A recent study confirms that patients with multiple sclerosis have an increased risk of fractures and broken bones. Researchers analyzed hospital records and death certificates using an English national linked Hospital Episode Statistics (HES) database covering the population of England of about 50 million people during the years 1999-2010.
In this English study, patients with MS had an overall 99% increased risk of fracture as compared to the reference group (Ramagopalan, 2012). This exceeds the results of previously published studies which investigated the risk of fracture in patients with MS.
A study using the Danish MS register found a 40% increased risk of fracture in MS patients (Bazelier, April 2012). However, another study by the same authors and using the same database came to a different conclusion and said that "patients with MS had no overall increased risk of fracture" (Bazelier, October 2012). A study from the United Kingdom (UK) using the General Practice Research Database (GPRD) observed a 20% elevated risk for all fractures (Bazelier, 2011).
Authors note that patients with MS may be at risk of fracture due to low bone mineral density (Gibson, 2011) and an elevated risk of falling (Finlayson, 2006). Osteoporosis occurs more frequently among patients with MS, possibly as a result of immobility, imbalance, progressive disability or other undetermined yet factors (Hearn, 2010; Dobson, 2012). An increased risk of falling may arise from imbalance or disability (Finlayson, 2006).
In the present study, overall risk for all types of fractures was increased in patients with MS by 99%. The relative risk of all fractures was almost double (RR = 1.99) for MS patients. Data was analyzed by type of fracture (location). A significant increased risk of femoral fracture - the femur is the thigh bone - of the femoral neck (RR = 2.79) and femoral shaft (RR = 6.69) was seen. A femoral neck fracture is commonly known as a "hip fracture." Increased fractures of the tibia (shinbone) or ankle were also evident (RR = 2.81).
Data was further analyzed by the time of fracture in reference to MS diagnosis (within the first year post-diagnosis or later). The greatest increased risk of fracture was seen in the femoral shaft (thigh bone) of patients who had been diagnosed with MS for more than one year (RR = 7.00). The lowest (reduced) risk of fracture was seen in the wrists/hands of patients within their first year post-diagnosis (RR = 0.78). Reduced risks of fractures were also seen in the ribs, clavicle, and forearm of patients newly diagnosed with MS (less than one year).
Combining the results of this study and several similar studies, an association between MS and and the risk of fractures is quite evident. Potential explanations for this include an increased risk of osteoporosis in MS patients (perhaps due to immobility, steroid use, or low vitamin D levels) (Dobson, 2012; Gibson, 2011; Hearn, 2010) and/or low bone mineral density (BMD) which can be seen with increased disability and immobility (Kampman, 2011). However, lower than expected BMD has been reported in patients newly diagnosed with MS or with clinically isolated syndromes as compared to controls (Moen, 2011, 2012).
Regardless of why MS patients may be at increased risk for osteoporosis, low bone mineral density, and fracture, it is important to optimize our bone health and to protect ourselves from falling. The National MS Society has an excellent brochure - "Minimizing your risk of falls" - which provides concrete recommendations to protect yourself. The National MS Society also offers a popular eight-week in-person course - Free from Falls: A Comprehensive Fall Prevention Program for People with MS. Call your local chapter for more information.
What do you do to protect yourself from osteoporosis, falling, and broken bones?
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"Minimizing your risk of falls" (pdf) by Debra Frankel, MS, OTR with Diana M Schneider, PhD. National MS Society, 2011. Accessed November 12, 2012.