Abstract
Background: Sarcoidosis is a chronic inflammatory multisystem disorder that manifests in every organ, including the bone. Glucocorticosteroids (GCs) are key to disease management, but are associated with decreased bone density and an increased risk of fractures.
Objectives: To examine the risk of osteoporotic fractures in sarcoidosis patients receiving GCs.
Methods: A population-based case-control study was performed using the Danish National Database. Cases were those who sustained a fracture and controls (matched on age and gender) were those without a fracture during the study period (1 Jan 1996 – 31 Dec 2011), all aged 18 years or older. Index date was the date of the initial fracture (controls received the same date as their matched case). GC use was defined prior to index-date, and patients were classified as current users (1-91days prior to index), recent (92-182 days), past (183-264days) and distant >364 days). All analyses were stratified by sarcoidosis diagnosis (yes/no). Conditional logistic regression estimated odds ratios (OR) for the risk of fracture in individuals with and without sarcoidosis using GC and compared to individuals without GC use. Analyses were adjusted for comorbidities and recent medications.
Results: Among cases (n = 376,858) there were 493 (0.13%) with sarcoidosis and 14,751 (3.9%) with current GC use. Similarly, among controls (n = 376,858) 402 (0.1%) had sarcoidosis and 9,789 (2.6%) had current exposure to GCs. In the adjusted analysis, current GC exposure was associated with a significant increased osteoporotic fracture risk in sarcoidosis (ORadj = 1.74, 95% CI 1.17-2.58) and non-sarcoidosis (ORadj = 1.38, 95% CI 1.32-1.40) patients. The noted risk was not significantly different between sarcoidosis and non-sarcoidosis patients. There was also no significant fracture risk for recent, past or distant GC use, as compared to non-users.
Conclusions: In a population-based case-control study we identified increased osteoporotic fracture risk with current GC use. This risk was not different between patients with and without sarcoidosis, suggesting the disease itself may not increase osteoporotic fracture risk.
Objectives: To examine the risk of osteoporotic fractures in sarcoidosis patients receiving GCs.
Methods: A population-based case-control study was performed using the Danish National Database. Cases were those who sustained a fracture and controls (matched on age and gender) were those without a fracture during the study period (1 Jan 1996 – 31 Dec 2011), all aged 18 years or older. Index date was the date of the initial fracture (controls received the same date as their matched case). GC use was defined prior to index-date, and patients were classified as current users (1-91days prior to index), recent (92-182 days), past (183-264days) and distant >364 days). All analyses were stratified by sarcoidosis diagnosis (yes/no). Conditional logistic regression estimated odds ratios (OR) for the risk of fracture in individuals with and without sarcoidosis using GC and compared to individuals without GC use. Analyses were adjusted for comorbidities and recent medications.
Results: Among cases (n = 376,858) there were 493 (0.13%) with sarcoidosis and 14,751 (3.9%) with current GC use. Similarly, among controls (n = 376,858) 402 (0.1%) had sarcoidosis and 9,789 (2.6%) had current exposure to GCs. In the adjusted analysis, current GC exposure was associated with a significant increased osteoporotic fracture risk in sarcoidosis (ORadj = 1.74, 95% CI 1.17-2.58) and non-sarcoidosis (ORadj = 1.38, 95% CI 1.32-1.40) patients. The noted risk was not significantly different between sarcoidosis and non-sarcoidosis patients. There was also no significant fracture risk for recent, past or distant GC use, as compared to non-users.
Conclusions: In a population-based case-control study we identified increased osteoporotic fracture risk with current GC use. This risk was not different between patients with and without sarcoidosis, suggesting the disease itself may not increase osteoporotic fracture risk.
| Original language | English |
|---|---|
| Article number | 853 |
| Journal | Pharmacoepidemiology and Drug Safety |
| Volume | 25 |
| Issue number | S3 |
| DOIs | |
| Publication status | Published - Aug 2016 |
| Event | 32nd International conference on Pharmacoepidemiology & Therapeutic Risk Management - The convention centre Dublin, Dublin, Ireland Duration: 25 Aug 2016 → 28 Aug 2016 |