Risk of fractures in MS

Epub: Bazelier et al. Risk of fractures in patients with multiple sclerosis: A population-based cohort study. Neurology. 2012 May 16.

OBJECTIVE: To examine the risk of fracture in MSers compared with population-based controls.

METHODS: A population-based cohort study was performed in the Dutch PHARMO Record Linkage System (1998-2008). MSers (n = 2,415) were matched by year of birth, sex, and practice to up to 6 patients without MS (controls). We used Cox proportional hazards models to estimate the hazard ratio (HR) of fracture in MS. Time-dependent adjustments were made for age, history of disease, and drug use.

RESULTS: During follow-up, there were 59 fractures among MSers (2.4%) and 227 fractures among controls (1.8%). MSers had a 1.7-fold increased risk of osteoporotic fracture (HR 1.73 [95% confidence interval (CI) 1.18-2.53]) and a 4-fold increased risk of hip fracture (HR 4.08 [95% CI 2.21-7.56]). The risk of osteoporotic fracture was significantly greater for MSers who had been prescribed antidepressants (HR 3.25 [95% CI 1.77-5.97]) or hypnotics/anxiolytics (HR 3.40 [95% CI 2.06-5.63]) in the previous 6 months, compared with controls.

CONCLUSIONS: Increased awareness of the risk of hip fracture is warranted in MSers, especially in those who have recently been prescribed antidepressants or hypnotics/anxiolytics.


“This study is very timely. We have just completed a meta-analysis on this topic and will now need to update it with these latest figures. We are acutely aware of the risk of fractures in MSers and it is on our agenda to tackle. We are about to do a bone health audit and start routinely screening for the risk of falls in all our MSers attending our service.”

“Why now? In the last 6 months 4 MSers under my care have had fractures. All these were due to falls. Could we have prevented these? Possibly, and that is enough to try and do something about it.”

“I will be doing a new survey via the blog to assess risk of falls and fractures. I hope you can participate?”

“What can you do as an MSer in the interim? If you are having falls please let your MS nurse and neurologist know. They can then refer you to see a physiotherapist to see if anything can be done to prevent falls. In addition, you should get your bone density checked and if your bones are thin you will need to go onto treatment to strengthen your bones. MSers are at high risk of having thin bones due to low vitamin D levels and inactivity.”

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