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Keywords:

  • sarcoidosis;
  • calcium and vitamin D supplementation;
  • somatostatin receptor scintigraphy;
  • 25-hydroxy vitamin D

Abstract

Granulomas in sarcoidosis express high levels of 1α-hydroxylase, an enzyme that catalyzes the hydroxylation of 25-OH vitamin D to its active form, 1,25(OH)2 vitamin D. Overproduction of 1α-hydroxylase is held responsible for the development of hypercalcemia in sarcoidosis patients. Corticosteroids are used as first-line treatment in organ-threatening sarcoidosis. In this light, osteoporosis prevention with calcium and vitamin D (CAD) supplementation is often warranted. However, sarcoidosis patients are at risk for hypercalcemia and CAD supplementation affect the calcium metabolism. We studied calcium and vitamin D disorders in a large cohort of sarcoidosis patients and investigated if CAD supplementation is safe.

Retrospectively data of 301 sarcoidosis patients from July 1986 to June 2009 were analyzed for serum calcium, 25-hydroxy vitamin D (25-(OH)D), 1,25-dihydroxy vitamin D (1,25(OH)2D) and use of CAD supplementation. Disease activity of sarcoidosis was compared with serum levels of vitamin D.

Hypercalcemia occurred in 8%. A significant negative correlation was found between 25-(OH)D and disease activity of sarcoidosis measured by somatostatin receptor scintigraphy. In our study 5 of the 104 CAD suppleted patients developed hypercalcemia, but CAD supplementation was not the cause of hypercalcemia. Patients without CAD supplementation were at higher risk for developing hypercalcemia. During CAD supplementation no hypercalcemia developed due to supplementation. Hypovitaminosis D seems to be related with more disease activity of sarcoidosis and therefore could be a potential risk factor for disease activity of sarcoidosis. Therefore vitamin D deficient sarcoidosis patients should be suppleted. © 2014 American Society for Bone and Mineral Research