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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/21550

Title: Risk of vertebral and non-vertebral fractures in patients with sarcoidosis: a population-based cohort
Authors: Bours, S.
de Vries, F.
Van den Bergh, Joop
Lalmohamed, A.
van Staa, T. P.
Leufkens, H. G. M.
Geusens, P. P. P.
Drent, M.
Harvey, N. C.
Issue Date: 2016
Publisher: SPRINGER LONDON LTD
Citation: OSTEOPOROSIS INTERNATIONAL, 27 (4), p. 1603-1610
Abstract: 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.
Notes: [Bours, S.; Geusens, P. P. P.] Maastricht Univ, Subdiv Rheumatol, Dept Internal Med, Med Ctr, NL-6200 MD Maastricht, Netherlands. [de Vries, F.; Lalmohamed, A.; van Staa, T. P.; Leufkens, H. G. M.] Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands. [de Vries, F.; Harvey, N. C.] Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England. [de Vries, F.] Maastricht Univ, Dept Clin Pharm & Toxicol, Med Ctr, NL-6200 MD Maastricht, Netherlands. [de Vries, F.] Maastricht Univ, CAPHRI Sch Publ Hlth & Primary Care, NL-6200 MD Maastricht, Netherlands. [van Staa, T. P.] Univ Manchester, Farr Inst, Manchester, Lancs, England. [van den Bergh, J. P. W.] Viecuri MC Venlo, Dept Internal Med, Venlo, Netherlands. [van den Bergh, J. P. W.] Maastricht Univ, NUTRIM Sch Nutr & Translat Res Metab, NL-6200 MD Maastricht, Netherlands. [van den Bergh, J. P. W.; Geusens, P. P. P.] Hasselt Univ, Biomed Res Inst, Hasselt, Belgium. [Lalmohamed, A.] Univ Med Ctr Utrecht, Dept Clin Pharm, Utrecht, Netherlands. [Drent, M.] St Antonius Hosp, ILD Ctr Excellence, Nieuwegein, Netherlands. [Drent, M.] Maastricht Univ, Dept Pharmacol & Toxicol, FHML, NL-6200 MD Maastricht, Netherlands. [de Vries, F.] Univ Utrecht, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht Inst Pharmaceut Sci, Utrecht, Netherlands.
URI: http://hdl.handle.net/1942/21550
DOI: 10.1007/s00198-015-3426-1
ISI #: 000372304400025
ISSN: 0937-941X
Category: A1
Type: Journal Contribution
Validation: ecoom, 2017
Appears in Collections: Research publications

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