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Osteoporosis management and secondary fragility fracture rates in patients with multiple sclerosis: a matched cohort study

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Abstract

This study highlights the persistent osteoporosis treatment gap following fragility fractures. Patients with multiple sclerosis sustained more primary hip fractures than controls and exhibited significantly higher rates of falls within three years post-fracture. However, multiple sclerosis (MS) patients were significantly more likely to be diagnosed with osteoporosis and treated with medications.

Introduction

The purpose of this study was to compare rates of osteoporosis management, falls, and secondary fractures following primary fragility fractures among patients with MS versus matched controls.

Materials and methods

A retrospective matched cohort study was conducted using the PearlDiver database. Patients aged ≥ 50 years with primary fragility fractures were identified (n = 120,368). Within this population, patients with MS were matched 1:10 with controls across age, sex, and US region. Rates of osteoporosis diagnoses and pharmacologic treatment, low-energy falls, and secondary fragility fractures were compared at three years post-fracture via logistic regression.

Results

A total of 1,232 patients with MS (mean age, 65.7 years) with primary fragility fractures were matched with 12,320 controls (mean age, 65.8 years). Primary hip fractures were significantly more common in the MS cohort (47.4% vs. 34.2%, p < 0.001). After the initial fracture, patients with MS were significantly more likely to receive a formal osteoporosis diagnosis (12.9% vs. 9.7%; OR 1.35; 95% CI, 1.13–1.61) and osteoporosis pharmacotherapy (14.4% vs. 11.9%; OR 1.24; 95% CI, 1.04–1.46). The MS cohort also exhibited significantly higher rates of falls (27.8% vs 22.7%; OR 1.15; 95% CI, 1.01–1.32). Rates of secondary fractures were comparable (6.3% vs. 5.0%; OR 1.10; 95% CI, 0.85–1.40).

Conclusion

Primary hip fragility fractures were significantly more common in patients with MS compared to matched controls. Following an initial fracture, patients with MS exhibited a significantly higher rate of falls but were more likely to be diagnosed with osteoporosis and treated with medications.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Bailey J. Ross

  2. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    Austin J. Ross, Olivia C. Lee, Timothy L. Waters, McCayn M. Familia & William F. Sherman

  3. Department of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, LA, USA

    Olivia C. Lee

  4. Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA

    Olivia C. Lee

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  1. Bailey J. Ross
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Appendix A PearlDiver Codes

Appendix A PearlDiver Codes

Table 4 Codes used to define inclusion/exclusion criteria, osteoporosis pharmacotherapy, and study outcomes
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Ross, B.J., Ross, A.J., Lee, O.C. et al. Osteoporosis management and secondary fragility fracture rates in patients with multiple sclerosis: a matched cohort study. Osteoporos Int 33, 1999–2010 (2022). https://doi.org/10.1007/s00198-022-06451-6

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