Analysis of Influence Factors on Osteopenia in Different Treatment of Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease associated with increased systemic inflammation, which may contribute to altered bone metabolism and decreased bone mineral density (BMD). Several studies have reported an elevated risk of osteopenia and osteoporosis in patients with moderate-to-severe psoriasis. The pathophysiological mechanisms may involve pro-inflammatory cytokines, such as TNF-α and IL-17, which influence both skin inflammation and bone remodeling.

Biologic therapies targeting these cytokines have demonstrated significant efficacy in managing psoriasis. However, their long-term impact on bone metabolism and density is still under investigation. Secukinumab, an IL-17A inhibitor, and Adalimumab, a TNF-α inhibitor, are both widely used in clinical practice, but their comparative effects on bone health are unclear.

This prospective, observational, real-world study aims to evaluate the longitudinal changes in BMD (lumbar spine and hip) and bone turnover markers (such as osteocalcin, P1NP, CTX, and iPTH) in psoriasis patients undergoing treatment with Secukinumab or Adalimumab over a follow-up period of XX months. Participants will undergo baseline and follow-up assessments, including dual-energy X-ray absorptiometry (DEXA) and laboratory testing for bone biomarkers.

Key endpoints include:

Changes in BMD at lumbar spine and hip from baseline.

Temporal trends in bone metabolism biomarkers.

Comparison between treatment groups after adjusting for potential confounders (e.g., age, sex, BMI, PASI score, disease duration, inflammatory markers).

Statistical methods such as linear mixed models (LMM), marginal means estimation, and subgroup analysis will be used to evaluate treatment effects. Additional sensitivity analyses including propensity score matching (PSM) and multiple imputation for missing data will be performed to enhance the robustness of findings.

This study is expected to provide clinical evidence on how different biological treatments may influence bone health in psoriatic patients, thus guiding personalized and preventive care strategies for comorbid osteoporosis.

Inclusion criteria

• Adults aged 18 years or older.
• Clinically confirmed diagnosis of psoriasis (with or without psoriatic arthritis).
• Currently receiving one of the following treatments: TNF-α inhibitor (adalimumab), or IL-17A inhibitor (secukinumab).
• Able and willing to undergo bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry (DXA).
• Signed informed consent provided. Exclusion Criteria
• History of other systemic diseases affecting bone metabolism (e.g., primary hyperparathyroidism, severe chronic kidney disease, Cushing's syndrome).
• Current use of medications known to strongly affect bone metabolism (e.g., long-term corticosteroids, bisphosphonates, denosumab, teriparatide).
• Pregnant or breastfeeding women.
• History of malignancy or other autoimmune diseases requiring systemic immunosuppressive therapy.
• Inability to complete study visits, assessments, or provide informed consent.