PURPOSE:Sarcoidosis is a chronic multisystem disorder, characterised by the presence of non-caseating granulomas and accumulation of T-lymphocytes and macrophages in multiple organs, including bone. Glucocorticoid therapy, the mainstay of treatment in sarcoidosis exacerbations, also causes decreased bone formation and increased bone resorption.
METHODS:In this study, 65 biopsy-positive patients with sarcoidosis were examined, (45 female, 20 male). Dual energy X-ray absorptiometry (DXA) to assess Bone Mineral Density (BMD) and T-scores at the anterior-posterior (AP) Spine and Left femur was perfomed. Furthermore, Lateral Vertebral Assessment (LVA) for morphometric assessment of vertebral deformities was assessed.
RESULTS:20 (30.8%) patients had osteoporosis. The average BMD at the AP spine was 0.824 g/cm2, (T-score -3.0). The average BMD at the Left femur in these patients was 0.718 g/cm2, (T-score -1.86). 20 (30.8%) patients had osteopenia, with the average T-score at the AP spine being -2.1, and at the left femur -1.2. The remaining 25 (38.4%) had normal BMD. 10 patients (15.4%) had evidence of vertebral fractures on LVA, all of these patients had T-scores < -2.5. Severe vertebral compression and biconcavity was evident in 7 of these cases. In relation to glucocorticoid use, 35 (54%) of patients had never used steroid treatment, while 30 (46%) had required oral or inhaled steroids at some point during the course of their condition.
CONCLUSION:Sarcoidosis patients have a high prevalence of osteoporosis (30.8%), osteopenia (30.8%) and vertebral fractures (15.4%).
CLINICAL IMPLICATIONS:All patients with sarcoidosis should be screened with DXA and LVA for osteoporosis, osteopenia and vertebral fractures. It is important that these conditions are diagnosed and early treatment is initiated, ideally in a specialist bone clinic, as sarcoidosis patients have the potential for hypercalciuria and hypercalcemia.
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