Chronic Fatigue Syndrome Is Associated With the Risk of Fracture: A Nationwide Cohort Study

[Bob]

China & Taiwan

Chronic Fatigue Syndrome Is Associated With the Risk of Fracture: A Nationwide Cohort Study.
Chen CS, Lin WM, Yang TY, Chen HJ, Kuo CN, Kao CH.
March 11, 2014
QJM. 2014 Mar 11.
http://qjmed.oxfordjournals.org/content/early/2014/03/13/qjmed.hcu037.abstract

Abstract

Purpose: Chronic fatigue syndrome (CFS) is a complex disorder that is associated with unreasonable persistent fatigue. CFS has also been reported to be a possible risk factor for osteopathy. We propose that CFS might be associated with an increased risk of fracture.

METHODS: We used the National Health Insurance Research Database (NHIRD) to conduct a prospective cohort study, identifying 3744 patients with a CFS diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 780.71) and 14 976 patients without CFS until 2006, with follow-up observed until the end of 2010.

RESULTS: The incidence rate of fracture was higher in the CFS cohort than in the non-CFS cohort (17.44 vs 14.53 per 1000 person-year, respectively), with an adjusted hazard ratio (HR) of 1.14 (95% confidence interval [CI] = 1.00-1.30). The risks of fracture between CFS and non-CFS were shown without comorbidity for each would be elevated than with other comorbidities, particularly in osteoporosis. The patients without osteoporosis in the CFS cohort exhibited a 1.16-fold higher risk of fracture than did those in the non-CFS cohort.

CONCLUSION: We propose that CFS-related fracture might not be associated with osteoporosis. The mechanism for developing CFS-related fracture remains unclear; however, we recommend noticing the prevention of fracture for CFS patients before clarifying the etiology of CFS-related fracture.

 

[barbc56]

Interesting. Thanks @Bob

I have an appointment on Monday for a bone density test, so this piqued my interest.

Barb

 

[peggy-sue]

I would think it is likely to be because we are more accident prone, because of loss of co-ordination and balance.
We are also struggling a load of the time with not seeing everything that is around us, and falling over stuff.

 

[PennyIA]

Considering half of my falls come from either sudden onset vertigo, difficulty with POTS (well, I think that's what some of it is) and sudden onset muscle weakness... none of which are related to osteoporosis, but are related to ME/CFS... that really doesn't suprise me much. In the last eight years, I've had at least twenty really bad falls, and probably one or two in the eight years before getting sick. FWIW - I do have osteopenia as well... but again - if you fall more often, bump into things more often - doesn't it actually make a ton of sense that you would break more bones?

 

[Bob]

It's a very large study and, unless I'm misreading it, there doesn't seem to be much difference between CFS patients and healthy controls:

The incidence rate of fracture was higher in the CFS cohort than in the non-CFS cohort (17.44 vs 14.53 per 1000 person-year, respectively)

 

[peggy-sue]

It's a 20% increase over the controls.
17.44 - 14.53 = 2.91.
(2.91/14.43) x100 = 20.000275.... 20%

 

[barbc56]

I do know my balance issues make me more likely to fall and I've had a few.

I also have a tendency to look in one direction while walking in another, even before this DD.

I have been told I am clumsy because I'm left handed but tend to be skeptical about that theory.

 

[PennyIA]

It's a 20% increase over the controls.
17.44 - 14.53 = 2.91.
(2.91/14.43) x100 = 20.000275.... 20%

This means it's not SUPER elevated. But how much you want to bet that depressed people don't see any increase over the healthy controls (snark).

 

[Bob]

I have been told I am clumsy because I'm left handed but tend to be skeptical about that theory.

Hehe, yes, I would be sceptical about that theory! It sounds like an old-fashioned Victorian belief!

 

[Annesse]

I think this would be related to the elevated levels of homocysteine found in patients with CFS. Homocysteine has been established through numerous studies to be a “strong and independent risk factor” for osteoporosis. Homocysteine may affect osteoporosis by interfering with collagen cross-linking, which results in a defective bone matrix.

The following study was part of The Framingham Osteoporosis Study funded by the National Institutes of Health (McLean, 2004). The age-adjusted risk for hip fracture was four times higher for men and nearly twice as high for women in the group with the highest homocysteine levels.
Homocysteine as a predictive factor for hip fracture in older persons.
McLean, R.R., P.F. Jacques, J. Selhub, K.L. Tucker, E.J. Samelson, K.E. Broe, M.T. Hannan, L.A. Cupples, D.P. Kiel. 2004. New Engl J Med. 350(20):2042-9.

