This study revealed the risk of major osteoporotic fracture in patients with sarcoidosis exposed to glucocorticoids. Current use of glucocorticoids was associated with a risk of fracture, with no difference between patients with and without sarcoidosis. Sarcoidosis per se was not associated with an increased fracture risk.
Sarcoidosis is a multi-organ, chronic inflammatory, granulomatous disorder that most frequently affects the lungs, lymph nodes, skin, eyes, and liver, but may occur in any organ, including the bones. While oral glucocorticoids (GCs) are commonly used as initial treatment, little is known about the risk of major osteoporotic fractures in patients with sarcoidosis exposed to GCs.
A case-control study was conducted using the Danish National Hospital Discharge Registry (NHDR) between January 1995 and December 2011. Conditional logistics regression models were used to derive adjusted odds ratios (OR) of major osteoporotic fractures in subjects with and without sarcoidosis stratified by average daily and cumulative dose exposures.
A total of 376,858 subjects with a major osteoporotic fracture and the same number of subjects without this event were identified (mean age 64.2 ± 19.5 years, 69% female). In patients with sarcoidosis (n = 124), current use of GC was associated with an increased risk of major osteoporotic fracture (adjusted (adj.) OR 1.74; 95% CI 1.17–2.58), which dropped to baseline levels after discontinuation. In subjects without sarcoidosis, this risk was comparable (adj. OR 1.36; 95% CI 1.32–1.40). In sarcoidosis patients, cumulative dose 1.0–4.9 g and >10 g prednisolone equivalents were associated with increased risk of major osteoporotic fracture (adj. OR 2.75; 95% CI 1.06–7.14 and 2.22; 95% CI 1.17–4.22, respectively), whereas a cumulative dose of <1.0 g and 5.0–9.9 g was not associated with major osteoporotic fracture risk.
Both in subjects with and without sarcoidosis, current expose to GC is associated with increased risk of major osteoporotic fractures, with no between-group difference. Sarcoidosis per se was not associated with increased fracture risk. Having sarcoidosis per se, i.e., if not treated with GC, is not a risk factor for fracture, and such patients may only need risk assessment when they commence GC therapy.
Heijckmann AC, Huijberts MSP, De Vries J et al (2007) Bone turnover and hip bone mineral density in patients with sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 24:51–58 PubMed
Mosbech J, Jorgensen J, Madsen M et al (1995) The national patient registry. Evaluation of data quality. Ugeskr Laeger 157:3741–3745 PubMed
Sverrild A, Backer V, Kyvik KO et al (2008) Heredity in sarcoidosis: a registry-based twin study. Thorax 63:894 LP–894896 CrossRef
Byg KE, Milman N, Hansen S (2003) Sarcoidosis in Denmark 1980–1994. A registry-based incidence study comprising 5536 patients. Sarcoidosis Vasc Diffus lung Dis 20:46–52
Van Staa TP, Abenhaim L, Cooper C et al (2000) The use of a large pharmacoepidemiological database to study exposure to oral corticosteroids and risk of fractures: validation of study population and results. Pharmacoepidemiol Drug Saf 9:359–366. doi: 10.1002/1099-1557(200009/10)9:5<359::AID-PDS507>3.0.CO;2-E CrossRefPubMed
Montemurro L, Fraioli P, Rizzato G (1991) Bone loss in untreated longstanding sarcoidosis. Sarcoidosis 8:29–34 PubMed
Cremers JP, Drent M, Elfferich MD et al (2013) Body composition profiling in a Dutch sarcoidosis population. Sarcoidosis Vasc Diffuse Lung Dis 30:289–299 PubMed
- Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis
O. A. Oshagbemi
J. H. M. Driessen
E. F. M. Wouters
J. van den Bergh
F. M. E. Franssen
F. de Vries
- Springer London
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II