Rate and types of fractures in corticosteroid‐treated multiple sclerosis patients

Troiano, Raymond; Jotkowitz, A.; Cook, Stuart D.; Bansil, S.; Zito, George

doi:10.1212/wnl.42.7.1389

Cited by 29 publications

(14 citation statements)

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“…Some are virtually atraumatic, for example, a rib fracture due to turning in bed at night, a vertebral fracture due to lifting [32] and pelvic, hip or femoral fractures in wheelchair-dependent individuals with no obvious precipitating cause [33][34][35]. Fractures can be found incidentally [33] or present with pain and immobility [33,34], leg swelling [35] or even shortness of breath (attributed to fat embolism) [35].…”

Section: Fracturesmentioning

confidence: 99%

“…The incidence of fractures during the course of MS has been described in four studies (see Table 3) [16,32,36,37]. Logan et al used the Veterans Health Administration (VHA) National Spinal Cord Dysfunction Register to identify retrospectively inpatient and outpatient encounters for non-axial fractures in people with MS (n=1,700) and traumatic spinal cord injury (n=6,132).…”

Section: Fracturesmentioning

confidence: 99%

“…The number of fractures occurring during the years of corticosteroid treatment (mean average of 7.1 years) was recorded. Overall, 26 of the 103 patients had a total of 30 fractures, yielding an annual fracture incidence of 3.2% [32]. Weinstock-Guttman et al assessed 40 consecutive male patients attending their MS centre with a mean age of MS symptom onset of 34 years, a mean MS disease duration of 17 years and a mean EDSS of 5.8.…”

Section: Fracturesmentioning

confidence: 99%

“…In addition, there was no record of axial fractures or any fracture care outside of the VHA [36]. A limitation of two studies [16,32] was the reliance or part reliance on self-reporting of fractures by people with MS who can experience cognitive deficits. These considerations may partly explain why, with one exception [37], fracture rates were not increased compared to the general population annual fracture incidence, which has been estimated at 3.6% [38].…”

Section: Fracturesmentioning

confidence: 99%

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Bone health in multiple sclerosis

Gibson

Summers

2011

Osteoporos Int

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People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.

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Section: Fracturesmentioning

confidence: 99%

Section: Fracturesmentioning

confidence: 99%

Section: Fracturesmentioning

confidence: 99%

Section: Fracturesmentioning

confidence: 99%

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Bone health in multiple sclerosis

Gibson

Summers

2011

Osteoporos Int

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“…57 MS patients appear to have decreased bone density and increased fracture risk; this situation may be underrecognized. 56,[58][59][60][61] Risk factors for osteoporosis that may be common in MS patients include female gender (especially postmenopausal women), immobility, decreased weight, and steroid treatment. 56 Vitamin D and calcium supplements should be considered for these patients.…”

Section: Vitamin D and Calciummentioning

confidence: 99%

Alternative Medicine and Multiple Sclerosis: An Objective Review from an American Perspective

Bowling

Ibrahim

Stewart

2000

International Journal of MS Care

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The use of complementary and alternative medicine (CAM), or unconventional medicine, may be challenging for health care providers in the United States. There are several definitions of CAM, and therapies that are considered alternative in one country may be conventional in other countries. Unconventional medical practices may be used instead of, or in addition to, conventional medical therapy. It may be difficult for people with multiple sclerosis (MS) to obtain reliable MS-relevant CAM information, and there may be conflicts between the values of patients and those of health care providers. These issues may create problems in the clinical decision-making process. The relevance to MS of some commonly used CAM therapies is discussed: herbal medicine, vitamins and minerals, marijuana, and a histamine and caffeine transdermal gel patch. Current information about the efficacy and safety of CAM therapies is extremely variable. Some therapies appear promising, others are unsafe or ineffective, and nearly all need to be studied further.In the United States, complementary and alternative medicine (CAM) are increasing in popularity 1 and appears to be widely used by multiple sclerosis (MS) patients. 2,3 However, there are limitations to the MS-relevant CAM information that is currently available. In addition, addressing issues raised by patients interested in CAM may be particularly challenging for mainstream health care professionals.This review article discusses CAM issues that are important to health professionals who are specialized in MS care. CAM therapy is defined, and the demographics of CAM users are discussed. The clinical decision-making process is considered as it applies specifically to MS patients. Differing and potentially clashing value systems of MS patients and health care providers are highlighted. Information provided in this article is limited to CAM therapies and selected MS-relevant information. More detailed information may be found in the literature about CAM, [4][5][6][7]8 and dietary supplements. [9][10][11][12][13][14][15][16] Definition Controversy and confusion surround alternative medicine, and even the definition itself is controversial. Alternative medicine (also known as unconventional or unorthodox medicine) is often defined by what it is not: It generally refers to medical therapies that typically are not taught in medical schools or are not readily available in community hospitals. 1 According to this definition, the term means one thing in the United States, another in Germany, and something completely different in China. In the United States, the definition is a "moving target," since increasingly alternative medicine therapies are provided in hospitals and alternative medicine courses are offered in medical schools. 17 To define alternative medicine by what it is, the National Institutes of Health (NIH) has developed a classification system for alternative medicine (Table 1) Alternative use means that they are used instead of conventional medicine, while complementary use ...

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