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Published in: Osteoporosis International 6/2008

Open Access 01-06-2008 | Original Article

Progressive vertebral deformities despite unchanged bone mineral density in patients with sarcoidosis: a 4-year follow-up study

Authors: A. C. Heijckmann, M. Drent, B. Dumitrescu, J. De Vries, A. C. Nieuwenhuijzen Kruseman, B. H. R. Wolffenbuttel, P. Geusens, M. S. P. Huijberts

Published in: Osteoporosis International | Issue 6/2008

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Abstract

Summary

To evaluate the incidence of new and/or progressive vertebral deformities and changes in bone mineral density, we re-examined 66 patients with sarcoidosis after a follow-up period of four years. In 17 subjects (26%) new and/or progressive vertebral deformities were found, though BMD did not change significantly.

Introduction

Previous studies from our group have shown that morphometric vertebral deformities suggestive of fractures can be found in 20% of patients with sarcoidosis, despite a normal bone mineral density (BMD). The aim of this study was to determine the incidence of new and/or progressive vertebral deformities and the evolution of BMD during the course of this disease.

Methods

BMD of the hip (DXA) and vertebral fracture assessment (VFA) with lateral single energy densitometry was performed at baseline and after 45 months in 66 patients with sarcoidosis. Potential predictors of new/progressive vertebral deformities were assessed using logistic regression analysis.

Results

The BMD of the total group was unchanged after follow-up. The prevalence of vertebral deformities increased from 20 to 32% (p < 0.05); in 17 subjects (26%) new or progressive vertebral deformities were diagnosed. A lower T-score of the femoral neck [(OR = 2.5 (CI: 1.0-5.9), p < 0.05)] and mother with a hip fracture [(OR = 14.1 (CI:1.4-142.6), p < 0.05)] were independent predictors of new/progressive deformities.

