Bazelier Marloes T, Bentzen Joan, Vestergaard Peter, Stenager Egon, Leufkens Hubert G M, van Staa Tjeerd-Pieter, de Vries Frank
Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands.
Mult Scler. 2012 Nov;18(11):1609-16. doi: 10.1177/1352458512442755. Epub 2012 Apr 3.
Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.
To evaluate the risk of fracture in incident MS patients drawn from a dedicated MS registry compared with population-based controls.
We conducted a population-based cohort study (1996-2007) utilising the Danish National Health Registers that were linked to the Danish MS Registry and the Danish MS Treatment Registry. Incident MS patients (2963 cases) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Cox proportional hazards models and logistic regression were used to estimate the risk of fracture in MS. Time-dependent adjustments were made for age, history of diseases and drug use.
Compared with controls, patients with MS had no overall increased risk of fracture (adjusted hazard ratio (adj. HR): 1.0, 95% CI: 0.9-1.2). However, the risk of femur/hip fracture (adj. HR: 1.9, 95% CI: 1.1-3.4) was significantly increased compared to controls. As compared with unexposed patients, MS patients who had been exposed to a short course of methylprednisolone in the prior year had no significantly increased risk of osteoporotic fracture (adj. HR: 1.2, 95% CI: 0.5-2.9). Disabled MS patients with Expanded Disability Status Scale [EDSS] scores between 6 and 10, had a 2.6-fold increased risk of osteoporotic fracture (adjusted odds ratio (adj. OR): 2.6, 95% CI: 1.0-6.6) compared to patients with an EDSS score between 0 and 3.
Patients with MS had a higher risk of femur/hip fracture than controls. Disability status is probably more important than glucocorticoid use in the aetiology of MS and osteoporotic fracture.
由于骨质疏松和跌倒，多发性硬化症（MS）患者可能面临更高的骨折风险。
评估与基于人群的对照组相比，从专门的MS登记处选取的新发MS患者的骨折风险。
我们利用丹麦国家健康登记处进行了一项基于人群的队列研究（1996 - 2007年），这些登记处与丹麦MS登记处和丹麦MS治疗登记处相链接。新发MS患者（2963例）按出生年份、性别、日历时间和地区与无MS的人（对照组）进行1:6匹配。采用Cox比例风险模型和逻辑回归来估计MS患者的骨折风险。对年龄、疾病史和药物使用情况进行了时间依赖性调整。
与对照组相比，MS患者总体骨折风险没有增加（调整后风险比（adj. HR）：1.0，95%置信区间：0.9 - 1.2）。然而，与对照组相比，股骨/髋部骨折风险（adj. HR：1.9，95%置信区间：1.1 - 3.4）显著增加。与未接受治疗的患者相比，前一年接受过短期甲基泼尼松龙治疗的MS患者骨质疏松性骨折风险没有显著增加（adj. HR：1.2，95%置信区间：0.5 - 2.9）。扩展残疾状态量表（EDSS）评分在6至10之间的残疾MS患者，与EDSS评分在0至3之间的患者相比，骨质疏松性骨折风险增加了2.6倍（调整后优势比（adj. OR）：2.6，95%置信区间：1.0 - 6.6）。
MS患者股骨/髋部骨折风险高于对照组。在MS和骨质疏松性骨折的病因中，残疾状态可能比糖皮质激素的使用更为重要。
