How is osteoporosis treated in patients with sarcoidosis?
Hypercalcemia (5%–25%) and hypercalciuria can occur in patients with sarcoidosis due to increased activity of the 1-α-hydroxylase enzyme in granulomas leading to increased 1,25-dihydroxyvitamin D (calcitriol). This can lead to nephrocalcinosis and renal dysfunction. Patients may have a high calcitriol level despite a low 25-hydroxyvitamin D. Osteopenia and osteoporosis are well known adverse effects of corticosteroids, and sarcoidosis can also cause direct bone lesions with subsequent bone loss. All sarcoidosis patients on corticosteroids or who are postmenopausal should have bone density measurements. Bisphosphonate therapy can be started in those at risk for fractures. However, calcium and vitamin D supplementation should be used with caution and monitored closely since sarcoid patients are prone to develop hypercalcemia and hypercalciuria.