Conclusions

In subjects with sarcoidosis the number of vertebral deformities increases in the course of this disease, despite unchanged BMD. The combination of low normal BMD and family history of fragility fractures confers an increased risk of the incidence of these deformities.
Literature
1.
go back to reference Hofbauer LC, Schoppet M (2004) Clinical implications of the osteoprotegerin/RANKL/RANK system for bone and vascular diseases. JAMA 292:490–495CrossRefPubMed Hofbauer LC, Schoppet M (2004) Clinical implications of the osteoprotegerin/RANKL/RANK system for bone and vascular diseases. JAMA 292:490–495CrossRefPubMed
2.
go back to reference Gravallese EM, Goldring SR (2000) Cellular mechanisms and the role of cytokines in bone erosions in rheumatoid arthritis. Arthritis Rheum 43:2143–2151CrossRefPubMed Gravallese EM, Goldring SR (2000) Cellular mechanisms and the role of cytokines in bone erosions in rheumatoid arthritis. Arthritis Rheum 43:2143–2151CrossRefPubMed
3.
go back to reference Manolagas SC (1998) The role of IL-6 type cytokines and their receptors in bone. Ann N Y Acad Sci 840:194–204CrossRefPubMed Manolagas SC (1998) The role of IL-6 type cytokines and their receptors in bone. Ann N Y Acad Sci 840:194–204CrossRefPubMed
4.
go back to reference Scheidt-Nave C, Bismar H, Leidig-Bruckner G et al (2001) Serum interleukin 6 is a major predictor of bone loss in women specific to the first decade past menopause. J Clin Endocrinol Metab 86:2032–2042PubMed Scheidt-Nave C, Bismar H, Leidig-Bruckner G et al (2001) Serum interleukin 6 is a major predictor of bone loss in women specific to the first decade past menopause. J Clin Endocrinol Metab 86:2032–2042PubMed
5.
go back to reference Heijckmann AC, Huijberts MS, De Vries J et al (2007) Bone turnover and bone mineral density in patients with sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 24:51–58 Heijckmann AC, Huijberts MS, De Vries J et al (2007) Bone turnover and bone mineral density in patients with sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 24:51–58
6.
go back to reference Tervonen S, Karjalainen P, Valta R (1974) Bone mineral in sarcoidosis. Acta Med Scand 196:497–503CrossRefPubMed Tervonen S, Karjalainen P, Valta R (1974) Bone mineral in sarcoidosis. Acta Med Scand 196:497–503CrossRefPubMed
7.
go back to reference Montemurro L, Fraioli P, Rizzato G (1991) Bone loss in untreated longstanding sarcoidosis. Sarcoidosis 8:29–34PubMed Montemurro L, Fraioli P, Rizzato G (1991) Bone loss in untreated longstanding sarcoidosis. Sarcoidosis 8:29–34PubMed
8.
go back to reference Sipahi S, Tuzun S, Ozaras R et al (2004) Bone mineral density in women with sarcoidosis. J Bone Miner Metab 22:48–52CrossRefPubMed Sipahi S, Tuzun S, Ozaras R et al (2004) Bone mineral density in women with sarcoidosis. J Bone Miner Metab 22:48–52CrossRefPubMed
9.
go back to reference Seeman E, Delmas PD (2006) Bone quality—the material and structural basis of bone strength and fragility. N Engl J Med 354:2250–2261CrossRefPubMed Seeman E, Delmas PD (2006) Bone quality—the material and structural basis of bone strength and fragility. N Engl J Med 354:2250–2261CrossRefPubMed
10.
go back to reference Chavassieux P, Seeman E, Delmas PD (2007) Insights into material and structural basis of bone fragility from diseases associated with fractures: how determinants of the biomechanical properties of bone are compromised by disease. Endocr Rev 28:151–164CrossRefPubMed Chavassieux P, Seeman E, Delmas PD (2007) Insights into material and structural basis of bone fragility from diseases associated with fractures: how determinants of the biomechanical properties of bone are compromised by disease. Endocr Rev 28:151–164CrossRefPubMed
11.
go back to reference Quanjer PH, Tammeling GJ, Cotes JE et al (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40CrossRefPubMed Quanjer PH, Tammeling GJ, Cotes JE et al (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40CrossRefPubMed
12.
go back to reference DeRemee RA (1983) The roentgenographic staging of sarcoidosis. Historic and contemporary perspectives. Chest 83:128–133CrossRefPubMed DeRemee RA (1983) The roentgenographic staging of sarcoidosis. Historic and contemporary perspectives. Chest 83:128–133CrossRefPubMed
13.
go back to reference Hunninghake GW, Costabel U, Ando M et al (1999) ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis 16:149–173PubMed Hunninghake GW, Costabel U, Ando M et al (1999) ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis 16:149–173PubMed
14.
go back to reference van der Veer E, Koerts K, Wagenmakers L et al (2005) Effect of fracture on bone turnover markers in daily clinical practice. J Bone Miner Res 20 suppl 1: van der Veer E, Koerts K, Wagenmakers L et al (2005) Effect of fracture on bone turnover markers in daily clinical practice. J Bone Miner Res 20 suppl 1:
