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The results of this study bring up two important points: 1) don't be too proud; use aids to help prevent falls and 2) do weight-bearing exercise as much as possible to preserve bone health. - Dave
The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers
Marloes T Bazelier1
Joan Bentzen2
Peter Vestergaard3
Egon Stenager4,-6
Hubert GM Leufkens1
Tjeerd-Pieter van Staa1,7,8
Frank de Vries1,7,9
1Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
2National Institute of Public Health, University of Southern Denmark, Denmark
3The Osteoporosis Clinic, Aarhus University Hospital, Denmark
4The Danish Multiple Sclerosis Registry, Rigshospitalet, Denmark
5MS Clinic of Southern Jutland, Denmark
6Institute of Regional Health Service Research, University of Southern Denmark, Denmark
7MRC Lifecourse Epidemiology Unit, University of Southampton, UK
8General Practice Research Database, Medicines and Healthcare products Regulatory Agency, UK
9Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Netherlands
Frank de Vries, Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
Abstract
Background: Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.
Objective: To evaluate the risk of fracture in incident MS patients drawn from a dedicated MS registry compared with population-based controls.
Methods: We conducted a population-based cohort study (1996–2007) utilising the Danish National Health Registers that were linked to the Danish MS Registry and the Danish MS Treatment Registry. Incident MS patients (2963 cases) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Cox proportional hazards models and logistic regression were used to estimate the risk of fracture in MS. Time-dependent adjustments were made for age, history of diseases and drug use.
Results: Compared with controls, patients with MS had no overall increased risk of fracture (adjusted hazard ratio (adj. HR): 1.0, 95% CI: 0.9–1.2). However, the risk of femur/hip fracture (adj. HR: 1.9, 95% CI: 1.1–3.4) was significantly increased compared to controls. As compared with unexposed patients, MS patients who had been exposed to a short course of methylprednisolone in the prior year had no significantly increased risk of osteoporotic fracture (adj. HR: 1.2, 95% CI: 0.5–2.9). Disabled MS patients with Expanded Disability Status Scale [EDSS] scores between 6 and 10, had a 2.6-fold increased risk of osteoporotic fracture (adjusted odds ratio (adj. OR): 2.6, 95% CI: 1.0–6.6) compared to patients with an EDSS score between 0 and 3.
Conclusion: Patients with MS had a higher risk of femur/hip fracture than controls. Disability status is probably more important than glucocorticoid use in the aetiology of MS and osteoporotic fracture.
The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers
Marloes T Bazelier1
Joan Bentzen2
Peter Vestergaard3
Egon Stenager4,-6
Hubert GM Leufkens1
Tjeerd-Pieter van Staa1,7,8
Frank de Vries1,7,9
1Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
2National Institute of Public Health, University of Southern Denmark, Denmark
3The Osteoporosis Clinic, Aarhus University Hospital, Denmark
4The Danish Multiple Sclerosis Registry, Rigshospitalet, Denmark
5MS Clinic of Southern Jutland, Denmark
6Institute of Regional Health Service Research, University of Southern Denmark, Denmark
7MRC Lifecourse Epidemiology Unit, University of Southampton, UK
8General Practice Research Database, Medicines and Healthcare products Regulatory Agency, UK
9Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Netherlands
Frank de Vries, Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
Abstract
Background: Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.
Objective: To evaluate the risk of fracture in incident MS patients drawn from a dedicated MS registry compared with population-based controls.
Methods: We conducted a population-based cohort study (1996–2007) utilising the Danish National Health Registers that were linked to the Danish MS Registry and the Danish MS Treatment Registry. Incident MS patients (2963 cases) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Cox proportional hazards models and logistic regression were used to estimate the risk of fracture in MS. Time-dependent adjustments were made for age, history of diseases and drug use.
Results: Compared with controls, patients with MS had no overall increased risk of fracture (adjusted hazard ratio (adj. HR): 1.0, 95% CI: 0.9–1.2). However, the risk of femur/hip fracture (adj. HR: 1.9, 95% CI: 1.1–3.4) was significantly increased compared to controls. As compared with unexposed patients, MS patients who had been exposed to a short course of methylprednisolone in the prior year had no significantly increased risk of osteoporotic fracture (adj. HR: 1.2, 95% CI: 0.5–2.9). Disabled MS patients with Expanded Disability Status Scale [EDSS] scores between 6 and 10, had a 2.6-fold increased risk of osteoporotic fracture (adjusted odds ratio (adj. OR): 2.6, 95% CI: 1.0–6.6) compared to patients with an EDSS score between 0 and 3.
Conclusion: Patients with MS had a higher risk of femur/hip fracture than controls. Disability status is probably more important than glucocorticoid use in the aetiology of MS and osteoporotic fracture.