Robert P Baughman1, Ilias Papanikolaou. 1. aDepartment of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, ISA bDepartment of Pulmonary Medicine, Corfu General Hospital, Corfu c2nd Pulmonary Department, ATTIKON University Hospital, Athens, Greece.
Abstract
PURPOSE OF REVIEW: Vitamin D supplementation is widespread used in the general population. In sarcoidosis, up to 50% of patients, especially postmenopausal women and those taking corticosteroids, show evidence of increased bone fragility. The purpose of this review is to provide an evidence-based rationale on how to treat sarcoidosis patients with bone health issues. RECENT FINDINGS: Evidence from observational studies show that decreased 25-hydroxy vitamin D is common in sarcoidosis. However, the great majority of sarcoidosis patents have normal or often elevated levels of 1,25-dihydroxy vitamin D (calcitriol), a marker associated with disease activity. High calcitriol levels may often be associated with hypercalcemia and hypercalcuria. The few interventional randomized controlled studies in the field, suggest that vitamin D supplementation may not be well tolerated because of hypercalcemia, moreover without substantial benefit on bone health and risk for fractures in these patients. SUMMARY: Vitamin D supplementation may be withheld in sarcoidosis patients with bone fragility, unless calcitriol levels are below normal limits. A treating scheme is proposed.
PURPOSE OF REVIEW: Vitamin D supplementation is widespread used in the general population. In sarcoidosis, up to 50% of patients, especially postmenopausal women and those taking corticosteroids, show evidence of increased bone fragility. The purpose of this review is to provide an evidence-based rationale on how to treat sarcoidosispatients with bone health issues. RECENT FINDINGS: Evidence from observational studies show that decreased 25-hydroxy vitamin D is common in sarcoidosis. However, the great majority of sarcoidosis patents have normal or often elevated levels of 1,25-dihydroxy vitamin D (calcitriol), a marker associated with disease activity. High calcitriol levels may often be associated with hypercalcemia and hypercalcuria. The few interventional randomized controlled studies in the field, suggest that vitamin D supplementation may not be well tolerated because of hypercalcemia, moreover without substantial benefit on bone health and risk for fractures in these patients. SUMMARY:Vitamin D supplementation may be withheld in sarcoidosispatients with bone fragility, unless calcitriol levels are below normal limits. A treating scheme is proposed.
Authors: Paolo Cameli; Carla Caffarelli; Rosa Metella Refini; Laura Bergantini; Miriana d'Alessandro; Martina Armati; Maria Dea Tomai Pitinca; Piersante Sestini; Stefano Gonnelli; Elena Bargagli Journal: Front Med (Lausanne) Date: 2020-10-29