Osteoporosis Prevalent Among Women With Sarcoidosis

Key Point

Patients with sarcoidosis are prone to bone loss due to the disease itself and to the effects of some sarcoidosis treatments.

CHICAGO—Sarcoidosis and some of its treatment regimens put women at risk for bone loss and related quality-of-life concerns, according to research presented by Violeta Vucinic, MD, PhD, of the Institute of Pulmonary Diseases, Belgrade, Serbia, and colleagues at the American College of Chest Physicians’ 2007 Annual International Scientific Assembly. 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 (age range of women, 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 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.

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, Dr. Vucinic told Pulmonary Reviews. Dr. Vucinic plans to study different types of steroids and treatment duration among several subgroups of about 1,000 sarcoidosis patients registered with her clinic.           

—Kathlyn Stone

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