Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Osteoporos Int. 2022 Sep;33(9):1999-2010. doi: 10.1007/s00198-022-06451-6. Epub 2022 Jun 7.
This study highlights the persistent osteoporosis treatment gap following fragility fractures. Patients with multiple sclerosis sustained more primary hip fractures than controls and exhibited significantly higher rates of falls within three years post-fracture. However, multiple sclerosis (MS) patients were significantly more likely to be diagnosed with osteoporosis and treated with medications.
The purpose of this study was to compare rates of osteoporosis management, falls, and secondary fractures following primary fragility fractures among patients with MS versus matched controls.
A retrospective matched cohort study was conducted using the PearlDiver database. Patients aged ≥ 50 years with primary fragility fractures were identified (n = 120,368). Within this population, patients with MS were matched 1:10 with controls across age, sex, and US region. Rates of osteoporosis diagnoses and pharmacologic treatment, low-energy falls, and secondary fragility fractures were compared at three years post-fracture via logistic regression.
A total of 1,232 patients with MS (mean age, 65.7 years) with primary fragility fractures were matched with 12,320 controls (mean age, 65.8 years). Primary hip fractures were significantly more common in the MS cohort (47.4% vs. 34.2%, p < 0.001). After the initial fracture, patients with MS were significantly more likely to receive a formal osteoporosis diagnosis (12.9% vs. 9.7%; OR 1.35; 95% CI, 1.13-1.61) and osteoporosis pharmacotherapy (14.4% vs. 11.9%; OR 1.24; 95% CI, 1.04-1.46). The MS cohort also exhibited significantly higher rates of falls (27.8% vs 22.7%; OR 1.15; 95% CI, 1.01-1.32). Rates of secondary fractures were comparable (6.3% vs. 5.0%; OR 1.10; 95% CI, 0.85-1.40).
Primary hip fragility fractures were significantly more common in patients with MS compared to matched controls. Following an initial fracture, patients with MS exhibited a significantly higher rate of falls but were more likely to be diagnosed with osteoporosis and treated with medications.
本研究旨在比较多发性硬化症 (MS) 患者与匹配对照者发生原发性脆性骨折后的骨质疏松管理、跌倒和继发性骨折的发生率。
使用 PearlDiver 数据库进行回顾性匹配队列研究。确定了年龄≥50 岁且患有原发性脆性骨折的患者（n=120368）。在该人群中，MS 患者按年龄、性别和美国地区与对照者 1:10 匹配。通过逻辑回归比较骨折后 3 年的骨质疏松诊断和药物治疗、低能量跌倒和继发性脆性骨折的发生率。
共纳入 1232 例患有 MS（平均年龄 65.7 岁）且发生原发性脆性骨折的患者，与 12320 例对照者（平均年龄 65.8 岁）进行匹配。MS 队列中主要髋部骨折更为常见（47.4% vs. 34.2%，p<0.001）。初次骨折后，MS 患者更有可能接受正式的骨质疏松诊断（12.9% vs. 9.7%；比值比 [OR] 1.35；95%置信区间 [CI]，1.13-1.61）和骨质疏松症药物治疗（14.4% vs. 11.9%；OR 1.24；95% CI，1.04-1.46）。MS 队列的跌倒发生率也显著更高（27.8% vs. 22.7%；OR 1.15；95% CI，1.01-1.32）。继发性骨折的发生率相当（6.3% vs. 5.0%；OR 1.10；95% CI，0.85-1.40）。
与匹配对照者相比，MS 患者的原发性髋部脆性骨折明显更为常见。初次骨折后，MS 患者跌倒的发生率明显更高，但更有可能被诊断为骨质疏松症并接受药物治疗。