15.
go back to reference Koopmans N, de JI, Breeuwsma AJ et al (2007) Serum bone turnover markers (PINP and ICTP) for the early detection of bone metastases in patients with prostate cancer: a longitudinal approach. J Urol 178:849–853CrossRefPubMed Koopmans N, de JI, Breeuwsma AJ et al (2007) Serum bone turnover markers (PINP and ICTP) for the early detection of bone metastases in patients with prostate cancer: a longitudinal approach. J Urol 178:849–853CrossRefPubMed
16.
go back to reference Duboeuf F, Bauer DC, Chapurlat RD et al (2005) Assessment of vertebral fracture using densitometric morphometry. J Clin Densitom 8:362–368CrossRefPubMed Duboeuf F, Bauer DC, Chapurlat RD et al (2005) Assessment of vertebral fracture using densitometric morphometry. J Clin Densitom 8:362–368CrossRefPubMed
17.
go back to reference Genant HK, Wu CY, van KC et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMed Genant HK, Wu CY, van KC et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMed
18.
go back to reference Elders PJ, Netelenbos JC, Lips P et al (1989) Perimenopausal bone mass and risk factors. Bone Miner 7:289–299CrossRefPubMed Elders PJ, Netelenbos JC, Lips P et al (1989) Perimenopausal bone mass and risk factors. Bone Miner 7:289–299CrossRefPubMed
19.
go back to reference Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843CrossRefPubMed Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843CrossRefPubMed
20.
go back to reference Angeli A, Guglielmi G, Dovio A et al (2006) High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 39:253–259CrossRefPubMed Angeli A, Guglielmi G, Dovio A et al (2006) High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 39:253–259CrossRefPubMed
21.
go back to reference Heijckmann AC, Huijberts MS, Geusens P et al (2005) Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma. Eur J Endocrinol 153:23–29CrossRefPubMed Heijckmann AC, Huijberts MS, Geusens P et al (2005) Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma. Eur J Endocrinol 153:23–29CrossRefPubMed
22.
go back to reference O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018CrossRefPubMed O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018CrossRefPubMed
23.
go back to reference van der Klift M, de Laet CE, McCloskey EV et al (2002) The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 17:1051–1056CrossRefPubMed van der Klift M, de Laet CE, McCloskey EV et al (2002) The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 17:1051–1056CrossRefPubMed
24.
go back to reference Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMed Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMed
25.
go back to reference Eastell R, Cedel SL, Wahner HW et al (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215CrossRefPubMed Eastell R, Cedel SL, Wahner HW et al (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215CrossRefPubMed
26.
go back to reference Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541CrossRefPubMed Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541CrossRefPubMed
27.
go back to reference Smith-Bindman R, Steiger P, Cummings SR et al (1991) The index of radiographic area (IRA): A new approach to estimating the severity of vertebral deformity. Bone Miner 15:137–149CrossRefPubMed Smith-Bindman R, Steiger P, Cummings SR et al (1991) The index of radiographic area (IRA): A new approach to estimating the severity of vertebral deformity. Bone Miner 15:137–149CrossRefPubMed
28.
go back to reference McCloskey EV, Spector TD, Eyres KS et al (1993) The assessment of vertebral deformity: A method for use in population studies and clinical trials. Osteoporos Int 3:138–147CrossRefPubMed McCloskey EV, Spector TD, Eyres KS et al (1993) The assessment of vertebral deformity: A method for use in population studies and clinical trials. Osteoporos Int 3:138–147CrossRefPubMed
29.
go back to reference Black DM, Palermo L, Nevitt MC et al (1999) Defining incident vertebral deformity: a prospective comparison of several approaches. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:90–101CrossRefPubMed Black DM, Palermo L, Nevitt MC et al (1999) Defining incident vertebral deformity: a prospective comparison of several approaches. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:90–101CrossRefPubMed
30.
go back to reference Roy DK, O’Neill TW, Finn JD et al (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26CrossRefPubMed Roy DK, O’Neill TW, Finn JD et al (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26CrossRefPubMed
31.
33.
