ArticleSarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG2026
Bone involvement in sarcoidosis: Insights from a multicentre Italian cohort.
Article in Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSarcoidosis is a multisystemic granulomatous disease that can involve the skeletal system, although bone manifestations are considered relatively uncommon and often underdiagnosed.
objectivesTo describe the prevalence, clinical characteristics, and treatment outcomes of bone involvement in a large multicenter Italian cohort of patients with sarcoidosis.
methodsThis retrospective, two-center observational study included 867 patients with histologically confirmed sarcoidosis followed at two Italian referral centers (2018-2025). Bone localization was identified by imaging (PET/CT, MRI, X-ray) and/or biopsy. Clinical, functional, laboratory, and therapeutic data were collected.
resultsBone involvement was found in 46 patients (5.3%), predominantly women (58.7%), with mean age at diagnosis of 49.7 ± 12.2 years. Osseous lesions were most frequently localized in the axial skeleton, particularly pelvis (54.3%) and vertebrae (52.2%). Bone sarcoidosis was significantly associated with extra-thoracic lymphadenopathy, hepatic, and splenic involvement (p < 0.001), reflecting a pattern of clustered multi-organ disease. Osteoporosis and osteopenia were present in 15.2% and 13.0% of cases, respectively. Corticosteroid monotherapy was the most common initial treatment (56.5%), while 30.4% received combination therapy with csDMARDs or biologics. At one-year PET/CT re-evaluation, 56.5% showed a reduction of SUV at bone sites, with no significant correlation between therapeutic regimen and metabolic response.
conclusionsBone involvement in sarcoidosis, though relatively rare, represents a clinically relevant phenotype strongly associated with hepatosplenic and lymphatic disease and characterized by a preferential axial skeleton localization. Recognition of this pattern is essential for diagnosis and management. Given the retrospective design and the limited follow-up sample, these findings should be interpreted with caution. Close radiological monitoring and tailored therapeutic strategies are warranted to improve outcomes.
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