Association of fractures with the incidence of amyotrophic lateral sclerosis.
Elevated bone turnover observed in ALS patients suggests poor bone health and increased fracture risk. We therefore evaluated the relationship of fracture to subsequent ALS risk.



We followed 4,529,460 Swedes from 1987 to 2010 and identified ALS and fractures from the Swedish National Patient Register. We examined associations of ALS risk with all fractures, osteoporotic and non-osteoporotic fractures, and traumatic and non-traumatic fractures among individuals aged 30-80 years. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We analysed the association of ALS with time since fracture using a Poisson regression model.



All fractures (HR: 1.51, 95% CI 1.39-1.65) as well as osteoporotic (HR: 1.59, 95% CI 1.41-1.79), non-osteoporotic (HR: 1.46, 95% CI 1.31-1.63), traumatic (HR: 1.50, 95% CI 1.37-1.63), and non-traumatic (HR: 1.80, 95% CI 1.35-2.40) fractures were associated with a higher incidence of ALS. Increased ALS incidence was associated with fractures occurring from one (HR: 2.33, 95% CI 2.04-2.66) to 18 (HR: 1.19, 95% CI 1.01-1.43) years before ALS diagnosis.



Poor bone health may be related to ALS. These findings may offer insight into ALS pathophysiology.
a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.|b Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park , NC , USA , and.
Tracy L
TL
Peters
a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.
Caroline E
CE
Weibull
a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.
Fang
F
Fang
b Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park , NC , USA , and.
Dale P
DP
Sandler
a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.|c Department of Health Sciences , University of Leicester , Leicester , UK.
Paul C
PC
Lambert
a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.
Weimin
W
Ye
b Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park , NC , USA , and.
Freya
F
Kamel
D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
Amyotrophic lateral sclerosis; cohort study; fractures; risk factors