go back to reference Hofbauer LC, Heufelder AE (2001) The role of osteoprotegerin and receptor activator of nuclear factor kappaB ligand in the pathogenesis and treatment of rheumatoid arthritis. Arthritis Rheum 44:253–259CrossRefPubMed Hofbauer LC, Heufelder AE (2001) The role of osteoprotegerin and receptor activator of nuclear factor kappaB ligand in the pathogenesis and treatment of rheumatoid arthritis. Arthritis Rheum 44:253–259CrossRefPubMed
34.
go back to reference Boivin G, Lips P, Ott SM et al (2003) Contribution of raloxifene and calcium and vitamin D3 supplementation to the increase of the degree of mineralization of bone in postmenopausal women. J Clin Endocrinol Metab 88:4199–4205CrossRefPubMed Boivin G, Lips P, Ott SM et al (2003) Contribution of raloxifene and calcium and vitamin D3 supplementation to the increase of the degree of mineralization of bone in postmenopausal women. J Clin Endocrinol Metab 88:4199–4205CrossRefPubMed
35.
go back to reference Viguet-Carrin S, Garnero P, Delmas PD (2006) The role of collagen in bone strength. Osteoporos Int 17:319–336CrossRefPubMed Viguet-Carrin S, Garnero P, Delmas PD (2006) The role of collagen in bone strength. Osteoporos Int 17:319–336CrossRefPubMed
36.
go back to reference Garnero P, Hausherr E, Chapuy MC et al (1996) Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res 11:1531–1538CrossRefPubMed Garnero P, Hausherr E, Chapuy MC et al (1996) Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res 11:1531–1538CrossRefPubMed
37.
go back to reference Melton LJ III, Khosla S, Atkinson EJ et al (1997) Relationship of bone turnover to bone density and fractures. J Bone Miner Res 12:1083–1091CrossRefPubMed Melton LJ III, Khosla S, Atkinson EJ et al (1997) Relationship of bone turnover to bone density and fractures. J Bone Miner Res 12:1083–1091CrossRefPubMed
38.
go back to reference Frediani B, Falsetti P, Bisogno S et al (2004) Effects of high dose methylprednisolone pulse therapy on bone mass and biochemical markers of bone metabolism in patients with active rheumatoid arthritis: A 12-month randomized prospective controlled study. J Rheumatol 31:1083–1087PubMed Frediani B, Falsetti P, Bisogno S et al (2004) Effects of high dose methylprednisolone pulse therapy on bone mass and biochemical markers of bone metabolism in patients with active rheumatoid arthritis: A 12-month randomized prospective controlled study. J Rheumatol 31:1083–1087PubMed
39.
go back to reference de VF, Bracke M, Leufkens HG et al (2007) Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis Rheum 56:208–214CrossRef de VF, Bracke M, Leufkens HG et al (2007) Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis Rheum 56:208–214CrossRef
40.
go back to reference Chapurlat RD, Duboeuf F, Marion-Audibert HO et al (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17:1189–1195CrossRefPubMed Chapurlat RD, Duboeuf F, Marion-Audibert HO et al (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17:1189–1195CrossRefPubMed
41.
go back to reference Rea JA, Li J, Blake GM et al (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668CrossRefPubMed Rea JA, Li J, Blake GM et al (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668CrossRefPubMed
42.
go back to reference Black DM, Palermo L, Nevitt MC et al (1995) Comparison of methods for defining prevalent vertebral deformities: the Study of Osteoporotic Fractures. J Bone Miner Res 10:890–902CrossRefPubMed Black DM, Palermo L, Nevitt MC et al (1995) Comparison of methods for defining prevalent vertebral deformities: the Study of Osteoporotic Fractures. J Bone Miner Res 10:890–902CrossRefPubMed
43.
go back to reference Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323CrossRefPubMed Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323CrossRefPubMed
44.
go back to reference Siris ES, Genant HK, Laster AJ et al (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770CrossRefPubMed Siris ES, Genant HK, Laster AJ et al (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770CrossRefPubMed
45.
go back to reference Abdel-Hamid OA, Bassiouni H, Koutri R et al (1994) Aging of the thoracic spine: Distinction between wedging in osteoarthritis and fracture in osteoporosis-a cross-sectional and longitudinal study. Bone 15:437–442CrossRef Abdel-Hamid OA, Bassiouni H, Koutri R et al (1994) Aging of the thoracic spine: Distinction between wedging in osteoarthritis and fracture in osteoporosis-a cross-sectional and longitudinal study. Bone 15:437–442CrossRef
Metadata
Title
Progressive vertebral deformities despite unchanged bone mineral density in patients with sarcoidosis: a 4-year follow-up study
Authors
A. C. Heijckmann
M. Drent
B. Dumitrescu
J. De Vries
A. C. Nieuwenhuijzen Kruseman
B. H. R. Wolffenbuttel
P. Geusens
M. S. P. Huijberts
Publication date
01-06-2008
Publisher
Springer London
Published in
Osteoporosis International / Issue 6/2008
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0513-y

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