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

Risk of vertebral and non-vertebral fracture in patients with sarcoidosis: a population-based cohort
Risk of vertebral and non-vertebral fracture in patients with sarcoidosis: a population-based cohort
Summary: In this retrospective cohort study using the Clinical Practice Research Datalink (CPRD), patients with sarcoidosis have an increased risk of clinical vertebral fractures and when on recent treatment with oral glucocorticoids, also an increased risk of any fractures and osteoporotic fractures.

Introduction: Sarcoidosis is a chronic inflammatory disease, in which fragility fractures have been reported despite normal BMD. The aim of this study was to assess whether patients with sarcoidosis have an increased risk of clinical fractures compared to the general population.

Methods: A retrospective cohort study was conducted using the CPRD. All patients with a CPRD code for sarcoidosis between January 1987 and September 2012 were included. Cox proportional hazards models were used to derive adjusted relative risks (RRs) of fractures in all sarcoidosis patients compared to matched controls, and within the sarcoidosis group according to use and dose of systemic glucocorticoids.

Results: Five thousand seven hundred twenty-two sarcoidosis patients (mean age 48.0 years, 51 % females, mean follow-up 6.7 years) were identified.

Compared to 28,704 matched controls, the risk of any fracture was not different in patients with sarcoidosis. However, the risk of clinical vertebral fractures was significantly increased (adj RR 1.77; 95 % CI 1.06–2.96) and the risk of non-vertebral fractures was decreased although marginally significant (adj RR 0.87; 95 % CI 0.77–0.99). Compared to sarcoidosis patients not taking glucocorticoids, recent use of systemic glucocorticoids was associated with an increased risk of any fracture (adj RR 1.50; 95 % CI 1.20–1.89) and of an osteoporotic fracture (adj RR 1.47; 95 % CI 1.07–2.02).

Conclusions: Patients with sarcoidosis have an increased risk of clinical vertebral fractures, and when using glucocorticoid therapy, an increased risk of any fractures and osteoporotic fractures. In contrast, the risk of non-vertebral fractures maybe decreased. Further investigation is needed to understand the underlying mechanisms of these contrasting effects on fracture risk.
bone, epidemiology, fractures, glucocorticoids, osteoporosis, sarcoidosis
0937-941X
1-8
Bours, S.
5f50883e-1a63-4ca7-b858-5f1dc3a30a62
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
van den Bergh, J.P.W.
c30fc1ae-c65a-4c7e-a71f-cfd251a8b8b5
Lalmohamed, A.
b3bef1c3-1d0f-4e3d-b999-a00b16aff528
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
Leufkens, H.G.M.
04854167-bea6-4508-a8e2-aeb920a2d6b1
Geusens, P.P.P.
77419ac5-d945-40a6-b5b1-40225e37290f
Drent, M.
24b2e2f2-36e8-45bc-a748-31630672d87b
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Bours, S.
5f50883e-1a63-4ca7-b858-5f1dc3a30a62
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
van den Bergh, J.P.W.
c30fc1ae-c65a-4c7e-a71f-cfd251a8b8b5
Lalmohamed, A.
b3bef1c3-1d0f-4e3d-b999-a00b16aff528
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
Leufkens, H.G.M.
04854167-bea6-4508-a8e2-aeb920a2d6b1
Geusens, P.P.P.
77419ac5-d945-40a6-b5b1-40225e37290f
Drent, M.
24b2e2f2-36e8-45bc-a748-31630672d87b
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145

Bours, S., de Vries, F., van den Bergh, J.P.W., Lalmohamed, A., van Staa, T.P., Leufkens, H.G.M., Geusens, P.P.P., Drent, M. and Harvey, N.C. (2015) Risk of vertebral and non-vertebral fracture in patients with sarcoidosis: a population-based cohort. Osteoporosis International, 1-8. (doi:10.1007/s00198-015-3426-1). (PMID:26630976)

Record type: Article

Abstract

Summary: In this retrospective cohort study using the Clinical Practice Research Datalink (CPRD), patients with sarcoidosis have an increased risk of clinical vertebral fractures and when on recent treatment with oral glucocorticoids, also an increased risk of any fractures and osteoporotic fractures.

Introduction: Sarcoidosis is a chronic inflammatory disease, in which fragility fractures have been reported despite normal BMD. The aim of this study was to assess whether patients with sarcoidosis have an increased risk of clinical fractures compared to the general population.

Methods: A retrospective cohort study was conducted using the CPRD. All patients with a CPRD code for sarcoidosis between January 1987 and September 2012 were included. Cox proportional hazards models were used to derive adjusted relative risks (RRs) of fractures in all sarcoidosis patients compared to matched controls, and within the sarcoidosis group according to use and dose of systemic glucocorticoids.

Results: Five thousand seven hundred twenty-two sarcoidosis patients (mean age 48.0 years, 51 % females, mean follow-up 6.7 years) were identified.

Compared to 28,704 matched controls, the risk of any fracture was not different in patients with sarcoidosis. However, the risk of clinical vertebral fractures was significantly increased (adj RR 1.77; 95 % CI 1.06–2.96) and the risk of non-vertebral fractures was decreased although marginally significant (adj RR 0.87; 95 % CI 0.77–0.99). Compared to sarcoidosis patients not taking glucocorticoids, recent use of systemic glucocorticoids was associated with an increased risk of any fracture (adj RR 1.50; 95 % CI 1.20–1.89) and of an osteoporotic fracture (adj RR 1.47; 95 % CI 1.07–2.02).

Conclusions: Patients with sarcoidosis have an increased risk of clinical vertebral fractures, and when using glucocorticoid therapy, an increased risk of any fractures and osteoporotic fractures. In contrast, the risk of non-vertebral fractures maybe decreased. Further investigation is needed to understand the underlying mechanisms of these contrasting effects on fracture risk.

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More information

Accepted/In Press date: 13 November 2015
e-pub ahead of print date: 2 December 2015
Keywords: bone, epidemiology, fractures, glucocorticoids, osteoporosis, sarcoidosis
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 385185
URI: https://eprints.soton.ac.uk/id/eprint/385185
ISSN: 0937-941X
PURE UUID: c7b70225-4a84-418d-9174-d45533e59d8d
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 18 Jan 2016 11:24
Last modified: 01 Feb 2019 01:36

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Contributors

Author: S. Bours
Author: F. de Vries
Author: J.P.W. van den Bergh
Author: A. Lalmohamed
Author: T.P. van Staa
Author: H.G.M. Leufkens
Author: P.P.P. Geusens
Author: M. Drent
Author: N.C. Harvey ORCID iD

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