• Open Access

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

Authors

  • Marloes T Bazelier,

    1. Utrecht Institute of Pharmaceutical Sciences, Utrecht University, The Netherlands
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  • Tjeerd van Staa,

    1. Utrecht Institute of Pharmaceutical Sciences, Utrecht University, The Netherlands
    2. General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London, UK
    3. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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  • Bernard MJ Uitdehaag,

    1. MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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  • Cyrus Cooper,

    1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
    2. Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK
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  • Hubert GM Leufkens,

    1. Utrecht Institute of Pharmaceutical Sciences, Utrecht University, The Netherlands
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  • Peter Vestergaard,

    1. The Osteoporosis Clinic, Aarhus University Hospital, Aarhus, Denmark
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  • Joan Bentzen,

    1. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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  • Frank de Vries

    Corresponding author
    1. Utrecht Institute of Pharmaceutical Sciences, Utrecht University, The Netherlands
    2. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
    3. Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
    • Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands.
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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

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