title: Bone fragility in sarcoidosis and relationships with calcium metabolism disorders: a cross sectional study on 142 patients.
abstract: BACKGROUND
  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.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Saidenberg-Kermanac'h
authors.forename: Luca
authors.initials: L
authors.lastname: Semerano
authors.forename: Hilario
authors.initials: H
authors.lastname: Nunes
authors.forename: Danielle
authors.initials: D
authors.lastname: Sadoun
authors.forename: Xavier
authors.initials: X
authors.lastname: Guillot
authors.forename: Marouane
authors.initials: M
authors.lastname: Boubaya
authors.forename: Nicolas
authors.initials: N
authors.lastname: Naggara
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.forename: Marie-Christophe
authors.initials: MC
authors.lastname: Boissier
mesh_terms: D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D002128:Calcium Metabolism Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D012507:Sarcoidosis / Q000150:complications* / Q000378:metabolism*; D016103:Spinal Fractures / Q000453:epidemiology*; D014807:Vitamin D / Q000097:blood
chemical_list: D014807:Vitamin D; D002118:Calcium