Association between bone mineral density and benign paroxysmal positional vertigo: a meta-analysis.

Background: The association between bone mineral density (BMD) and benign paroxysmal positional vertigo (BPPV) has been investigated by multiple studies, but the conclusions are controversial. This meta-analysis was conducted to evaluate whether the bone mineral density is associated with BPPV.

Methods: The relevant studies were identified by searching PubMed, EMBASE, Cochrane Library, ScienceDirect, Web of Science database up to June 2018. Statas14.0 software was used for meta-analysis. We used the pooled odds ratio (OR) and 95% confidence interval (CI) to assess the incidence of osteoporosis and osteopenia in patients with BPPV and controls (free of BPPV disease). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to assess the T score in BPPV patients and controls. This meta-analysis has been registered at International Prospective Register of Systematic Reviews (PROSPERO) (number CRD42018082271).

Results: A total of 11 studies were eligible for meta-analysis, including 1982 subjects. When compared with the controls, the total incidence of osteoporosis and osteopenia was significantly higher in BPPV patients (OR 3.27, 95% CI 2.66-4.03, p < 0.0001). Further analysis was conducted by separate discussion about the incidence of osteoporosis and osteopenia in BPPV patients, the result of which shows that both the incidence of osteoporosis (OR 3.48, 95% CI 1.86-6.51, p < 0.0001) and the incidence of osteopenia (OR 1.75, 95% CI 1.01-3.04, p < 0.0001) were higher in BPPV patients than that in controls. There was an significant reduction in T scores of BPPV patients (SMD - 0.82, 95% CI -1.18 to - 0.46, p < 0.0001). Publication bias for each analysis was evaluated by Egger's test and Begg's indicating that no publication bias existed. Sensitivity analysis was conducted for each analysis demonstrating that the results were robust.

Conclusions: Our meta-analysis provided stronger evidence that patients with BPPV were associated with a lower T score and a higher risk of osteoporosis and osteopenia. The results demonstrated that lower bone mineral density may be a risk factor for BPPV. However, large-scare, multicenter clinical studies need to be carried out to explore the precise risk of osteoporosis and osteopenia in patients with BPPV in future.