Fractures and falls in patients with newly diagnosed clinically isolated syndrome and multiple sclerosis

Abstract

Increased risk of falls and reduced bone strength may both contribute to enhanced fracture risk in patients with multiple sclerosis (MS). Fall tendency and fractures have not been investigated in newly diagnosed patients. The aim was to compare the fall tendency and fracture risk in a cohort of newly diagnosed clinically isolated syndrome (CIS) and MS patients with that in the general population. We performed a population-based case-control study in Oslo of self-reported fall tendency and fracture history in consecutive patients diagnosed with either a CIS suggestive of demyelinating disease or MS between January 2005 and January 2008. Two age-, sex-, and ethnicity-matched control groups were included; one group from the population registry and one group recruited by the patients. Ninety-nine patients (mean time since the first symptom 1.6 ± 1.3 years, mean expanded disability status scale [EDSS] score 1.4 ± 1.1) and 159 controls were included. Whereas no difference in the number of fractures was reported, 20% of the patients and 3% of the controls reported a tendency to fall (P<0.001). Fall tendency was associated with degree of disability (mean EDSS score among patients with and without self-reported fall tendency was 2.4 ± 1.4 and 1.1 ± 0.9, respectively; P=0.001). Fall tendency was also reported in two of 22 patients with EDSS 0. Fall tendency may occur early in the disease course of MS, before impairment of locomotion and balance becomes evident on clinical examination.