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Open Access Highly Accessed Research article

Bone fragility in sarcoidosis and relationships with calcium metabolism disorders: a cross sectional study on 142 patients

Nathalie Saidenberg-Kermanac’h123*, Luca Semerano123, Hilario Nunes4, Danielle Sadoun4, Xavier Guillot123, Marouane Boubaya5, Nicolas Naggara6, Dominique Valeyre4 and Marie-Christophe Boissier123

Author Affiliations

1 INSERM UMR1125, Bobigny, France

2 Sorbonne Paris Cité-Université Paris 13, Bobigny, France

3 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Department of Rheumatology, Bobigny, France

4 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Department of Respiratory Diseases, Bobigny, France

5 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Clinical Research Unit, Bobigny, France

6 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Department of Radiology, Bobigny, France

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Arthritis Research & Therapy 2014, 16:R78  doi:10.1186/ar4519

Published: 24 March 2014

Abstract

Introduction

The prevention of fragility fractures in patients with sarcoidosis is a serious concern and the potential risk of hypercalcemia limits vitamin D and calcium supplementation. The objective of this study was to evaluate the risk factors for low bone mineral density (BMD) and fractures in sarcoidosis. In particular, we aimed to determine the link among bone fragility and calcium and vitamin D metabolism in this population.

Methods

We performed a cross-sectional analysis on 142 consecutive patients with histologically proven sarcoidosis. BMD and prevalence of vertebral fractures on X-rays were assessed and the association with potential risk factors was studied by regression analysis.

Results

Fragility fractures occurred in 23.5% of patients, despite a normal mean BMD in the study population. In a multivariate analysis, low dietary calcium, fracture, age, gender and menopause were associated with increased risk of low BMD. Low dietary calcium, high current corticosteroid dose and low creatinine clearance were associated with increased risk of fracture. Serum 25(OH)D between 10 and 20 ng/ml was significantly associated with higher BMD. Conversely, values greater than 20 ng/ml were associated with increased risk of fracture. Serum 25(OH)D level was inversely correlated with disease activity. Of note, vitamin D supplements increased serum 25(OH)D in a dose-dependent manner but had no effect on serum calcium level.

Conclusions

Sarcoidosis patients have a high risk of fracture despite not having a lowered BMD suggesting that other independent factors are involved. Current corticosteroid dose, low dietary calcium and serum 25(OH)D levels are associated with bone fragility. In sarcoidosis, calcium and vitamin D supplementation might be warranted, but desirable 25(OH)D serum levels might be lower than those advised for the general population.