Use of Systemic Glucocorticoids and the Risk of Major Osteoporotic Fractures in Patients with Sarcoidosis

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2017 Jun 23

PMID 28638981

Citations 9

Authors

O A Oshagbemi

J H M Driessen

A Pieffers

E F M Wouters

P Geusens

P Vestergaard

J van den Bergh

F M E Franssen

F de Vries

Affiliations

Soon will be listed here.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

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Imaging Plays a Key Role in the Diagnosis and Control of the Treatment of Bone Sarcoidosis.

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The Risk of Sarcoidosis Misdiagnosis and the Harmful Effect of Corticosteroids When the Disease Picture Is Incomplete.

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Bone fragility and sarcoidosis: An underestimated relationship.

Caffarelli C, Cameli P, Al Refaie A, Giglio E, Manzana G, Mondillo C Front Med (Lausanne). 2022; 9:1026028.

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