title: Fractures and falls in patients with newly diagnosed clinically isolated syndrome and multiple sclerosis.
abstract: BACKGROUND
  Increased risk of falls and reduced bone strength may both contribute to enhanced fracture risk in patients with multiple sclerosis (MS). Fall tendency and fractures have not been investigated in newly diagnosed patients.
  
  
  OBJECTIVE
  The aim was to compare the fall tendency and fracture risk in a cohort of newly diagnosed clinically isolated syndrome (CIS) and MS patients with that in the general population.
  
  
  METHODS
  We performed a population-based case-control study in Oslo of self-reported fall tendency and fracture history in consecutive patients diagnosed with either a CIS suggestive of demyelinating disease or MS between January 2005 and January 2008. Two age-, sex-, and ethnicity-matched control groups were included; one group from the population registry and one group recruited by the patients.
  
  
  RESULTS
  Ninety-nine patients (mean time since the first symptom 1.6 ± 1.3 years, mean expanded disability status scale [EDSS] score 1.4 ± 1.1) and 159 controls were included. Whereas no difference in the number of fractures was reported, 20% of the patients and 3% of the controls reported a tendency to fall (P<0.001). Fall tendency was associated with degree of disability (mean EDSS score among patients with and without self-reported fall tendency was 2.4 ± 1.4 and 1.1 ± 0.9, respectively; P=0.001). Fall tendency was also reported in two of 22 patients with EDSS 0.
  
  
  CONCLUSIONS
  Fall tendency may occur early in the disease course of MS, before impairment of locomotion and balance becomes evident on clinical examination.
authors.affiliation: Department of Neurology, Oslo University Hospital Ullevål, Oslo, Norway. s.m.moen@medisin.uio.no
authors.forename: S M
authors.initials: SM
authors.lastname: Moen
authors.forename: E G
authors.initials: EG
authors.lastname: Celius
authors.forename: L
authors.initials: L
authors.lastname: Nordsletten
authors.forename: T
authors.initials: T
authors.lastname: Holmøy
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D016022:Case-Control Studies; D003711:Demyelinating Diseases; D018450:Disease Progression; D005260:Female; D050723:Fractures, Bone; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis; D009460:Neurologic Examination; D012306:Risk