Chronic fatigue syndrome is associated with the risk of fracture: a nationwide cohort study

QJM. 2014 Aug;107(8):635-41. doi: 10.1093/qjmed/hcu037. Epub 2014 Mar 11.


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 to conduct a prospective cohort study, identifying 3744 patients with a CFS diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification 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 of 1.14 (95% confidence interval = 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.

Conclusions: 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 aetiology of CFS-related fracture.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Cohort Studies
  • Comorbidity
  • Fatigue Syndrome, Chronic / complications*
  • Fatigue Syndrome, Chronic / epidemiology
  • Female
  • Fractures, Bone / epidemiology
  • Fractures, Bone / etiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Osteoporosis / epidemiology
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / etiology
  • Prospective Studies
  • Sex Distribution
  • Taiwan / epidemiology
  • Young Adult