For patients with sarcoidosis, no consensus exists about the management of
osteoporosis, whether related or unrelated to glucocorticoid therapy.
Methods
We report the first series of 4 patients with histologically documented sarcoidosis who received teriparatide therapy for severe osteoporosis manifesting as a fracture cascade with multilevel vertebral fractures. When teriparatide was started, 1 patient was receiving 10 mg of prednisone equivalents per day, 1 was progressively tapering glucocorticoid dose, 2 had never received any glucocorticoid treatment.
Results
In all 4 patients, teriparatide was effective in halting the fracture cascade, including in the 2 patients who remained on long-term glucocorticoid therapy. None of the patients developed hypercalcemia. During teriparatide therapy, 3 patients underwent a flare or a complication of sarcoidosis. Only the patient on stable glucocorticoid treatment did not present any adverse event. Before teriparatide initiation, sarcoidosis had been well controlled in all 3 patients for several years.
Conclusions
Even if the implication of teriparatide is unclear, the appearance of adverse events in 3 out of 4 patients in this small series suggest caution in the use of teriparatide in patients with sarcoidosis.
