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A simple score for estimating the long-term risk of fracture in patients with multiple sclerosis
Marloes T Bazelier1, Tjeerd-Pieter van Staa, Bernard M J Uitdehaag
1Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
Objective:
To derive a simple score for estimating the long-term risk of osteoporotic and hip fracture in individual patients with MS.
Methods:
Using the UK General Practice Research Database linked to the National Hospital Registry (1997-2008), we identified patients with incident MS (n = 5,494). They were matched 1:6 by year of birth, sex, and practice with patients without MS (control subjects). Cox proportional hazards models were used to calculate the long-term risk of osteoporotic and hip fracture. We fitted the regression model with general and specific risk factors, and the final Cox model was converted into integer risk scores.
Results:
In comparison with the FRAX calculator, our risk score contains several new risk factors that have been linked with fracture, which include MS, use of antidepressants, use of anticonvulsants, history of falling, and history of fatigue. We estimated the 5- and 10-year risks of osteoporotic and hip fracture in relation to the risk score. The C-statistic was moderate (0.67) for the prediction of osteoporotic fracture and excellent (0.89) for the prediction of hip fracture.
Conclusion:
This is the first clinical risk score for fracture risk estimation involving MS as a risk factor.
Insights
This study developed a new risk score to estimate long-term osteoporotic and hip fracture risk in patients with multiple sclerosis (MS). The score incorporates MS and other factors like falls and fatigue, improving fracture risk prediction.
Area of Science:
- Orthopedics and Musculoskeletal Diseases
- Neurology
- Geriatrics
Background:
- Osteoporotic and hip fractures pose significant health risks, particularly in aging populations.
- Multiple sclerosis (MS) is increasingly recognized as a potential risk factor for fractures.
- Existing fracture risk assessment tools may not adequately account for MS-specific factors.
Purpose of the Study:
- To develop and validate a simple clinical risk score for estimating long-term osteoporotic and hip fracture risk in individuals with multiple sclerosis (MS).
- To identify novel risk factors associated with fracture in the MS population.
Main Methods:
- Utilized UK General Practice Research Database and National Hospital Registry data (1997-2008).
- Identified 5,494 incident MS patients, matched 1:6 with controls.
- Employed Cox proportional hazards models to calculate fracture risk, incorporating general and MS-specific factors, and derived integer risk scores.
Main Results:
- The developed risk score includes MS, antidepressant use, anticonvulsant use, history of falling, and fatigue.
- The score demonstrated moderate predictive ability for osteoporotic fractures (C-statistic=0.67) and excellent ability for hip fractures (C-statistic=0.89).
- Estimated 5- and 10-year risks of osteoporotic and hip fracture were derived.
Conclusions:
- This is the first clinical risk score designed for fracture risk estimation that explicitly includes multiple sclerosis (MS) as a contributing factor.
- The score offers a novel approach to personalize fracture risk assessment in MS patients.
- Further validation and implementation in clinical practice are warranted.
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