Contributions
Abstract: EP1437
Type: ePoster
Abstract Category: Clinical aspects of MS - 11 Comorbidity
Background: People with MS (pwMS) are at risk of osteoporosis due to immobility and repetitive steroid use. PwMS are also at risk of falls due to physical, visual and/or cognitive disability. Vitamin D deficiency is associated with both disease progression in MS and increased risk of osteoporotic fractures.
Objectives: To assess fracture risk, fall risk and serum vitamin D in ambulatory patients with moderately advanced MS; to compare the utility of 3 fracture risk scoring methods and a fall risk tool.
Methods: Consecutive pwMS aged 18-75 years with Expanded Disability Severity Scale (EDSS) score of 3.0-6.5 attending the MS clinic were invited to participate in the study involving measurement of serum vitamin D level and administration of an amalgamated questionnaire containing all question items included in the Fracture Risk Assessment Tool (FRAX), QFracture, an MS-Specific Fracture Score (MSSFS) and the Johns Hopkins Fall Risk Assessment Tool (JHFRAT). Data was analysed using SPSS v24.
Results: Of a total of 26 pwMS (n=13, RRMS; n=11, SPMS; n=2 PPMS), 58% were female, median age 51 years, median MS disease duration 12.5 years, median EDSS 5.0. Only 15% (4/26) had ever received specific advice on bone protection in MS. 46% had a serum vitamin D level (overall median 96nmol/l, range 16-315) below the threshold (70nmol/l) required for optimal bone health. No significant associations existed between serum vitamin D and fall risk score, prior falls, fracture risk scores or prior fracture.
Although there were moderate to strong correlations between each fracture risk score with one other score (MSSFS and QFracture, rs=0.484, p=0.01; MSSFS and FRAX, rs=0.83, p< 0.0001; FRAX and QFracture, rs=0.835, p< 0.0001), there was a wide variation in proportion of patients exceeding threshold for intervention (bone mineral density measurement +/- anti-osteoporotic therapy) across the 3 fracture scores (54% MSSFS; 38% FRAX; 19% QFracture; p< 0.0001).
46% (12/26) reported prior falls. Using JHFRAT, 54% (14/26) were categorised as having moderate fall risk. JHFRAT did not distinguish between patients with and without prior falls (p=0.671). JHFRAT showed a moderate correlation with MSSFS (rs=0.505, p< 0.0001) but not with FRAX or QFracture.
Conclusion: These results highlight the underestimated importance of assessing bone health in pwMS. Serial serum vitamin D measurements may be of value. Choice of fracture and fall risk assessment tools for pwMS should be further studied.
Disclosure:
SMY has received a Newman Research Fellowship sponsored by Novartis.
NMcN has received a Newman Research Fellowship sponsored by Biogen.
SJ has nothing to disclose.
LB has nothing to disclose.
PI has nothing to disclose.
ES has nothing to disclose.
NT has received research support from Bayer-Schering, Biogen Idec, and Sanofi-Aventis.
MH has received speaker's honoraria from Novartis, Biogen Idec and Bayer-Schering; and receives research support from Dystonia Ireland, the Health Research Board of Ireland and the European Dystonia Foundation.
CMcG has received research funding and/or honoraria from Bayer, Biogen, Genzyme, Novartis and Teva.
Abstract: EP1437
Type: ePoster
Abstract Category: Clinical aspects of MS - 11 Comorbidity
Background: People with MS (pwMS) are at risk of osteoporosis due to immobility and repetitive steroid use. PwMS are also at risk of falls due to physical, visual and/or cognitive disability. Vitamin D deficiency is associated with both disease progression in MS and increased risk of osteoporotic fractures.
Objectives: To assess fracture risk, fall risk and serum vitamin D in ambulatory patients with moderately advanced MS; to compare the utility of 3 fracture risk scoring methods and a fall risk tool.
Methods: Consecutive pwMS aged 18-75 years with Expanded Disability Severity Scale (EDSS) score of 3.0-6.5 attending the MS clinic were invited to participate in the study involving measurement of serum vitamin D level and administration of an amalgamated questionnaire containing all question items included in the Fracture Risk Assessment Tool (FRAX), QFracture, an MS-Specific Fracture Score (MSSFS) and the Johns Hopkins Fall Risk Assessment Tool (JHFRAT). Data was analysed using SPSS v24.
Results: Of a total of 26 pwMS (n=13, RRMS; n=11, SPMS; n=2 PPMS), 58% were female, median age 51 years, median MS disease duration 12.5 years, median EDSS 5.0. Only 15% (4/26) had ever received specific advice on bone protection in MS. 46% had a serum vitamin D level (overall median 96nmol/l, range 16-315) below the threshold (70nmol/l) required for optimal bone health. No significant associations existed between serum vitamin D and fall risk score, prior falls, fracture risk scores or prior fracture.
Although there were moderate to strong correlations between each fracture risk score with one other score (MSSFS and QFracture, rs=0.484, p=0.01; MSSFS and FRAX, rs=0.83, p< 0.0001; FRAX and QFracture, rs=0.835, p< 0.0001), there was a wide variation in proportion of patients exceeding threshold for intervention (bone mineral density measurement +/- anti-osteoporotic therapy) across the 3 fracture scores (54% MSSFS; 38% FRAX; 19% QFracture; p< 0.0001).
46% (12/26) reported prior falls. Using JHFRAT, 54% (14/26) were categorised as having moderate fall risk. JHFRAT did not distinguish between patients with and without prior falls (p=0.671). JHFRAT showed a moderate correlation with MSSFS (rs=0.505, p< 0.0001) but not with FRAX or QFracture.
Conclusion: These results highlight the underestimated importance of assessing bone health in pwMS. Serial serum vitamin D measurements may be of value. Choice of fracture and fall risk assessment tools for pwMS should be further studied.
Disclosure:
SMY has received a Newman Research Fellowship sponsored by Novartis.
NMcN has received a Newman Research Fellowship sponsored by Biogen.
SJ has nothing to disclose.
LB has nothing to disclose.
PI has nothing to disclose.
ES has nothing to disclose.
NT has received research support from Bayer-Schering, Biogen Idec, and Sanofi-Aventis.
MH has received speaker's honoraria from Novartis, Biogen Idec and Bayer-Schering; and receives research support from Dystonia Ireland, the Health Research Board of Ireland and the European Dystonia Foundation.
CMcG has received research funding and/or honoraria from Bayer, Biogen, Genzyme, Novartis and Teva.