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

The risk of fracture in patients with multiple sclerosis: the UK general practice research database
The risk of fracture in patients with multiple sclerosis: the UK general practice research database
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.
0884-0431
2271-2279
Bazelier, M.T.
18718009-818b-44f6-8784-bf8a958f0164
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
Uitdehaag, B.M.
3ac4dbe2-f985-43f9-af8e-d0a7e0e41b8e
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
Vestergaard, P.
b00ba0f8-a9b7-45f1-a0c7-579fec88b556
Bentzen, J.
9bb83b12-c03f-4d10-84df-fe97ec38dcd5
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
Bazelier, M.T.
18718009-818b-44f6-8784-bf8a958f0164
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
Uitdehaag, B.M.
3ac4dbe2-f985-43f9-af8e-d0a7e0e41b8e
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
Vestergaard, P.
b00ba0f8-a9b7-45f1-a0c7-579fec88b556
Bentzen, J.
9bb83b12-c03f-4d10-84df-fe97ec38dcd5
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613

Bazelier, M.T., van Staa, T.P., Uitdehaag, B.M., Cooper, C., Leufkens, H.G., Vestergaard, P., Bentzen, J. and de Vries, F. (2011) The risk of fracture in patients with multiple sclerosis: the UK general practice research database. Journal of Bone and Mineral Research, 26 (9), 2271-2279. (doi:10.1002/jbmr.418). (PMID:21557309)

Record type: Article

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.

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Published date: September 2011
Organisations: Faculty of Medicine

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Local EPrints ID: 198075
URI: https://eprints.soton.ac.uk/id/eprint/198075
ISSN: 0884-0431
PURE UUID: d3b4ca14-94d8-455f-a926-f831c0f8efd8
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 29 Sep 2011 14:07
Last modified: 05 Nov 2019 01:59

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Contributors

Author: M.T. Bazelier
Author: T.P. van Staa
Author: B.M. Uitdehaag
Author: C. Cooper ORCID iD
Author: H.G. Leufkens
Author: P. Vestergaard
Author: J. Bentzen
Author: F. de Vries

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