Abstract
Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We conducted a population-based cohort study using data from the UK General Practice Research Database linked to the National Hospital Registry (1997–2008). Incident MS patients (n = 5565) were matched 1:6 by year of birth, sex, and practice with patients without MS (controls). Cox proportional-hazards models were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5- and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost threefold increased risk of hip fracture [HR = 2.79, 95% confidence interval (CI) 1.83–4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR = 1.35, 95% CI 1.13–1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR = 1.85, 95% CI 1.14–2.98) or antidepressants (HR = 1.79, 95% CI 1.37–2.35) in the previous 6 months. Absolute fracture risks were low in younger MS patients but became substantial when patients were older than 60 years of age. It is concluded that MS is associated with an increased risk of fracture. Fracture risk assessment may be indicated in patients with MS, especially those prescribed GCs or antidepressants. © 2011 American Society for Bone and Mineral Research
Highlights
Multiple sclerosis (MS) is a neurodegenerative disease characterized by the gradual accumulation of focal plaques of demyelination, in the periventricular areas of the brain
The General Practice Research Database (GPRD) comprises prospectively collected computerized medical records for over 10 million patients under the care of general practitioners (GPs) in the United Kingdom (UK). It has been the source for numerous epidemiologic studies, and the accuracy and completeness of these data have been well validated and documented.[16]. Previous studies of GPRD data have shown a high level of data validity with respect to the reporting of fractures.[17]. GPRD data have been linked to the national Hospital Episode Statistics (HES) in England for approximately 45% of all practices.[18]. In this study, data were linked from April 1997 until March 2008
When we compared probable MS patients with possible MS patients, we found that the risk of osteoporotic fracture was higher in probable patients: hazard ratios (HRs) 1⁄4 1.46 in probable and HR 1⁄4 1.14 in possible MS patients, the difference was not significant ( p 1⁄4 .152)
Summary
Multiple sclerosis (MS) is a neurodegenerative disease characterized by the gradual accumulation of focal plaques of demyelination, in the periventricular areas of the brain. A recent study showed that in patients with RA, the underlying disease process may contribute to the fracture risk.[15] In patients. The aim of this study was to determine the relative risk of fracture in patients with MS compared with population-based controls and to calculate the absolute 5- and 10-year risks of fracture in MS patients
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