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With great interest, I have read the article by Xia et al,1 which evaluated the relationship between psoriasis, psoriatic arthritis (PsA) and osteoporosis. This Mendelian randomisation (MR) study suggests that the effect of PsA on osteoporosis is secondary, but not causal. However, it is important to discuss some methodological issues in MR. First, MR is a powerful tool for analysing causal relationships between exposures and outcomes because of minimisation of residual confounding.2 3 However, MR is often vulnerable to bias resulting from pleiotropy.2 Therefore, the use of a variety of robust methods working in diverse ways and relying on different assumptions has been recommended to derive …
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Contributors YHL is the sole author of this article.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.