Meta-Study Shows MS Associated with Bone Fractures

Studies investigating the association between MS and fracture risk have been inconsistent, say authors of a new meta-analysis study. When data was pooled from nine cohort studies involving 9,229,368 subjects, researchers found the following.

• Pooled data from nine studies confirms a significant association between MS and fracture risk (RR=1.58).
• Subgroup analysis showed that MS is associated with increased risk of specific bone fractures: tibia (RR=2.87), femur (RR=4.87), hip (RR=3.18), pelvis (RR=1.55), vertebrae (RR=1.44), and humerus (RR=1.56).
• No significant association was found between MS and fractures of the ribs (RR=1.14) and radius/ulna (RR=0.92). More studies with larger sample sizes are needed to address the association between MS and ribs or radius/ulna fracture risk.
• Female MS patients had greater increased risk of fracture (RR=1.80) than male MS patients (RR=1.18). This may be explained by lower bone mass in women with MS.
• Fracture risk is greater in people with MS who have used antidepressants, hypnotics/anxiolytics, anticonvulsants, or glucocorticoids.

Study limitations

While the results of the meta-analysis seem clear, authors suggest possible limitations in the study.

• The retrieved literature was potentially not comprehensive enough and authors did not track unpublished articles to obtain relative data for analysis.
• There are several factors contributing to bone fractures and potential interactions among MS-related environment and symptoms should be considered.
• Other factors, such as age that may influence the progression of fracture, were not investigated due to limited data.
• Severity of disease could influence fracture risk and most studies included in analysis involved MS patients with mild to moderate severity. However, it is patients with more severe disability that have more issues with walking and falling. Future studies to include information related to severity of MS (i.e. EDSS score).

Take-away

It is important to be aware of the increased risk of fracture when you have MS. If you are female and have used medications shown to increase risk of fracture, including antidepressants, hypnotics/anxiolytics, anticonvulsants, or glucocorticoids, definitely be careful to avoiding falling and work to maximize bone density. Talk to your doctor to discuss what you can do to avoid and decrease risk of bone fracture.


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New Meta-Study Confirms MS Increases Fracture Risk