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MS research update - Increased risk of a broken hip in people with MS? - 11 March 2014

Summary

It is known that people with MS are at a higher risk of broken bones, as they can have a reduced bone density and more frequent falls. This study looked at whether people with MS were at a higher risk of a hip fracture (broken hip) than people in the general population.

The researchers looked at 20 years of American hospital admissions information and found that people with MS had more than a two-fold (2.2 times) increased risk of hip fracture than for people who did not have MS. Although people with MS were more likely to have a fracture, it was found that as it was usually at a younger age, they had less complications and a straightforward discharge home, than for people from the general population.

There are a number of lifestyle and environment changes that people with MS can make to reduce the risk of falling and to improve bone density which can help reduce the risk of broken bones.

Background

It is known that people with MS are at a higher risk of broken bones, due to more frequent falls as a result of vision problems, problems with mobility, balance and co-ordination or reduced muscle strength. Previous studies have shown that people with MS can also have a reduced bone density from low vitamin D levels and steroid treatment, which could make a break more likely if they fell. This study aimed to find out of people with MS were at a higher risk of a hip fracture than people in the general population.

How this study was carried out

For this study the researchers used the information from the Nationwide Inpatient Sample (NIS), which is a record of USA hospital admissions from 1988 to 2011. They examined 20 years of information (1988 to 2007) and looked for people admitted to hospital with a hip fracture, who also had a diagnosis of MS.

The data was analysed to work out if people with MS made up a larger share of the hip fracture admissions than would be expected, based on how many people in the USA have MS.

What was found

The researchers found that of over a million hip fracture hospital admissions examined in the study, 2,631 were in people with MS. It was calculated that people with MS had more than a two-fold (2.2 times) increased risk of hip fracture than for people who did not have MS.

The people with MS were also significantly younger, when they fractured their hip, than in those who do not have MS. Although as the people with MS were younger, they tended to have fewer other health problems and so were more likely to have less complications and a straightforward discharge home from their hospital stay.

What does it mean?

This research shows that people with MS are more at risk than the general population of fracturing their hip. This is due in part to some of the risk factors for fracture being more common in people with MS. These include more frequent falls and reduced bone density.

Bhattacharya RK, Vaishnav N, Dubinsky RM.
Is there an increased risk of hip fracture in multiple sclerosis? Analysis of the Nationwide Inpatient Sample.
J Multidiscip Healthc. 2014 Feb 13;7:119-22.
abstract
Read the full text of this paper

More about falls

Why people fall

Falls are common irrespective of age or medical condition. Falls can happen for a variety of reasons not just because of a health related problem, things in the environment can also cause falls, such as tripping over something or slipping over.

There are a few factors that can be more common in people with MS that can make falls more likely:

How to prevent falls

There are a number of things you can do to reduce the risk of falling:

  • Have regular eye tests. If you do have eye problems, there are a number of special lenses that could help
  • Ensure your path is clear and free of obstacles, such as removing loose rugs, which could be a trip or slip hazard
  • If you feel unsteady talk to your physiotherapist about walking aids or other techniques for improving your balance and walking technique
  • If you get tired easily, pace yourself, and consider some fatigue management techniques

You can read more suggestions in Falls: managing the ups and downs of MS.

How to have strong bones so, if you fall, you are less likely to break a bone

Osteoporosis is a progressive condition that causes the bones to become thin and brittle, making them more prone to fractures. Losing some bone density is a natural part of aging and not everyone will get osteoporosis, but the advice given to help prevent it, is useful for anyone wanting to look after their bone health:

  • Consume sufficient vitamin D and calcium as both are needed for building strong bones
  • Eat a balanced diet, too much protein and salt can affect calcium levels in the body and weaken bones
  • Exercise or be active, as bones will stay strong if you use them

NHS choices has further information on how to maintain strong healthy bones.

Who can help if you do have falls

There are a number of ways you can get help if you are having falls.

  • GP or MS Nurse – will be able to assess and treat any health issues that may be causing your falls and will also be able to refer you to other local services
  • Physiotherapist - can suggest exercises to improve fitness, balance and posture and can also advise on walking equipment
  • Occupational therapist - can help you to find easier ways of doing everyday tasks such as showering or cooking or at work
  • Opticians and specialist vision services

Research by topic areas...

MS relapses

Najmi Varzaneh F, Najmi Varzaneh F, Azimi AR, et al.
Efficacy of combination therapy with erythropoietin and methylprednisolone in clinical recovery of severe relapse in multiple sclerosis.
Acta Neurol Belg. 2014 Mar 7. [Epub ahead of print]
abstract

Disease modifying treatments

Garnock-Jones KP.
Alemtuzumab: A review of its use in patients with relapsing multiple sclerosis.
Drugs. 2014 Mar 7. [Epub ahead of print]
abstract

Kingwell E, Evans C, Zhu F, et al.
Assessment of cancer risk with β-interferon treatment for multiple sclerosis.
J Neurol Neurosurg Psychiatry. 2014 Mar 4. [Epub ahead of print]
abstract

Nicholas JA, Racke MK, Imitola J, et al.
First-line natalizumab in multiple sclerosis: rationale, patient selection, benefits and risks.
Ther Adv Chronic Dis. 2014 Mar;5(2):62-68.
abstract
Read the full text of this paper

Zecca C, Riccitelli GC, Calabrese P, et al.
Treatment satisfaction, adherence and behavioral assessment in patients de - escalating from natalizumab to interferon beta.
BMC Neurol. 2014 Feb 28;14(1):38.
abstract
Read the full text of this paper

