Journal of Multiple Sclerosis

High Frequency of Fractures in an Early Stage of MS

Olga Krökki, Risto Bloigu and Anne M Remes

Objective : Low-energy (fragility) fractures of the distal forearm, femur, and vertebrae are usually associated with osteoporosis. There is an increased risk of fractures and low bone mineral density in patients with MS, even during the early stages of the disease. We evaluated the prevalence and features of low-energy fractures in a population–based MS cohort residing in a region of Finland near the Arctic.

Methods: The prevalence of fractures was determined in 491 patients who had been newly diagnosed with clinically definite MS. The fracture type, as well as the association between the duration of MS and the expanded disability status scale (EDSS) score, with a fracture event was determined.

Results: The prevalence of fragility fractures was 7.1%. The most frequent fracture types were vertebral (19.2%), distal forearm (19.2%), and ankle (25%), and the majority were low-energy fractures. The majority of fractures occurred within five years of MS diagnosis verification in non-disabled to moderately disabled patients (EDSS score 0–4). The mean MS patient age at which low-energy fracture events occurred was 42.5 years (95% CI, 38.3–46.6 years). Osteoporosis had only been clinically investigated in 26% of patients with fragility fractures, 89% of whom returned a positive finding.

Conclusions: The prevalence of low-energy vertebrae fractures was notably high in the present cohort; however, the presence of osteoporosis was poorly evaluated in clinical practice for this cohort.