporosis, and an increased risk of fractures.
Yet another suggestion from the Taiwanese team was that eczema could possibly affect a person’s risk of fractures through sleep impairment. Eczema flares produce very itchy skin, and the irritation can often affect the quality and quantity of someone’s sleep. Poor sleep quality can result in daytime sleepiness and fatigue, two risk factors for falls, injuries, and fractures.
The analysis of data from the survey by the National Center for Health Statistics also looked at a possible association between eczema, sleep symptoms, and fatigue with a person’s risk of fractured bones. The researchers compared people with sleep disturbances and no eczema to people with sleep disturbances and eczema. The findings? They too determined that having eczema increased a person’s risk for having had fractures. The authors also noted, however, that sleep disturbances were not the sole cause of the higher number of fractures among people with eczema. They concluded that other factors must be at play.
Stepping outside those two major studies, past research indicates that the use of systemic oral steroids has been found to decrease bone density. However, it’s not clear if this effect is found in people taking oral steroids for eczema. It’s also not clear whether topical steroids — which are often used as creams to treat symptoms of eczema — have any effect on bone density and the risk of fractures. There is not a lot of research on this subject, and the findings from the studies that do exist are mixed.
One research study claimed that exposure to topical or oral corticosteroids increased the likelihood of fractures in people with eczema. Two more studies examined the use of low doses of topical corticosteroids in people with atopic dermatitis, but those didn’t find any effects on bone mineral density.
A Korean study that examined more than 145,000 children with atopic dermatitis found an association between their use of oral corticosteroid and their risk of fractures. Further, the Korean researchers also reported an increased risk of fractures in those who had long periods of sustained steroid use. But then a different study of nearly 3 million adults in the United Kingdom suggested that any association between atopic dermatitis and fractures was not due to oral corticosteroid use.
Though research studies have suggested a link between eczema and an increased risk of fractures, more research is needed around potential explanations for any such connection.
Nonetheless, there’s enough current research to suggest atopic eczema is a potential factor in predicting a person’s risk of fractures. This means that, when screening people who may be considered high risk for fractures, doctors should address their history of atopic eczema.
The bottom line: Simply having eczema doesn’t mean that you’ll definitely experience fractures, but it may put you at higher risk. If you think you may be at risk, talk to your health care provider about steps you can take to help prevent fractures or decrease your risk.
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