Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, 200 First Avenue SW, Rochester, MN, 55905, USA.
Division of Biomedical Informatics, Department of Health Science Research, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA.
Osteoporos Int. 2017 Jun;28(6):1875-1879. doi: 10.1007/s00198-017-3962-y. Epub 2017 Feb 16.
Incidence 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 hazard ratio (HR) of 2.18.
Several chronic inflammatory disorders increase the risk of fragility fracture. However, little is known about the risk of fragility fracture in patients with sarcoidosis.
This study was conducted using a previously identified population-based cohort of 345 patients with incident sarcoidosis from Olmsted County, Minnesota. Diagnosis of sarcoidosis required physician diagnosis supported by biopsy showing non-caseating granuloma, radiographic evidence of intrathoracic sarcoidosis, and compatible clinical presentations without evidence of other granulomatous diseases. Sex and age-matched subjects randomly selected from the same underlying population were used as comparators. Medical records of cases and comparators were reviewed for baseline characteristics and incident fragility fracture.
Fragility fractures were observed in 34 patients with sarcoidosis, corresponding to a cumulative incidence of 5.6% at 10 years, while 18 fragility fractures were observed among comparators for a cumulative incidence of 2.4% at 10 years. The HR of fragility fractures among cases compared with comparators was 2.18 (95% confidence interval [CI], 1.23-3.88). The risk of fragility fracture by site was significantly higher among patients with sarcoidosis, and was due to a higher rate of distal forearm fracture (HR 3.58; 95% CI 1.53-8.40). Statistically non-significant increased risk was also observed in proximal femur (HR 1.66; 95% CI 0.45-6.06) and proximal humerus (HR 3.27; 95% CI 0.66-16.21). Risk of vertebral fracture was not increased (HR 1.00; 95% CI 0.32-3.11).
Patients with sarcoidosis have an increased risk of fragility fracture which is primarily driven by the higher incidence of distal forearm fracture.
一些慢性炎症性疾病会增加脆性骨折的风险。然而，人们对类肉瘤病患者发生脆性骨折的风险知之甚少。
本研究采用了明尼苏达州奥姆斯特德县先前确定的 345 例类肉瘤病的基于人群的队列。类肉瘤病的诊断需要医生诊断，支持活检显示非干酪样肉芽肿、胸内类肉瘤的放射影像学证据，以及无其他肉芽肿性疾病证据的相符临床表现。从同一基础人群中随机选择性别和年龄匹配的受试者作为对照。对病例和对照者的病历进行回顾，以评估基线特征和脆性骨折的发生情况。
34 例类肉瘤病患者发生脆性骨折，10 年累积发生率为 5.6%，而 18 例对照者发生脆性骨折，10 年累积发生率为 2.4%。病例与对照者相比，脆性骨折的 HR 为 2.18（95%CI，1.23-3.88）。类肉瘤病患者发生脆性骨折的风险按部位显著升高，且远端前臂骨折的发生率更高（HR 3.58；95%CI 1.53-8.40）。股骨近端（HR 1.66；95%CI 0.45-6.06）和肱骨近端（HR 3.27；95%CI 0.66-16.21）也观察到统计学上非显著的风险增加，但椎体骨折的风险没有增加（HR 1.00；95%CI 0.32-3.11）。
类肉瘤病患者发生脆性骨折的风险增加，主要是由远端前臂骨折发生率升高所致。