“The increased prevalence of osteoporosis among people with ho- mocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of osteoporotic fracture…These findings suggest that the homocysteine concentration... is an important risk factor for hip fracture in older persons.”

In the following study the researchers concluded that homocysteine appeared to be a strong and independent risk factor for osteoporotic fractures in older men and women.
Homocysteine levels and the risk of osteoporotic fracture.
Van Meurs, J.B., R.A. Dhonukshe-Rutten, S.M. Pluijm, K. van der Klift, R. de Jonge, J. Lindemans, L.C. de Groot, A. Hofman, J.C. Witteman,J.P. van Leeuwen, M.M. Breteler, P. Lips,H.A. Pols, A.G. Uit- terlinden. 2004. New Engl J Med. 350(20):233-41.

“…An increased homocysteine level appears to be a strong and independent risk factor for osteoporotic fractures in older men and women.”

 

[peggy-sue]

It's not about osteoporosis, Annesse. But that is very interesting, thanks. Not heard that one before.

Barb said; "I have been told I am clumsy because I'm left handed"
well, I think that is just sinister.

 

[Simon]

RESULTS: The incidence rate of fracture was higher in the CFS cohort than in the non-CFS cohort (17.44 vs 14.53 per 1000 person-year, respectively), with an adjusted hazard ratio (HR) of 1.14 (95% confidence interval [CI] = 1.00-1.30).

Translation: the result was not statistically significant (since the confidence interval for Hazard Ratio includes 1.00; a ratio of 1.00 means no difference between patients and controls).

Also, they used a database (presumably GP records) to select patient who therefore didn't have a confirmed CFS diagnosis (at least not according to any recognised research criteria).

So a non-significant result in a flaky sample. Awesome.

 

[Annesse]

Homocysteine does weaken bone by interfering with collagen cross-linking so I do think it could be relevant. In the following study published in The Journal of Clinical Investigation the researchers stated: “It is concluded that homocysteine interferes with the formation of intermolecular cross-links that help stabilize the collagen macromolecular network.
A collagen defect in homocystinuria.
Kang, A.H., R.L. Trelstad. 1973. J Clin Invest 52(10):2571-8.
“…It is concluded that homocysteine interferes with the formation of intermolecular cross-links that help stabilize the collagen macromolecular network.”

 

[Sushi]

I have never heard that ME/CFS patients have higher levels of homocysteine...but I could have easily missed that one.

Another consideration: many ME/CFS patients get prescribed SSRI's which are said to be associated with bone loss. And, we just aren't doing as much weight bearing exercise as healthier people are. But then if the results aren't statistically significant, who knows?

Sushi

 

[PennyIA]

I have never heard that ME/CFS patients have higher levels of homocysteine...but I could have easily missed that one.

Another consideration: many ME/CFS patients get prescribed SSRI's which are said to be associated with bone loss. And, we just aren't doing as much weight bearing exercise as healthier people are. But then if the results aren't statistically significant, who knows?

Sushi

I'm not sure it's a direct correlation (pwME and high homocysteine)... however we do know that a lot of pwME have MTHFR defects and even the MTHFR defects that aren't supposed to lead to high homocyteine still can... so if pwME aren't treating their methylation issues, they can also have high homocysteine.

In my case, I had high homocysteine first, got told to take B12, B6, Folic Acid. Got the cheapest I could find without any knowledge around why not... within three months of the treatment was when I had my first crash. So, if you have MTHFR but doctors not clued in, you can end up with the in appropriate treatment plan and end up taking supplements that are in the wrong forms for you to tolerate (sigh).

But I would argue that the fact that it's not statistically significant might end up being related to the fact that our bones might not be more brittle (like ostepoporosis)... but I would be interested in hearing more about a study that factors in the higher frequency of falls in mobile pwME when compared with folks who are deconditioned and/or depressed and all the other things they keep trying to label us with. It would help highlight the differences that explain why ME is so much more than fatigue. Sadly, unless we can get the CCC criteria to be a value in the databases used for research it'll be impossible to do the research and know if we're pulling the right patients.