Fall prevention needed in multiple sclerosis patients

By Eleanor McDermid

Patients with multiple sclerosis (MS) are at increased risk for fractures, particularly those related to falls, a study shows.

The highest risk was for hip fracture, being elevated fourfold in patients with MS, relative to controls, after accounting for confounders. The risk was raised a significant 4.61-fold for fractures related to falls and a nonsignificant 2.76-fold for those not linked to falls.

"Fracture risk assessment may be indicated in patients with MS," Frank de Vries (Utrecht University, the Netherlands) and colleagues remark in Neurology.

The researchers obtained records from a Dutch database system on 2415 MS patients, and matched each by age, gender, and primary practice to up to six controls without MS. This yielded an overall fracture rate of 2.4% among MS patients and 1.8% among controls.

Besides the increased hip fracture risk, the risk for rib fracture was also significantly elevated, 3.79-fold, although this was based on a rib fracture rate of just 0.2%. The risk for fracture of vertebrae, the humerus, pelvis, and radius/ulna was not increased in MS patients.

These analyses were adjusted for confounders including age, gender, and medication use. However, medications were also found to affect fracture risk, specifically for osteoporotic fractures.

The overall rate of osteoporotic fracture was 1.73-fold higher in patients than controls (2.32-fold higher if associated with a fall, 1.01-fold if not). The risk for patients versus controls was increased 3.25-fold if they had used antidepressants in the previous 6 months, but 1.47-fold if they had not. The difference between the two risk increases was statistically significant.

Similarly, osteoporotic fracture risk was elevated 3.40-fold if patients had used hypnotics/anxiolytics in the preceding 6 months, but 1.40-fold if they had not. Use of oral glucocorticoids, opioids, and anticonvulsants did not influence fracture risk.

Editorialists Helen Tremlett (University of British Columbia, Vancouver, Canada) and Robyn Lucas (The Australian National University, Canberra) comment that supplementation with vitamin D, in addition to calcium, could improve the bone health of MS patients.

"However, whether vitamin D supplementation will have effects on prevention or disease progression in MS is unknown and the optimal doses or long-term safety have not been established," they say.

They therefore suggest that a "comprehensive multifaceted approach, including a medication screen, lifestyle choice modifications (related to diet, exercise, smoking, and alcohol), as well as appropriate mobility aids and home adaption to minimize falls would be of value."

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