title: Chronic fatigue syndrome is associated with the risk of fracture: a nationwide cohort study.
abstract: OBJECTIVE
  Chronic fatigue syndrome (CFS) is a complex disorder that is associated with unreasonable persistent fatigue. CFS has also been reported to be a possible risk factor for osteopathy. We propose that CFS might be associated with an increased risk of fracture.
  
  
  METHODS
  We used the National Health Insurance Research Database to conduct a prospective cohort study, identifying 3744 patients with a CFS diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 780.71) and 14 976 patients without CFS until 2006, with follow-up observed until the end of 2010.
  
  
  RESULTS
  The incidence rate of fracture was higher in the CFS cohort than in the non-CFS cohort (17.44 vs. 14.53 per 1000 person-year, respectively), with an adjusted hazard ratio of 1.14 (95% confidence interval = 1.00-1.30). The risks of fracture between CFS and non-CFS were shown without comorbidity for each would be elevated than with other comorbidities, particularly in osteoporosis. The patients without osteoporosis in the CFS cohort exhibited a 1.16-fold higher risk of fracture than did those in the non-CFS cohort.
  
  
  CONCLUSIONS
  We propose that CFS-related fracture might not be associated with osteoporosis. The mechanism for developing CFS-related fracture remains unclear; however, we recommend noticing the prevention of fracture for CFS patients before clarifying the aetiology of CFS-related fracture.
authors.affiliation: From the Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Tao Yuan, Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung; Department of Public Health, China Medical University, Taichung, Kau-Tang Traditional Medical Hospital, TaoYuan and Department of Nuclear Medicine and PET Center, China Medical University Hospital and Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: C-S
authors.initials: CS
authors.lastname: Chen
authors.affiliation: From the Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Tao Yuan, Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung; Department of Public Health, China Medical University, Taichung, Kau-Tang Traditional Medical Hospital, TaoYuan and Department of Nuclear Medicine and PET Center, China Medical University Hospital and Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: W-M
authors.initials: WM
authors.lastname: Lin
authors.affiliation: From the Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Tao Yuan, Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung; Department of Public Health, China Medical University, Taichung, Kau-Tang Traditional Medical Hospital, TaoYuan and Department of Nuclear Medicine and PET Center, China Medical University Hospital and Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: T-Y
authors.initials: TY
authors.lastname: Yang
authors.affiliation: From the Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Tao Yuan, Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung; Department of Public Health, China Medical University, Taichung, Kau-Tang Traditional Medical Hospital, TaoYuan and Department of Nuclear Medicine and PET Center, China Medical University Hospital and Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: From the Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Tao Yuan, Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung; Department of Public Health, China Medical University, Taichung, Kau-Tang Traditional Medical Hospital, TaoYuan and Department of Nuclear Medicine and PET Center, China Medical University Hospital and Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: C-N
authors.initials: CN
authors.lastname: Kuo
authors.affiliation: From the Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Tao Yuan, Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung; Department of Public Health, China Medical University, Taichung, Kau-Tang Traditional Medical Hospital, TaoYuan and Department of Nuclear Medicine and PET Center, China Medical University Hospital and Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan d10040@mail.cmuh.org.tw.
authors.forename: C-H
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D015673:Fatigue Syndrome, Chronic / Q000150:complications* / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult