Background: Autoimmune blistering skin disease (AIBD) encompasses a group of suprabasal and subepidermal diseases characterized by cutaneous and/ or mucocutaneous fragility such as pemphigus vulgaris (PV) and bullous pemphigoid (BP) among others. Multiple risk factors contributing to osteoporosis such as long term systemic corticosteroid therapy, immobility and chronic inflammatory state exist in AIBD patients. Despite this, there is no consensus on the risk of osteoporosis in AIBD, especially in the absence of corticosteroid treatment nor on the screening and prophylaxis of osteoporosis in AIBD.
Aim: To systematically appraise the current literature on the association between osteoporosis/osteopenia and AIBD
Method: Comprehensive literature search was done on 6 different online databases with search terms related to AIBD and bone health. Abstract and/ or full-text screen was done on 314 articles to determine relevance.
Results: A total of 21 peer-reviewed full-text articles examining osteoporosis in AIDB patients were identified. Eight articles examined the association between osteoporosis and pemphigus in patients receiving systemic corticosteroid therapy. One article examined the association between osteoporosis and pemphigus in patients receiving no steroid therapy. One article examined the direct association between mixed AIBD (BP and PV) and osteoporosis in patients receiving no steroid therapy. No articles exclusively examined the association between pemphigoid and osteoporosis. One case report identified osteoporosis as one of the complications of pemphigoid management. Three articles examined the effectiveness of osteoporosis prophylaxis in AIBD patients. Seven papers examined the levels of vitamin D in pemphigus and pemphigoid patients.
Conclusion: Abundant literature examines osteoporosis in pemphigus in the context of steroid therapy, with consistent findings. However, there is scarce literature examining the risk of osteoporosis in pemphigoid, or AIBD without steroid therapy. Prophylaxis and screening of osteoporosis in AIBD is suboptimal and more attention in this area is required to emphasize the gap in management.