Syed M, Rog D, Parkes L, et al.
Patient expectations and experiences of multiple sclerosis interferon β-1a treatment: a longitudinal, observational study in routine UK clinical practice.
Patient Prefer Adherence. 2014 Feb 17;8:247-55.
abstract
Read the full text of this paper

Cohen M, Maillart E, Tourbah A, et al.
Switching From Natalizumab to Fingolimod in multiple sclerosis: a French prospective study.
JAMA Neurol. 2014 Feb 24.[Epub ahead of print
abstract

Other treatments

Jensen HB, Ravnborg M, Dalgas U, et al.
4-Aminopyridine for symptomatic treatment of multiple sclerosis: a systematic review.
Ther Adv Neurol Disord. 2014 Mar;7(2):97-113. Review.
abstract
Read the full text of this paper

Epidemiology

Berg-Hansen P, Moen S, Harbo H, et al.
High prevalence and no latitude gradient of multiple sclerosis in Norway.
Mult Scler. 2014 Mar 6. [Epub ahead of print]
abstract

Manouchehrinia A, Weston M, Tench CR, et al.
Tobacco smoking and excess mortality in multiple sclerosis: a cohort study.
J Neurol Neurosurg Psychiatry. 2014 Feb 25.
abstract
Read the full text of this paper

Assessment tools

Minden SL, Feinstein A, Kalb RC, et al.
Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS: report of the Guideline Development Subcommittee of the American Academy of Neurology.
Neurology. 2014 Jan 14;82(2):174-81.
abstract

Quality of life

Oreja-Guevara C, Wiendl H, Kieseier BC, et al.
Specific aspects of modern life for people with multiple sclerosis: considerations for the practitioner.
Ther Adv Neurol Disord. 2014 Mar;7(2):137-149.
abstract
Read the full text of this paper

Causes of MS

Briggs FB, Acuña BS, Shen L, et al.
Adverse socioeconomic position during the life course is associated with multiple sclerosis.
J Epidemiol Community Health. 2014 Feb 27. [Epub ahead of print]
abstract

Vitamin D

Brum DG, Comini-Frota ER, Vasconcelos CC, et al.
Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology.
Arq Neuropsiquiatr. 2014 Feb;72(2):152-6.
abstract
Read the full text of this paper

Psychological aspects

Rosti-Otajärvi E, Ruutiainen J, Huhtala H, et al.
Relationship between subjective and objective cognitive performance in multiple sclerosis.
Acta Neurol Scand. 2014 Feb 20.[Epub ahead of print]
abstract

Physical activity

Hansen D, Wens I ; Keytsman C,, et al.
Is long-term exercise intervention effective to improve cardiac autonomic control during exercise in subjects with multiple sclerosis? A randomized controlled trial.
Eur J Phys Rehabil Med. 2014 Mar 6. [Epub ahead of print]
abstract

Motl RW.
Lifestyle physical activity in persons with multiple sclerosis: the new kid on the ms block.
Mult Scler. 2014 Mar 6. [Epub ahead of print]
abstract

Wagner JM, Kremer TR, Van Dillen LR, et al.
Plantarflexor weakness negatively impacts walking in persons with multiple sclerosis more than plantarflexor spasticity.
Arch Phys Med Rehabil. 2014 Feb 27. pii: S0003-9993(14)00137-3.[Epub ahead of print]
abstract

van der Linden ML, Scott SM, Hooper JE, et al.
Gait kinematics of people with multiple sclerosis and the acute application of Functional Electrical Stimulation.
Gait Posture. 2014 Feb 6. pii: S0966-6362(14)00035-6.[Epub ahead of print]
abstract

Coote S, O'Dwyer C.
Energy expenditure during everyday activities - a study comparing people with varying mobility limitations due to multiple sclerosis and healthy controls.
Disabil Rehabil. 2014 Feb 24. [Epub ahead of print]
abstract

Pathophysiology

Iannitti T, Kerr BJ, Taylor BK.
Mechanisms and pharmacology of neuropathic pain in multiple sclerosis.
Curr Top Behav Neurosci. 2014 Mar 4. [Epub ahead of print]
abstract

Self-management

Goodworth MC, Stepleman L, Hibbard J, et al.
Variables associated with patient activation in persons with multiple sclerosis.
J Health Psychol. 2014 Mar 3. [Epub ahead of print]
abstract

Falls

Argento O, Incerti CC, Pisani V, et al.
Domestic accidents and multiple sclerosis: an exploratory study of occurrence and possible causes.
Disabil Rehabil. 2014 Mar 4. [Epub ahead of print]
abstract

Giannì C, Prosperini L, Jonsdottir J, et al.
A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach.
Clin Rehabil. 2014 Feb 25. [Epub ahead of print]
abstract

Work

Patten SB, Williams JV, Lavorato DH, et al.
Depression as a predictor of occupational transition in a multiple sclerosis cohort.
Funct Neurol. 2014 Oct-Dec;28(4):275-80.
abstract
Read the full text of this paper

Services

Sadler C.
A decade full of achievements.
Nurs Stand. 2014 Mar 5;28(27):65.
abstract

Hanson RL, Habibi M, Khamo N, et al.
Integrated clinical and specialty pharmacy practice model for management of patients with multiple sclerosis.
Am J Health Syst Pharm. 2014 Mar 1;71(6):463-9.
abstract

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