Sarcoidosis Patients Have More Bone Fractures, Irrespective of Glucocorticoid Treatments

Patients with sarcoidosis have more than twice the risk of bone fractures compared to healthy people, a finding most likely linked to the inflammatory nature of the disease.

While glucocorticoids — the main treatment option for sarcoidosis — are known to cause osteoporosis, researchers at the Mayo Clinic in Rochester, Minn., did not find evidence that the treatment contributed to the increase. Nevertheless, they argued that the study may have been too small to detect a link.

The study, “Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976-2013” was published in the journal Osteoporosis International.

Patients with other inflammatory conditions, including rheumatoid arthritis and systemic lupus erythematosus, are known to have a higher likelihood of what is known as fragility fractures — bones broken as a result of normal activities.

Small studies also have indicated that the same may be true for sarcoidosis. To examine this in a larger setting, the research team examined the medical records of 345 patients with sarcoidosis in Olmsted County, Minn., — comparing them to healthy people of the same age and sex. Patients were followed for a median of 12.9 years.

The review showed that 34 of the patients had 41 fragility fractures between the years 1976–2013. This was significantly higher than among the controls (healthy) group, in which researchers noted 19 fractures among 18 people.

This translated to a 5.6% risk of a fracture within 10 years of a sarcoidosis diagnosis. Controls had a 2.4% risk in the same time period. Wrist fractures, along with injuries to the top part of the upper arm and upper leg bones, were more common in sarcoidosis patients than controls.

These are common sites of broken bones in people with osteoporosis. Spine fractures, which also are common in people with poor bone health, were equally likely in the two groups, however.

Of the 345 patients, 100 had been treated with glucocorticoids at some time point during the follow-up period. Despite the fact that such drugs are known to trigger osteoporosis, treated patients did not have an increased risk for fractures compared to those who had never used such drugs.

Patients who had been treated with high doses of glucocorticoids during an extended time also did not have an increased risk of fractures.