Fracture Risk in Patients with Myasthenia Gravis: A Population-Based Cohort Study

Article type: Research Article

Authors: Kassardjian, Charles^{a; b; *} | Widdifield, Jessica^{c; d; e} | Paterson, J. Michael^{d; e} | Kopp, Alexander^e | Nagamuthu, Chenthila^e | Barnett, Carolina^f | Tu, Karen^g | Breiner, Ari^h

Affiliations: [a] Department of Medicine, Division of Neurology, St. Michael’s Hospital, Toronto, ON, Canada | [b] Neurology Quality and Innovation Lab, University of Toronto, Toronto, ON, Canada | [c] Holland Bone & Joint Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada | [d] Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada | [e] ICES, Toronto, ON, Canada | [f] Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada | [g] Department of Community and Family Medicine, North York General Hospital, University Health Network, Toronto, ON, Canada | [h] Department of Medicine, Division of Neurology, The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, ON, Canada

Correspondence: [*] Correspondence to: Charles Kassardjian, MD MSc FRCPC, St. Michael’s Hospital, 9-Donnelly Clinical Neurophysiology, 80 Bond Street, Toronto, Ontario, M5C 1W6, Canada. Tel.: +1 416 864 5298; Fax: +1 416 864 6095; E-mail: [email protected].

Abstract: Background:Prednisone is a common treatment for myasthenia gravis (MG), and osteoporosis is a known potential risk of chronic prednisone therapy. Objective:Our aim was to evaluate the risk of serious fractures in a population-based cohort of MG patients. Methods:An inception cohort of patients with MG was identified from administrative health data in Ontario, Canada between April 1, 2002 and December 31, 2015. For each MG patient, we matched 4 general population comparators based on age, sex, and region of residence. Fractures were identified through emergency department and hospitalization data. Crude overall rates and sex-specific rates of fractures were calculated for the MG and comparator groups, as well as rates of specific fractures. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results:Among 3,823 incident MG patients (followed for a mean of 5 years), 188 (4.9%) experienced a fracture compared with 741 (4.8%) fractures amongst 15,292 matched comparators. Crude fracture rates were not different between the MG cohort and matched comparators (8.71 vs. 7.98 per 1000 patient years), overall and in men and women separately. After controlling for multiple covariates, MG patients had a significantly lower risk of fracture than comparators (HR 0.74, 95% CI 0.63–0.88). Conclusions:In this large, population-based cohort of incident MG patients, MG patients were at lower risk of a major fracture than comparators. The reasons for this finding are unclear but may highlight the importance osteoporosis prevention.

Keywords: Myasthenia gravis, fractures, osteoporosis, corticosteroids, immunosuppression

DOI: 10.3233/JND-200612

Journal: Journal of Neuromuscular Diseases, vol. 8, no. 4, pp. 625-632, 2021