Atopic dermatitis (AD) is the most common inflammatory skin disorder worldwide, affecting approximately 5% of adults. An AD comorbidity of interest for the purposes of our project is impaired bone health (IBH)- reduced bone mineral density (BMD), osteoporosis, fragility fracture.
Patients with AD have an approx. 2-fold higher risk of developing IBH compared to those without. Mechanisms are unclear but given the health impact of fractures and changing demographics with increased longevity, warrant further investigation.
Three theories exist:
A. Effect on bone metabolism of treating AD and atopic comorbidities with glucocorticoids
B. Type 2 inflammatory signals
C. Reduced physical activity and disturbed sleep due to itch, leading to reductions in weight bearing exercise and potential for injury
Research question:
– What mechanisms underpin the association between AD and impaired bone health?
This project aims to utilize UK Biobank data in key work packages.
A. Prevalence study. We aim to identify a cohort of participants with AD and stratify by severity utilizing prescription data, in addition to identifying a control cohort. Subsequently, prevalence of bone health outcomes will be calculated using dual X-ray absorptiometry data.
B. Glucocorticoid study. Utilising the above cohorts, we will establish cumulative glucocorticoid exposure across several administration routes in AD participants with/without impaired bone health. We are hoping to identify a threshold of glucocorticoid exposure beyond which the risk of bone health outcomes of interest increases.
C. Proteomics study. We aim to conduct a differential protein expression analysis of AD participants with/without impaired bone health, aiming to identify differentially expressed molecular signals that may contribute to such outcomes.
D. Behavioural study. We aim to utilized sleep questionnaire and derived accelerometry data to identify behavioural patterns in AD participants with/without IBH.