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Clinical impact of bone and calcium metabolism changes in sarcoidosis
  1. Gianfranco Rizzato
  1. Sarcoid Clinic, Niguarda Hospital, Milan, Italy
  1. Professor G Rizzato, Via Juvara 9, 20129 Alan, Italy.

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History

BONE CHANGES

Even before the introduction of X-rays, Besnier1 had noted the association of swelling of the fingers with lupus pernio. In 1904 Karl Kreibich, later Professor of Dermatology in Prague but at that time working in Vienna, described four patients with cystic changes in the bones of the hand in connection with lupus pernio and gave an excellent radiographic reproduction of the hands in one and sarcoid histology of the skin in another.2 Other reports showing bone involvement by sarcoidosis were published soon thereafter.3-6 In 1919 Schaumann5 was the first to emphasise the location of the specific granuloma in the marrow. The first detailed accounts of the radiology were those of Fleiscner7 and Jungling8 who demonstrated that radiological involvement is more frequent in the bones of the hands and feet than in the long bones, vertebrae, or skull. James9 in 1959 was the first to recognise that bone involvement occurs very rarely in the absence of skin lesions but is common in patients with persistent disease, especially with lupus pernio and other skin lesions.10 The first study on trabecular osteoporosis in 49 untreated patients was possible only when computed tomography became available11; our group has shown that a mild trabecular bone loss may appear only in chronic sarcoidosis. This feature had never been noted before because simple radiographic studies are not sensitive enough to show a mild osteoporosis and because there is rarely an indication for biopsy of the bone affected by sarcoidosis. Our findings have been confirmed by two other groups.12 13

Corticosteroids may, of course, cause osteoporosis14 which is spontaneously reversible, at least in young people, if the treatment can be discontinued for at least six months.15

CALCIUM METABOLISM CHANGES

Hypercalcaemia in sarcoidosis was first demonstrated in 1939.16 …

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