Dataset Information

Association of fractures with the incidence of amyotrophic lateral sclerosis.

ABSTRACT: OBJECTIVE:Elevated bone turnover observed in ALS patients suggests poor bone health and increased fracture risk. We therefore evaluated the relationship of fracture to subsequent ALS risk. METHODS:We followed 4,529,460 Swedes from 1987 to 2010 and identified ALS and fractures from the Swedish National Patient Register. We examined associations of ALS risk with all fractures, osteoporotic and non-osteoporotic fractures, and traumatic and non-traumatic fractures among individuals aged 30-80 years. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We analysed the association of ALS with time since fracture using a Poisson regression model. RESULTS:All fractures (HR: 1.51, 95% CI 1.39-1.65) as well as osteoporotic (HR: 1.59, 95% CI 1.41-1.79), non-osteoporotic (HR: 1.46, 95% CI 1.31-1.63), traumatic (HR: 1.50, 95% CI 1.37-1.63), and non-traumatic (HR: 1.80, 95% CI 1.35-2.40) fractures were associated with a higher incidence of ALS. Increased ALS incidence was associated with fractures occurring from one (HR: 2.33, 95% CI 2.04-2.66) to 18 (HR: 1.19, 95% CI 1.01-1.43) years before ALS diagnosis. CONCLUSIONS:Poor bone health may be related to ALS. These findings may offer insight into ALS pathophysiology.

SUBMITTER: Peters TL

PROVIDER: S-EPMC5527744 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Association of fractures with the incidence of amyotrophic lateral sclerosis.

Peters Tracy L TL Weibull Caroline E CE Fang Fang F Sandler Dale P DP Lambert Paul C PC Ye Weimin W Kamel Freya F

Amyotrophic lateral sclerosis & frontotemporal degeneration 20170320 5-6

<h4>Objective</h4>Elevated bone turnover observed in ALS patients suggests poor bone health and increased fracture risk. We therefore evaluated the relationship of fracture to subsequent ALS risk.<h4>Methods</h4>We followed 4,529,460 Swedes from 1987 to 2010 and identified ALS and fractures from the Swedish National Patient Register. We examined associations of ALS risk with all fractures, osteoporotic and non-osteoporotic fractures, and traumatic and non-traumatic fractures among individuals ag ...[more]

PMID: 28316249

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Project description:IMPORTANCE:Persistent environmental pollutants may represent a modifiable risk factor involved in the gene-time-environment hypothesis in amyotrophic lateral sclerosis (ALS). OBJECTIVE:To evaluate the association of occupational exposures and environmental toxins on the odds of developing ALS in Michigan. DESIGN, SETTING, AND PARTICIPANTS:Case-control study conducted between 2011 and 2014 at a tertiary referral center for ALS. Cases were patients diagnosed as having definitive, probable, probable with laboratory support, or possible ALS by revised El Escorial criteria; controls were excluded if they were diagnosed as having ALS or another neurodegenerative condition or if they had a family history of ALS in a first- or second-degree blood relative. Participants completed a survey assessing occupational and residential exposures. Blood concentrations of 122 persistent environmental pollutants, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and brominated flame retardants (BFRs), were measured using gas chromatography-mass spectrometry. Multivariable models with self-reported occupational exposures in various exposure time windows and environmental toxin blood concentrations were separately fit by logistic regression models. Concordance between the survey data and pollutant measurements was assessed using the nonparametric Kendall ? correlation coefficient. MAIN OUTCOMES AND MEASURES:Occupational and residential exposures to environmental toxins, and blood concentrations of 122 persistent environmental pollutants, including OCPs, PCBs, and BFRs. RESULTS:Participants included 156 cases (mean [SD] age, 60.5 [11.1] years; 61.5% male) and 128 controls (mean [SD] age, 60.4 [9.4] years; 57.8% male); among them, 101 cases and 110 controls had complete demographic and pollutant data. Survey data revealed that reported pesticide exposure in the cumulative exposure windows was significantly associated with ALS (odds ratio [OR]?=?5.09; 95% CI, 1.85-13.99; P?=?.002). Military service was also associated with ALS in 2 time windows (exposure ever happened in entire occupational history: OR?=?2.31; 95% CI, 1.02-5.25; P?=?.046; exposure ever happened 10-30 years ago: OR?=?2.18; 95% CI, 1.01-4.73; P?=?.049). A multivariable model of measured persistent environmental pollutants in the blood, representing cumulative occupational and residential exposure, showed increased odds of ALS for 2 OCPs (pentachlorobenzene: OR?=?2.21; 95% CI, 1.06-4.60; P?=?.04; and cis-chlordane: OR?=?5.74; 95% CI, 1.80-18.20; P?=?.005), 2 PCBs (PCB 175: OR?=?1.81; 95% CI, 1.20-2.72; P?=?.005; and PCB 202: OR?=?2.11; 95% CI, 1.36-3.27; P?=?.001), and 1 BFR (polybrominated diphenyl ether 47: OR?=?2.69; 95% CI, 1.49-4.85; P?=?.001). There was modest concordance between survey data and the measurements of persistent environmental pollutants in blood; significant Kendall ? correlation coefficients ranged from -0.18 (Dacthal and "use pesticides to treat home or yard") to 0.24 (trans-nonachlor and "store lawn care products in garage"). CONCLUSIONS AND RELEVANCE:In this study, persistent environmental pollutants measured in blood were significantly associated with ALS and may represent modifiable ALS disease risk factors.

Dataset Information

Association of fractures with the incidence of amyotrophic lateral sclerosis.

Publications

Association of fractures with the incidence of amyotrophic lateral sclerosis.

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