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To the Editor:
We read with interest the article by Marrie et al.,1 who described a cross-sectional study of bone health in multiple sclerosis (MS) based on an MS registry. The authors highlighted multiple risk factors for osteoporotic fractures and suggested a potential improvement of care in the bone health of patients with MS.
As the authors acknowledged, the impact of corticosteroid use on bone health was not studied in their research. However, we would like to know if there is an association of osteoporotic fractures with disabled level in patients with MS. The Patient Determined Disease Steps (PDDS), a self-report measure of disability, was used,2 but no correlation analysis results were presented. This analysis is important because a certain subclass of patients with MS, according to the disability assessment, might be associated with higher incidence of fracture. This may result from vitamin D insufficiency3 or exposure to pharmacologic treatment that may require increased supplementation of calcium, vitamin D, or other prophylactic measures.
As demonstrated by the authors,1 most fracture subjects have moderate disability yet we would be interested in the proportion of moderate disability in those with and without fractures.
Disclosure: The authors report no disclosures.
Reply from the Authors:
We appreciate Drs. Zhang and Wu's interest in our …
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