Risk of fractures in patients with multiple sclerosis: A population-based cohort study
Marloes T Bazelier,T P van Staa,Bernard M. J. Uitdehaag,Cyrus Cooper,Hubert G. M. Leufkens,P. Vestergaard,R. M. C. Herings,F. de Vries +7 more
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TLDR
Increased awareness of the risk of hip fracture is warranted in patients with MS, especially in those who have recently been prescribed antidepressants or hypnotics/anxiolytics.Abstract:
Objective: To examine the risk of fracture in patients with multiple sclerosis (MS) compared with population-based controls. Methods: A population-based cohort study was performed in the Dutch PHARMO Record Linkage System (1998–2008). Patients with MS (n = 2,415) were matched by year of birth, sex, and practice to up to 6 patients without MS (controls). We used Cox proportional hazards models to estimate the hazard ratio (HR) of fracture in MS. Time-dependent adjustments were made for age, history of disease, and drug use. Results: During follow-up, there were 59 fractures among patients with MS (2.4%) and 227 fractures among controls (1.8%). Patients with MS had a 1.7-fold increased risk of osteoporotic fracture (HR 1.73 [95% confidence interval (CI) 1.18–2.53]) and a 4-fold increased risk of hip fracture (HR 4.08 [95% CI 2.21–7.56]). The risk of osteoporotic fracture was significantly greater for patients with MS who had been prescribed antidepressants (HR 3.25 [95% CI 1.77–5.97]) or hypnotics/anxiolytics (HR 3.40 [95% CI 2.06–5.63]) in the previous 6 months, compared with controls. Conclusions: Increased awareness of the risk of hip fracture is warranted in patients with MS, especially in those who have recently been prescribed antidepressants or hypnotics/anxiolytics.read more
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Systematic review: The effectiveness of interventions to reduce falls and improve balance in adults with multiple sclerosis
TL;DR: It is suggested that balance may improve through exercise interventions, but that the magnitude of the improvements achieved in existing programs may not be sufficient to impact falls outcomes.
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Hospitalised hip fracture risk with rosiglitazone and pioglitazone use compared with other glucose-lowering drugs
Helen M. Colhoun,Shona J. Livingstone,Helen C. Looker,Andrew D. Morris,S H Wild,Robert S. Lindsay,Craig Reed,Peter T. Donnan,Bruce Guthrie,Graham P. Leese,John McKnight,D W M Pearson,Ewan R. Pearson,John R. Petrie,Sam Philip,Naveed Sattar,Frank Sullivan,Paul M. McKeigue +17 more
TL;DR: Hip fracture is a severe adverse effect with TZDs, affecting both sexes; labels should be changed to warn of this.
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A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach:
TL;DR: Elucidations regarding risk factors for accidental falls in patients with multiple sclerosis (PwMs) are provided, with worse disability score, progressive course, use of walking aid, and poorer performances in static and dynamic balance tests strongly associated with fall status.
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General health issues in multiple sclerosis: comorbidities, secondary conditions, and health behaviors.
Ruth Ann Marrie,Heather Hanwell +1 more
TL;DR: Physical and mental comorbidity and health behaviors are associated with adverse outcomes in MS and should be considered in the assessment and management of patients with MS.
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Frequency, Characteristics, and Consequences of Falls in Multiple Sclerosis: Findings From a Cohort Study
TL;DR: People with MS experience high numbers of falls, with associated injuries, and evaluating the characteristics of individuals who experience frequent near falls but few actual falls may be valuable for research and clinical practice.
References
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FRAX™ and the assessment of fracture probability in men and women from the UK
TL;DR: The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.
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Use of oral corticosteroids and risk of fractures.
T P van Staa,T P van Staa,Hubertus G. M. Leufkens,Lucien Abenhaim,Lucien Abenhaim,B. Zhang,Colin Cooper +6 more
TL;DR: The results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm, which has implications for the use of preventative agents against bone loss in patients at highest risk.
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Vitamin D and Multiple Sclerosis
TL;DR: The results of these studies support a protective effect of vitamin D, but there are uncertainties and many unanswered questions, including how vitamin D exerts a Protective effect, how genetic variations modify the effect, and whether vitamin D can influence the course of MS progression.
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Central Nervous System–Active Medications and Risk for Falls in Older Women
Kristine E. Ensrud,Terri L. Blackwell,Carol M. Mangione,Paula J. Bowman,Mary A. Whooley,Douglas C. Bauer,Ann V. Schwartz,Joseph T. Hanlon,Michael C. Nevitt +8 more
TL;DR: To determine whether current use of central nervous system (CNS)‐active medications, including benzodiazepines, antidepressants, anticonvulsants, and narcotics, increases the risk for subsequent falls.
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Antidepressants and the risk of falls among nursing home residents.
TL;DR: There was little difference in rates of falls between those treated with tricyclic antidepressants and those treating with selective serotonin-reuptake inhibitors, and the preferential use of the newer antidepressants is unlikely to reduce the higher rate of falls among nursing home residents taking antidepressants.