title: Risk of fractures in patients with multiple sclerosis: a population-based cohort study.
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.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Bazelier
authors.forename: T-P
authors.initials: TP
authors.lastname: van Staa
authors.forename: B M J
authors.initials: BM
authors.lastname: Uitdehaag
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: H G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: P
authors.initials: P
authors.lastname: Vestergaard
authors.forename: R M C
authors.initials: RM
authors.lastname: Herings
authors.forename: F
authors.initials: F
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006620:Hip Fractures / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009426:Netherlands; D058866:Osteoporotic Fractures / Q000150:complications; D012306:Risk; D012307:Risk Factors