Open Access Research article

Risk of fractures in patients with multiple sclerosis: record-linkage study

Sreeram V Ramagopalan1, Olena Seminog2, Raphael Goldacre2 and Michael J Goldacre2*

Author affiliations

1 Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, Oxford, UK

2 Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK

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Citation and License

BMC Neurology 2012, 12:135  doi:10.1186/1471-2377-12-135

Published: 5 November 2012



Patients with multiple sclerosis (MS) have been reported to be at higher risk of fracture than other people. We sought to test this hypothesis in a large database of hospital admissions in England.


We analysed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999–2010). Rate ratios for fractures were determined, comparing fracture rates in a cohort of all people in England admitted with MS and rates in a comparison cohort.


Significantly elevated risk for all fractures was found in patients with MS (rate ratio (RR) = 1.99, 95% confidence interval (CI) = 1.93-2.05)). Risks were particularly high for femoral fractures (femoral neck fracture RR = 2.79 (2.65-2.93); femoral shaft fracture RR 6.69 (6.12-7.29)), and fractures of the tibia or ankle RR = 2.81 (2.66-2.96).


Patients with MS have an increased risk of fractures. Caregivers should aim to optimize bone health in MS patients.

Multiple sclerosis; Fractures; Epidemiology