Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis

This study revealed the risk of major osteoporotic fracture in patients with sarcoidosis exposed to glucocorticoids. Current use of glucocorticoids was associated with a risk of fracture, with no difference between patients with and without sarcoidosis. Sarcoidosis per se was not associated with an increased fracture risk.IntroductionSarcoidosis is a multi-organ, chronic inflammatory, granulomatous disorder that most frequently affects the lungs, lymph nodes, skin, eyes, and liver, but may occur in any organ, including the bones. While oral glucocorticoids (GCs) are commonly used as initial treatment, little is known about the risk of major osteoporotic fractures in patients with sarcoidosis exposed to GCs.MethodsA case-control study was conducted using the Danish National Hospital Discharge Registry (NHDR) between January 1995 and December 2011. Conditional logistics regression models were used to derive adjusted odds ratios (OR) of major osteoporotic fractures in subjects with and without sarcoidosis stratified by average daily and cumulative dose exposures.ResultsA total of 376,858 subjects with a major osteoporotic fracture and the same number of subjects without this event were identified (mean age 64.2  ± 19.5 years, 69% female). In patients with sarcoidosis (n = 124), current use of GC was associated with an increased risk of major osteoporotic fracture (adjusted (adj.) OR 1.74; 95% CI 1.17–2.58), which dropped to baseline levels a...
Source: Osteoporosis International - Category: Orthopaedics Source Type: research

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DiscussionGiven the multiorgan system potential adverse side effects of prednisone, proving noninferiority of an alternate regimen would be sufficient to make the alternative compare favorably to standard dose steroids. This is the first ever clinical trial in cardiac sarcoidosis and thus in addition to the listed goals of the trial, we will also establish a multi-center, multinational cardiac sarcoidosis clinical trials network. Such a collaborative infrastructure will enable a new era of high quality data to guide physicians when treating cardiac sarcoidosis patients.
Source: American Heart Journal - Category: Cardiology Source Type: research
Discussion: Collecting outcomes in pulmonary sarcoidosis internationally and the use of a broadly accepted set can enable international comparison. Differences in outcomes can potentially be used as a starting point for quality improvement initiatives. PMID: 30956806 [PubMed]
Source: Respiratory Care - Category: Respiratory Medicine Authors: Tags: BMJ Open Respir Res Source Type: research
AbstractPurposeTo investigate inpatient prevalence, expenditures, and comorbidities of hospitalized patients with sarcoidosis in the USA.MethodsPatients with sarcoidosis were identified within the Nationwide Inpatient Sample (NIS) database for the years 2013 and 2014 using the respective ICD-9 diagnostic code. Data on patient and hospital characteristics, comorbidities, total hospital costs, and total hospitalization charges were collected. A propensity-matched cohort of patients without sarcoidosis from the same database was created and used as comparators for the analysis of comorbidities.ResultsA cohort of 78,055 patien...
Source: Lung - Category: Respiratory Medicine Source Type: research
A 60-year-old multi-morbid male patient with polycystic kidney disease and secondary chronic renal insufficiency stage G5 A3 according to Kidney Disease: Improving Global Outcomes (KDIGO) classification was referred to our hospital with radiological differential diagnoses of sarcoidosis, ectasia of the pulmonary arteries, lymphoma, or central bronchial carcinoma with contralateral hilar lymph node metastases. He had concomitant arterial hypertension, manifest osteoporosis due to renal osteopathy, secondary compensated renal hyperparathyroidism, compensated metabolic renal acidosis, and diabetes mellitus type 2.
Source: Heart, Lung and Circulation - Category: Cardiology Authors: Tags: Image Source Type: research
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 009 The diagnosis of HIV is no longer fatal and the term AIDS is becoming less frequent. In many countries, people with HIV are living longer than those with diabetes. This post will hopefully teach the basics of a complex disease and demystify some of the potential diseases you need to consider in those who are severely immunosuppressed. While trying to be comprehensive this post can not be exhaustive (as you can imagine any patient with ...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Clinical Cases Tropical Medicine AIDS art cryptococcoma cryptococcus HIV HIV1 HIV2 PEP PrEP TB toxoplasma tuberculoma Source Type: blogs
AbstractIncidence of fragility fracture of a population-based cohort of 345 patients with sarcoidosis was compared with age- and sex-matched comparators. The incidence of fragility fracture was higher among patients with sarcoidosis with a hazard ratio (HR) of 2.18.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
In this study, we compared the characteristics and bone histomorphometric findings between subtrochanteric and diaphyseal sites in patients with BP-associated AFFs. Nine women with BP-associated AFFs were recruited, including 3 with systemic lupus erythematosus, 2 with rheumatoid arthritis, 2 with primary osteoporosis, 1 with polymyalgia rheumatica, and 1 with sarcoidosis. Patients were divided into the subtrochanteric group (n = 5; average age, 52 years; BP treatment, 5.9 years) and the diaphyseal group (n = 4; average age, 77 years; BP treatment, 2.6 years). Compared with the diaphyseal group, the subtrochanteric group h...
Source: The Tohoku Journal of Experimental Medicine - Category: Research Authors: Tags: Tohoku J Exp Med Source Type: research
Conclusions: Collecting outcomes in pulmonary sarcoidosis internationally is feasible. The use of a standardized outcome indicator set will enable international comparison. Differences in outcomes could facilitate improvements in quality of care for pulmonary sarcoidosis.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Epidemiology Source Type: research
Conclusion: The need of alternative immunosuppressive therapy in sarcoidosis patients with lung parenchymal lesions is about 32,4 %. The study data indicate the necessity of development of new effective and safe immunosuppressive therapy in pulmonary sarcoidosis patients.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Diffuse Parenchymal Lung Disease Source Type: research
ConclusionPatients with sarcoidosis have an increased risk of fragility fracture which is primarily driven by the higher incidence of distal forearm fracture.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
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