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Fracture rate in patients with myasthenia gravis: the general practice research database

Fracture rate in patients with myasthenia gravis: the general practice research database
Fracture rate in patients with myasthenia gravis: the general practice research database
Summary
The aim of this study was to evaluate fracture risk after onset of myasthenia gravis using the UK General Practice Research Database. Overall fracture risk is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use, but was increased in those using antidepressants, anxiolytics or anticonvulsants.

Introduction
Myasthenia gravis (MG) is a neuromuscular disease which has been associated with an increased falls risk and glucocorticoid-induced osteoporosis, recognized determinants of increased fracture risk. The aim of this study was to evaluate the risk of fracture after onset of MG.

Methods
We conducted a retrospective cohort study using the UK General Practice Research Database (1987–2009). Each MG patient was matched by age, sex, calendar time and practice to up to six patients without a history of MG and we identified all fractures and those associated with osteoporosis.

Results
Compared to the control cohort, there was no statistically significant increased risk observed in patients with MG for any fracture (adjusted hazard ratio [AHR] 1.11; 95 % confidence interval [CI], 0.84–1.47) or osteoporotic fractures (AHR 0.98 [95 % CI 0.67–1.41]). Further, use of oral glucocorticoids up to a cumulative dose exceeding 5 g prednisolone equivalents did not increase risk of osteoporotic fracture (AHR 0.99 [95 % CI, 0.31–3.14]) compared with MG patients without glucocorticoid exposure. However, fracture risk was higher in patients with MG prescribed antidepressants (AHR 3.27 [95 % CI, 1.63–6.55]), anxiolytics (AHR 2.18 [95 % CI, 1.04–4.57]) and anticonvulsants (AHR 6.88 [95 % CI, 2.91–16.27]).

Conclusion
Overall risk of fracture in patients with MG is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use but was increased in those using antidepressants, anxiolytics or anticonvulsants. These findings have implications in strategies preserving bone health in patients with MG.
0937-941X
467-476
Pouwels, S.
3d97460d-5b2e-4ec6-b46f-e82e338cf0c1
de Boer, A.
5621b588-a1e0-4827-8940-89efef278f13
Javaid, M.K.
51d3310b-032e-4c15-83ac-b878bce090f3
Hilton-Jones, D.
a56bcdea-c3c8-482b-8a75-38872315f50b
Verschuuren, J.
5c2abada-0c54-4cdc-8ce4-18a95b69499a
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Pouwels, S.
3d97460d-5b2e-4ec6-b46f-e82e338cf0c1
de Boer, A.
5621b588-a1e0-4827-8940-89efef278f13
Javaid, M.K.
51d3310b-032e-4c15-83ac-b878bce090f3
Hilton-Jones, D.
a56bcdea-c3c8-482b-8a75-38872315f50b
Verschuuren, J.
5c2abada-0c54-4cdc-8ce4-18a95b69499a
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1

Pouwels, S., de Boer, A., Javaid, M.K., Hilton-Jones, D., Verschuuren, J., Cooper, C., Leufkens, H.G. and de Vries, Frank (2013) Fracture rate in patients with myasthenia gravis: the general practice research database. Osteoporosis International, 24 (2), 467-476. (doi:10.1007/s00198-012-1970-5). (PMID:22531999)

Record type: Article

Abstract

Summary
The aim of this study was to evaluate fracture risk after onset of myasthenia gravis using the UK General Practice Research Database. Overall fracture risk is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use, but was increased in those using antidepressants, anxiolytics or anticonvulsants.

Introduction
Myasthenia gravis (MG) is a neuromuscular disease which has been associated with an increased falls risk and glucocorticoid-induced osteoporosis, recognized determinants of increased fracture risk. The aim of this study was to evaluate the risk of fracture after onset of MG.

Methods
We conducted a retrospective cohort study using the UK General Practice Research Database (1987–2009). Each MG patient was matched by age, sex, calendar time and practice to up to six patients without a history of MG and we identified all fractures and those associated with osteoporosis.

Results
Compared to the control cohort, there was no statistically significant increased risk observed in patients with MG for any fracture (adjusted hazard ratio [AHR] 1.11; 95 % confidence interval [CI], 0.84–1.47) or osteoporotic fractures (AHR 0.98 [95 % CI 0.67–1.41]). Further, use of oral glucocorticoids up to a cumulative dose exceeding 5 g prednisolone equivalents did not increase risk of osteoporotic fracture (AHR 0.99 [95 % CI, 0.31–3.14]) compared with MG patients without glucocorticoid exposure. However, fracture risk was higher in patients with MG prescribed antidepressants (AHR 3.27 [95 % CI, 1.63–6.55]), anxiolytics (AHR 2.18 [95 % CI, 1.04–4.57]) and anticonvulsants (AHR 6.88 [95 % CI, 2.91–16.27]).

Conclusion
Overall risk of fracture in patients with MG is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use but was increased in those using antidepressants, anxiolytics or anticonvulsants. These findings have implications in strategies preserving bone health in patients with MG.

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More information

Published date: February 2013
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 350212
URI: http://eprints.soton.ac.uk/id/eprint/350212
ISSN: 0937-941X
PURE UUID: 06b28fac-a574-4aeb-8833-cc55763c0394
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 25 Mar 2013 11:46
Last modified: 18 Mar 2024 02:45

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Contributors

Author: S. Pouwels
Author: A. de Boer
Author: M.K. Javaid
Author: D. Hilton-Jones
Author: J. Verschuuren
Author: C. Cooper ORCID iD
Author: H.G. Leufkens
Author: Frank de Vries

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