Risk of fracture in patients with Myasthenia Gravis: The general practice research database

S. Pouwels, M. Javaid, A. De Boer, F. De Vries

Research output: Contribution to journalSpecial issueAcademicpeer-review

Abstract

Introduction: Myasthenia Gravis (MG) is a neuromuscular disease with symptoms of muscle weakness and fatiguability. MG has been associated with falling and glucocorticoid induced osteoporosis. Therefore, the aim of our study is to evaluate the risk of fracture after onset of myasthenia gravis. Methods: We conducted a retrospective cohort study (1987-2009, n=7,458) using the UK General Practice Research Database. Each MG patient was matched by age, sex, calendar time, and practice to up to 6 patients without a history of MG. The overall risk of fracture after onset of MG and the risk stratified by use of oral glucocorticoids and by drugs affecting the central nervous system (CNS) was determined. Results: No increased fracture risk was observed in patients with incident MG (adjusted hazard ratio [AHR] 1.11; 95% confidence interval [CI], 0.84-1.47). Use of oral glucocorticoids did not significantly increase fracture risk, but MG patients using antidepressants or anxiolytics/sedatives in the previous 6 months were at a significantly 2-fold increased fracture risk (AHR 1.99; 95% CI, 1.07-3.69 and 2.15; 95% CI, 1.14-4.03 respectively). The highest risk was observed among MG patients who had been exposed to anticonvulsants in the previous 6 months (AHR 4.98; 95% CI, 2.68-9.26). Conclusion: MG seems not to be associated with an increased fracture risk, except for patients using CNS medication. Moreover, use of (very high dosages of) oral glucocorticoids among MG patients did not alter fracture risk, for which the underlying mechanism remains unclear. Fracture risk assessment may be indicated among patients with MG who have recently used CNS medication.
Original languageEnglish
Pages (from-to)270
Number of pages1
JournalBone
Volume48
DOIs
Publication statusPublished - 7 May 2011

Keywords

  • mineral
  • glucocorticoid
  • antidepressant agent
  • anticonvulsive agent
  • risk
  • patient
  • fracture
  • general practice
  • myasthenia gravis
  • society
  • tissues
  • data base
  • bone
  • central nervous system
  • drug therapy
  • risk assessment
  • neuromuscular disease
  • muscle weakness
  • cohort analysis
  • osteoporosis
  • hazard ratio
  • United Kingdom
  • confidence interval

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