Abstract:

Objective

To explore the influence of systemic immune inflammation index （SII） on bone mass density （BMD） and osteoporosis （OP）， and provide a basis for early screening and diagnosis of osteoporosis.

Methods

According to the PRISMA standard， six databases including PubMed， Web of Science， Excerpta Medica Database （Embase）， China National Knowledge Infrastructure （CNKI）， China Science and Technology Journal Database （VIP）， and Wanfang were searched for observational studies from database establishment to December 28， 2023. Related data were extracted from included literatures and quality of each articles was evaluated. For different outcomes， the calculation of pooled effect values， meta regression， subgroup analysis，sensitivity analysis， and publication bias test （Egger method and funnel plot） were performed. STATA 15.0 was used to analysis， with a testing level of α=0.05.

Results

A total of eight observational studies were included，including 11453 subjects. Compared with the low-level SII group， the high-level SII group has lower BMD levels in the femoral neck， and the difference is statistically significan［trandom effects mode： β=-0.023， 95%confidence interval （CI） （-0.039， -0.006）， I²=78.3%， P=0.001l］. Through subgroup analysis， high levels of SII were associated with a decrease in femoral neck BMD in the elderly population and postmenopausal female［age ≥60 years old： β=-0.016， 95%CI（-0.031， -0.002）； postmenopausal women： β=-0.029， 95%CI （-0.048，-0.010）］. Compared with the low-level SII group， the high-level SII group has a higher risk of OP［ random effects model： odds ratio （OR）=1.990； 95% CI （1.280， 3.090）， I²=72.5%， P=0.012］. The results of subgroup analysis showed that high levels of SII were associated with the risk of OP in postmenopausal women［OR=2.250，95%CI （1.270， 4.000）］. Continuous SII was not related to the risk of OP［ random effects model： OR=1.010，95%CI （0.910， 1.310）， I²=100%］. The meta regression analyses indicated that no factor affecting heterogeneity among studies was identified. Sensitivity analyses suggested that the results of this study were robust， and no publication bias was found.

Conclusions

High level of SII associates with lower BMD levels and higher OP risk， especially in postmenopausal women and the elderly population. SII can comprehensively reflect the immune and inflammatory status of the body， and it is calculated from blood routine examination results， which is easy to obtain. Therefore， this study may provide new ideas for early screening and diagnosis of osteoporosis.

Key words: Immune system, Inflammation, Bone density, Osteoporosis, Meta-analysis