Atopic dermatitis and the risk of osteoporosis and fractures: a meta-analysis of cohort studies

This meta-analysis aims to evaluate the risk of osteoporosis and fractures in patients with atopic dermatitis (AD) by synthesizing data from cohort studies. We also provide a comprehensive analysis of fracture risks across different severities of AD and anatomical sites. Following the PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Embase, and the Cochrane Library up to May 30, 2025. Studies that investigated the relationship between AD and osteoporosis or fractures were included in the analysis. Data extraction and screening were performed independently by two reviewers. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was applied, alongside sensitivity and subgroup analyses. Publication bias was evaluated using funnel plots and Egger’s test. Ten cohort studies, involving 368 to over 2 million AD patients, were included. NOS scores ranged from 7 to 8, indicating generally high study quality. The pooled analysis revealed a 56% increased risk of osteoporosis (OR = 1.56, 95% CI: 1.14–2.13; I2 = 99.9%, p I2 = 82.1%, p I2 = 67.3%, p = 0.009) and lower limb fractures (OR = 1.11, 95% CI: 1.08–1.13; I2 = 65.0%, p = 0.014). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected (p = 0.316). AD is associated with an increased risk of osteoporosis and fractures, particularly among patients with severe AD and those experiencing vertebral or lower limb fractures. These findings highlight the importance of targeted bone health monitoring in the clinical management of AD patients. Registration: (PROSPERO: CRD420251066550) Atopic dermatitis (AD) is associated with a 56% increased risk of osteoporosis and an 8% increased risk of all-cause fractures.The risk of fracture increases progressively with AD severity, and is particularly elevated for vertebral and lower limb fractures.Clinicians should be aware of the skeletal complications of AD and consider targeted bone health monitoring, especially in patients with moderate to severe AD. Atopic dermatitis (AD) is associated with a 56% increased risk of osteoporosis and an 8% increased risk of all-cause fractures. The risk of fracture increases progressively with AD severity, and is particularly elevated for vertebral and lower limb fractures. Clinicians should be aware of the skeletal complications of AD and consider targeted bone health monitoring, especially in patients with moderate to severe AD.