title: Risk of fractures in patients with multiple sclerosis: record-linkage study.
abstract: BACKGROUND
  Patients with multiple sclerosis (MS) have been reported to be at higher risk of fracture than other people. We sought to test this hypothesis in a large database of hospital admissions in England.
  
  
  METHODS
  We analysed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999-2010). Rate ratios for fractures were determined, comparing fracture rates in a cohort of all people in England admitted with MS and rates in a comparison cohort.
  
  
  RESULTS
  Significantly elevated risk for all fractures was found in patients with MS (rate ratio (RR) = 1.99, 95% confidence interval (CI) = 1.93-2.05)). Risks were particularly high for femoral fractures (femoral neck fracture RR = 2.79 (2.65-2.93); femoral shaft fracture RR 6.69 (6.12-7.29)), and fractures of the tibia or ankle RR = 2.81 (2.66-2.96).
  
  
  CONCLUSIONS
  Patients with MS have an increased risk of fractures. Caregivers should aim to optimize bone health in MS patients.
authors.affiliation: Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK.
authors.forename: Sreeram V
authors.initials: SV
authors.lastname: Ramagopalan
authors.forename: Olena
authors.initials: O
authors.lastname: Seminog
authors.forename: Raphael
authors.initials: R
authors.lastname: Goldacre
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000453:epidemiology*; D012306:Risk