Epidemiology of hip fracture in nursing home residents with multiple sclerosis.
Tingting Zhang, Andrew R Zullo, Theresa I Shireman and 7 others
PMID 29598927WHAT IT FOUND
Nursing home residents with multiple sclerosis had lower hip fracture rates than matched residents without MS, except in residents requiring extensive or total transfer assistance.
Within MS, wandering, low BMI, antidepressants and opioids were linked to higher fracture risk.
Key findings
01After adjusting for baseline differences, hip fracture incidence was 7.1 per 1,000 person-years in nursing home residents with MS and 18.6 per 1,000 person-years in matched residents without MS.
02When death before hip fracture was accounted for separately, hip fracture risk was approximately 35% lower in residents with MS than in matched residents without MS.
03Risk factors differed by transfer performance: low BMI, wandering and anxiolytic use were linked to higher hip fracture risk in independent or mildly assisted residents with MS, while macular degeneration, pneumonia, antidepressant and thyroid hormone use were linked to higher risk in dependent residents.
STILL TO COME
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What it does not show
The study included only people aged 65 years and older with Medicare fee-for-service, so it may not apply to younger people with MS. It did not have MS disease course, duration or severity, so fracture risk could not be linked to how advanced the MS was. Lifetime corticosteroid, calcium and vitamin D exposure were not available in the data. MS was identified from nursing home assessment records, and that method correctly identified MS in 0.65 of cases in prior validation, so some residents may have been misclassified. Follow-up stopped 61 days after a resident left the nursing home, so outcomes after that period were not followed. The study did not test whether fall prevention, medication changes or pneumonia prevention reduce hip fracture risk.
Declared interests
The article is listed as supported by NIH extramural and U.S. government public health service research support. Authors declared no conflicts except Dr. Shireman received consulting fees from Pfizer, the University of Kansas Medical Center and Temple University on unrelated projects, and grant funding from Insight Therapeutics and the National MS Society.
The easy way to misread this
Do not conclude that multiple sclerosis protects against hip fracture or that residents with MS need less fall prevention. The study was observational, and fracture risk was higher in independent or mildly assisted residents with MS than in dependent residents.