Bours S, de Vries F, van den Bergh J P W, Lalmohamed A, van Staa T P, Leufkens H G M, Geusens P P P, Drent M, Harvey N C
Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
Osteoporos Int. 2016 Apr;27(4):1603-1610. doi: 10.1007/s00198-015-3426-1. Epub 2015 Dec 2.
In this retrospective cohort study using the Clinical Practice Research Datalink (CPRD), patients with sarcoidosis have an increased risk of clinical vertebral fractures and when on recent treatment with oral glucocorticoids, also an increased risk of any fractures and osteoporotic fractures.
Sarcoidosis is a chronic inflammatory disease, in which fragility fractures have been reported despite normal BMD. The aim of this study was to assess whether patients with sarcoidosis have an increased risk of clinical fractures compared to the general population.
A retrospective cohort study was conducted using the CPRD. All patients with a CPRD code for sarcoidosis between January 1987 and September 2012 were included. Cox proportional hazards models were used to derive adjusted relative risks (RRs) of fractures in all sarcoidosis patients compared to matched controls, and within the sarcoidosis group according to use and dose of systemic glucocorticoids.
Five thousand seven hundred twenty-two sarcoidosis patients (mean age 48.0 years, 51 % females, mean follow-up 6.7 years) were identified. Compared to 28,704 matched controls, the risk of any fracture was not different in patients with sarcoidosis. However, the risk of clinical vertebral fractures was significantly increased (adj RR 1.77; 95 % CI 1.06-2.96) and the risk of non-vertebral fractures was decreased although marginally significant (adj RR 0.87; 95 % CI 0.77-0.99). Compared to sarcoidosis patients not taking glucocorticoids, recent use of systemic glucocorticoids was associated with an increased risk of any fracture (adj RR 1.50; 95 % CI 1.20-1.89) and of an osteoporotic fracture (adj RR 1.47; 95 % CI 1.07-2.02).
Patients with sarcoidosis have an increased risk of clinical vertebral fractures, and when using glucocorticoid therapy, an increased risk of any fractures and osteoporotic fractures. In contrast, the risk of non-vertebral fractures maybe decreased. Further investigation is needed to understand the underlying mechanisms of these contrasting effects on fracture risk.
在这项使用临床实践研究数据链（CPRD）的回顾性队列研究中，结节病患者发生临床椎体骨折的风险增加，并且在近期接受口服糖皮质激素治疗时，发生任何骨折和骨质疏松性骨折的风险也增加。
结节病是一种慢性炎症性疾病，尽管骨密度正常，但仍有脆性骨折的报道。本研究的目的是评估结节病患者与普通人群相比，发生临床骨折的风险是否增加。
使用CPRD进行了一项回顾性队列研究。纳入了1987年1月至2012年9月期间所有有结节病CPRD编码的患者。使用Cox比例风险模型得出所有结节病患者与匹配对照相比骨折的调整后相对风险（RRs），并在结节病组内根据全身糖皮质激素的使用情况和剂量进行分析。
共识别出5722例结节病患者（平均年龄48.0岁，51%为女性，平均随访6.7年）。与28704例匹配对照相比，结节病患者发生任何骨折的风险无差异。然而，临床椎体骨折的风险显著增加（调整后RR 1.77；95%CI 1.06 - 2.96），非椎体骨折的风险虽略有降低但有统计学意义（调整后RR 0.87；95%CI 0.77 - 0.99）。与未服用糖皮质激素的结节病患者相比，近期使用全身糖皮质激素与发生任何骨折（调整后RR 1.50；95%CI 1.20 - 1.89）和骨质疏松性骨折（调整后RR 1.47；95%CI 1.07 - 2.02）的风险增加相关。
结节病患者发生临床椎体骨折的风险增加，并且在使用糖皮质激素治疗时，发生任何骨折和骨质疏松性骨折的风险增加。相比之下，非椎体骨折的风险可能降低。需要进一步研究以了解这些对骨折风险的相反影响的潜在机制。
