Wednesday, 21 March 2012

MS and bone fractures

Epub ahead of printDennison et al. Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone. 2012 Mar 9.  

INTRODUCTION: Greater awareness of the relationship between co-morbidities (disease) and fracture risk may improve fracture-prediction algorithms such as FRAX (risk stratification tool).

MATERIALS AND METHODS: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. 

RESULTS: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease.
CONCLUSION: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.

"This is not new information; we have known about this for a long time."

"This is another hidden problem for MSers, factures! Thin bones or osteopaenia (the medical jargon) from low vD, reduced physical activity, liberal use of steroids for relapses and disease progression, smoking, etc. and the increased risk of falls results in an increase in fractures. Every month a patient of mine comes into clinic with a fracture; we need to stop this. How? By addressing the risk factors, treating thin bones (osteopaenia) and improving walking and balance."
"I suggest promoting fracture prevention in MSers, measured by the rate of fractures in the population, as a metric to judge the quality of our MS clinical service. What do you think?"

"As someone with MS were you aware of this data on fractures?"

1 comment:

  1. No I', not surprised, when you consider the cocktail of steroids, lack of weight bearing exercise and tendency to tripping and falling. Depressing, eh?

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.