Risk of vertebral and non-vertebral fractures in patients with sarcoidosis: a population-based cohort

Bours, S.; Vries, Frank de; Bergh, Joop van den; Lalmohamed, Arief; Staa, Tjeerd van; Leufkens, Hubert G. M.; Geusens, Piet; Drent, Marjolein; Harvey, Nicholas C.

doi:10.1007/s00198-015-3426-1

Cited by 24 publications

(41 citation statements)

References 44 publications

(47 reference statements)

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“…Increased risk of fragility fracture was observed among patients with sarcoidosis which was primarily driven by the increased risk of distal forearm fracture. These results differ from a recent coding-based study that observed an increased risk of vertebral fracture, but not non-vertebral fracture, among patients with sarcoidosis [12]. The difference in the methods used to identify patients with sarcoidosis and the events of interest may explain the different observations, as the prior study relied primarily on diagnostic codes while individual medical record review was performed in the current study.…”

Section: Discussioncontrasting

confidence: 84%

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Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976–2013

2017

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Summary Incidence of fragility fracture of a population-based cohort of 345 patients with sarcoidosis was compared with age and sex-matched comparators. The incidence of fragility fracture was higher among patients with sarcoidosis with hazard ratio (HR) of 2.18. Introduction Several chronic inflammatory disorders increase the risk of fragility fracture. However, little is known about the risk of fragility fracture in patients with sarcoidosis. Methods This study was conducted using a previously identified population-based cohort of 345 patients with incident sarcoidosis from Olmsted County, Minnesota. Diagnosis of sarcoidosis required physician diagnosis supported by biopsy showing non-caseating granuloma, radiographic evidence of intrathoracic sarcoidosis and compatible clinical presentations without evidence of other granulomatous diseases. Sex and age-matched subjects randomly selected from the same underlying population were used as comparators. Medical records of cases and comparators were reviewed for baseline characteristics and incident fragility fracture. Results Fragility fractures were observed in 34 patients with sarcoidosis, corresponding to a cumulative incidence of 5.6% at 10 years, while 18 fragility fractures were observed among comparators for a cumulative incidence of 2.4% at 10 years. The HR of fragility fractures among cases compared with comparators was 2.18 (95% confidence interval [CI], 1.23 – 3.88). The risk of fragility fracture by site was significantly higher among patients with sarcoidosis, and was due to higher rate of distal forearm fracture (HR 3.58; 95% CI 1.53 – 8.40). Statistically non-significant increased risk was also observed in proximal femur (HR 1.66; 95% CI 0.45 – 6.06) and proximal humerus (HR 3.27; 95% CI 0.66 – 16.21). Risk of vertebral fracture was not increased (HR 1.00; 95% CI 0.32 – 3.11). Conclusion Patients with sarcoidosis have an increased risk of fragility fracture which is primarily driven by the higher incidence of distal forearm fracture.

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Section: Discussioncontrasting

confidence: 84%

“…A recent population-based cohort of patients with sarcoidosis using a database of general practitioners across the United Kingdom also showed an increased incidence of vertebral fracture [12]. …”

Section: Introductionmentioning

confidence: 99%

Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976–2013

2017

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“…Patients with sarcoid granulomas may experience decreased bone mineral density prior to corticosteroid treatment, [27][28][29] although not all studies confirm an increased risk for osteoporosis. 30,31 One study found an increased risk for bone fracture without change in bone mineral density.…”

Section: Bone Health Alterations In Sarcoidosis Patientsmentioning

confidence: 99%

“…Interestingly, higher daily or cumulative doses of glucocorticoids did not further increase risk. 29…”

Section: Bone Health Alterations In Sarcoidosis Patientsmentioning

confidence: 99%

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

Zhou

Lower

2020

Semin Respir Crit Care Med

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Abnormal calcium metabolism in sarcoidosis patients can lead to hypercalcemia, hypercalciuria, and kidney stones. Hypercalcemia in sarcoidosis is usually due to increased activity of 1α-hydroxylase in macrophages of pulmonary granulomata, resulting in low levels of 25-hydroxyvitamin D and high levels of calcitriol. Vitamin D supplementation may be dangerous for some sarcoidosis patients and is recommended only for those with decreased 25-hydroxyvitamin D and reduced or normal calcitriol level. Diagnosis, treatment of osteoporosis, and maintenance of bone health are complex issues for sarcoidosis patients. An approach to diagnosis and treatment of bone fragility is presented.

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“…These data suggest an increased risk of vertebral fractures in patients with sarcoidosis, which is not reflected by changes in BMD [ 6 – 8 ]. A large observational cohort study using data from the UK Clinical Practice Research Datalink showed a doubled risk of osteoporotic fracture (spine, hip, forearm, or humerus fracture) in sarcoidosis patients who had received >10 mg prednisone per day [ 9 ]. Whether or not sarcoidosis per se is a risk factor for fractures is currently unknown.…”

Section: Introductionmentioning

confidence: 99%

Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis

et al. 2017

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SummaryThis 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.IntroductionSarcoidosis 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.MethodsA 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.ResultsA 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.ConclusionBoth 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.

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Risk of vertebral and non-vertebral fractures in patients with sarcoidosis: a population-based cohort

Cited by 24 publications

References 44 publications

Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976–2013

Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976–2013

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis

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