The risk of fracture in patients with multiple sclerosis: the UK general practice research database

Marloes T Bazelier, Tjeerd van Staa, Bernard M J Uitdehaag, Cyrus Cooper, Hubert G M Leufkens, Peter Vestergaard, Joan Bentzen, Frank de Vries*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)2271-9
Number of pages9
JournalJournal of Bone and Mineral Research
Volume26
Issue number9
DOIs
Publication statusPublished - Sep 2011
Externally publishedYes

Keywords

  • Adolescent
  • Adult
  • Aged
  • Case-Control Studies
  • Databases as Topic/statistics & numerical data
  • Female
  • Fractures, Bone/epidemiology
  • General Practice/statistics & numerical data
  • Hip Fractures/epidemiology
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis/complications
  • Osteoporotic Fractures/epidemiology
  • Risk Factors
  • United Kingdom/epidemiology
  • Young Adult

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