Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
Osteoporos Int. 2017 Oct;28(10):2859-2866. doi: 10.1007/s00198-017-4115-z. Epub 2017 Jun 21.
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.
Sarcoidosis 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.
A 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.
A 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 after discontinuation. In subjects without sarcoidosis, this risk was comparable (adj. OR 1.36; 95% CI 1.32-1.40). In sarcoidosis patients, cumulative dose 1.0-4.9 g and >10 g prednisolone equivalents were associated with increased risk of major osteoporotic fracture (adj. OR 2.75; 95% CI 1.06-7.14 and 2.22; 95% CI 1.17-4.22, respectively), whereas a cumulative dose of <1.0 g and 5.0-9.9 g was not associated with major osteoporotic fracture risk.
Both in subjects with and without sarcoidosis, current expose to GC is associated with increased risk of major osteoporotic fractures, with no between-group difference. Sarcoidosis per se was not associated with increased fracture risk. Having sarcoidosis per se, i.e., if not treated with GC, is not a risk factor for fracture, and such patients may only need risk assessment when they commence GC therapy.
本研究揭示了接受糖皮质激素治疗的类肉瘤病患者发生主要骨质疏松性骨折的风险。目前使用糖皮质激素与骨折风险相关，无论患者是否患有类肉瘤病，风险均无差异。类肉瘤病本身与骨折风险增加无关。
类肉瘤病是一种多器官慢性炎症性肉芽肿性疾病，最常累及肺部、淋巴结、皮肤、眼睛和肝脏，但也可能发生于任何器官，包括骨骼。虽然口服糖皮质激素（GCs）通常作为初始治疗，但对于接受 GCs 治疗的类肉瘤病患者发生主要骨质疏松性骨折的风险知之甚少。
本项病例对照研究于 1995 年 1 月至 2011 年 12 月期间在丹麦国家住院患者数据库（NHDR）中进行。使用条件逻辑回归模型，根据平均日剂量和累积剂量暴露情况，对患有和不患有类肉瘤病的患者进行主要骨质疏松性骨折风险的调整比值比（OR）分层。
共确定了 376858 例发生主要骨质疏松性骨折的患者和相同数量未发生该事件的患者（平均年龄 64.2±19.5 岁，69%为女性）。在患有类肉瘤病的患者（n=124）中，目前使用 GC 与主要骨质疏松性骨折风险增加相关（调整（adj.）OR 1.74；95%CI 1.17-2.58），停药后风险降至基线水平。在没有类肉瘤病的患者中，这种风险相似（adj.OR 1.36；95%CI 1.32-1.40）。在类肉瘤病患者中，累积剂量 1.0-4.9 g 和 >10 g 泼尼松龙当量与主要骨质疏松性骨折风险增加相关（adj.OR 2.75；95%CI 1.06-7.14 和 2.22；95%CI 1.17-4.22），而累积剂量 <1.0 g 和 5.0-9.9 g 与主要骨质疏松性骨折风险无关。
在患有和不患有类肉瘤病的患者中，目前接触 GC 均与主要骨质疏松性骨折风险增加相关，且两组之间无差异。类肉瘤病本身与骨折风险增加无关。类肉瘤病本身，即未接受 GC 治疗，不是骨折的危险因素，此类患者仅在开始 GC 治疗时才需要进行风险评估。
