title: Teriparatide for osteoporosis in patients with sarcoidosis: Report on risk-benefit ratio in four cases.
abstract: OBJECTIVE
  For patients with sarcoidosis, no consensus exists about the management of osteoporosis, whether related or unrelated to glucocorticoid therapy.
  
  
  METHODS
  We report the first series of 4patients with histologically documented sarcoidosis who received teriparatide therapy for severe osteoporosis manifesting as a fracture cascade with multilevel vertebral fractures. When teriparatide was started, 1patient was receiving 10mg of prednisone equivalents per day, 1 was progressively tapering glucocorticoid dose, 2 had never received any glucocorticoid treatment.
  
  
  RESULTS
  In all 4patients, teriparatide was effective in halting the fracture cascade, including in the 2patients who remained on long-term glucocorticoid therapy. None of the patients developed hypercalcemia. During teriparatide therapy, 3patients underwent a flare or a complication of sarcoidosis. Only the patient on stable glucocorticoid treatment did not present any adverse event. Before teriparatide initiation, sarcoidosis had been well controlled in all 3patients for several years.
  
  
  CONCLUSIONS
  Even if the implication of teriparatide is unclear, the appearance of adverse events in 3 out of 4patients in this small series suggest caution in the use of teriparatide in patients with sarcoidosis.
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Rhumatologie, 125, rue de Stalingrad, 93017 Bobigny, France.
authors.forename: Salima
authors.initials: S
authors.lastname: Challal
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Rhumatologie, 125, rue de Stalingrad, 93017 Bobigny, France; Sorbonne Paris Cité, Université Paris 13, 74, rue Marcel-Cachin, 93017 Bobigny, France; Inserm UMR 1125, 74, rue Marcel-Cachin, 93000 Bobigny, France.
authors.forename: Luca
authors.initials: L
authors.lastname: Semerano
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Pneumologie, 125, rue de Stalingrad, 93017 Bobigny, France.
authors.forename: Hilario
authors.initials: H
authors.lastname: Nunes
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Pneumologie, 125, rue de Stalingrad, 93017 Bobigny, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Rhumatologie, 125, rue de Stalingrad, 93017 Bobigny, France; Sorbonne Paris Cité, Université Paris 13, 74, rue Marcel-Cachin, 93017 Bobigny, France; Inserm UMR 1125, 74, rue Marcel-Cachin, 93000 Bobigny, France.
authors.forename: Marie-Christophe
authors.initials: MC
authors.lastname: Boissier
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Rhumatologie, 125, rue de Stalingrad, 93017 Bobigny, France; Inserm UMR 1125, 74, rue Marcel-Cachin, 93000 Bobigny, France. Electronic address: nathalie.saidenberg@avc.aphp.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Saidenberg-Kermanac'h
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012507:Sarcoidosis / Q000150:complications*; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control*; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide
keywords: Fracture; Osteoporosis; Sarcoidosis; Teriparatide