title: Fracture rate in patients with myasthenia gravis: the general practice research database.
abstract: CONCLUSIONS
  The aim of this study was to evaluate fracture risk after onset of myasthenia gravis using the UK General Practice Research Database. Overall fracture risk is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use, but was increased in those using antidepressants, anxiolytics or anticonvulsants.
  
  
  BACKGROUND
  Myasthenia gravis (MG) is a neuromuscular disease which has been associated with an increased falls risk and glucocorticoid-induced osteoporosis, recognized determinants of increased fracture risk. The aim of this study was to evaluate the risk of fracture after onset of MG.
  
  
  METHODS
  We conducted a retrospective cohort study using the UK General Practice Research Database (1987-2009). Each MG patient was matched by age, sex, calendar time and practice to up to six patients without a history of MG and we identified all fractures and those associated with osteoporosis.
  
  
  RESULTS
  Compared to the control cohort, there was no statistically significant increased risk observed in patients with MG for any fracture (adjusted hazard ratio [AHR] 1.11; 95 % confidence interval [CI], 0.84-1.47) or osteoporotic fractures (AHR 0.98 [95 % CI 0.67-1.41]). Further, use of oral glucocorticoids up to a cumulative dose exceeding 5 g prednisolone equivalents did not increase risk of osteoporotic fracture (AHR 0.99 [95 % CI, 0.31-3.14]) compared with MG patients without glucocorticoid exposure. However, fracture risk was higher in patients with MG prescribed antidepressants (AHR 3.27 [95 % CI, 1.63-6.55]), anxiolytics (AHR 2.18 [95 % CI, 1.04-4.57]) and anticonvulsants (AHR 6.88 [95 % CI, 2.91-16.27]).
  
  
  CONCLUSIONS
  Overall risk of fracture in patients with MG is not statistically increased compared with age- and gender-matched controls irrespective of glucocorticoid use but was increased in those using antidepressants, anxiolytics or anticonvulsants. These findings have implications in strategies preserving bone health in patients with MG.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Utrecht, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Pouwels
authors.forename: A
authors.initials: A
authors.lastname: de Boer
authors.forename: M K
authors.initials: MK
authors.lastname: Javaid
authors.forename: D
authors.initials: D
authors.lastname: Hilton-Jones
authors.forename: J
authors.initials: J
authors.lastname: Verschuuren
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: H G
authors.initials: HG
authors.lastname: Leufkens
authors.forename: F
authors.initials: F
authors.lastname: de Vries
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000453:epidemiology*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000139:chemically induced / Q000453:epidemiology*; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000927:Anticonvulsants; D000928:Antidepressive Agents; D005938:Glucocorticoids