Women with sarcoidosis prone to osteoporosis

People with sarcoidosis are prone to bone loss due to the disease itself and to treatment side effects.

Sarcoidosis and some of its treatment regimens put women at risk for bone loss and related quality-of-life concerns, according to research led by Violeta Vucinic, MD, PhD, of the Institute of Pulmonary Diseases, Belgrade, Serbia, and colleagues. The multiorgan involvement of sarcoidosis and the therapy used to suppress the granulomatous inflammation contribute to the severity of the disease and patient health status, they said. 

The study involved 88 patients whose sarcoidosis diagnosis was confirmed by biopsy; 76% of participants were women (ages 49 to 57). All participants had previously received steroid treatment for sarcoidosis — which in turn had affected some neurologic processes as well as various organs, including the eyes, skin, liver, and spleen. Bone density measurements were obtained through computed tomography (CT) osteodensitometry. Patients were categorized into three groups based on their T scores: 20% of patients (group A) had normal T scores of 0 to -1; 72% (group B) were osteopenic, with T scores of -1 to -2.5; and 8% (group C) had osteoporosis, with T scores of -2.5 or lower. (T score refers to a test score converted to an equivalent standard score in a normal distribution with a mean of 50 and a standard deviation of 10.)  

In addition to undergoing imaging tests, the participants reported their perceptions of the disease’s effect on their health status using ECOS-16, a questionnaire that combines generic and disease-specific questions relating to osteoporosis in postmenopausal women, and the Sarcoidosis Health Questionnaire (SHQ), which measures daily, physical, and emotional functioning. With 1 being “best” and 5 being “worst,” the mean ECOS-16 score was 2.17 in Group A, 2.24 in group B, and 2.51 in group C. The ECOS-16 scores closely correlated with the SHQ scores, the authors noted. 

Previous studies have shown abnormal calcium metabolism to be a common complication of sarcoidosis that may lead to hypercalcemia, hypercalciuria, and reduced bone density. Long courses of oral or inhaled corticosteroids block inflammation and granuloma formulation but also are strongly associated with an increased risk for osteoporosis and fracture. Corticosteroid-induced osteoporosis has led to rib fractures and the formation of calluses at the healing site. There is evidence for both genetic and environmental causes for the higher occurrence of reduced bone density in sarcoidosis patients. 

“The disease most likely represents an inflammatory response to one or many agents,” such as bacteria, fungi, chemicals, and viruses present in someone with either an inherited or acquired predisposition, said Dr. Vucinic. She plans to study different types of steroids and treatment duration among several subgroups of about 1,000 sarcoidosis patients registered with her clinic.