{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:12:24Z","timestamp":1768443144009,"version":"3.49.0"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Neurology, Toho University Ohashi Medical Center"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Patients with myasthenia gravis (MG) are at increased risk of osteoporotic fractures due to long-term oral corticosteroid use and disease-related muscle weakness. FRAX\u00ae estimates 10-year fracture probability but does not incorporate falls or MG-specific functional impairment. To explore heterogeneity of fracture occurrence within MG patients classified as high risk by FRAX major osteoporotic fracture (MOF) probability. Methods: In a single-center retrospective cohort of 68 MG patients assessed in 2012, FRAX MOF with femoral neck BMD was calculable in 54 patients; the 29 patients with FRAX MOF \u2265 9.0% (the median of these 54 patients) comprised the high-FRAX cohort. Patients were stratified by the cohort medians of age (67 years) and MG-ADL (2 points) into four strata (HH, HL, LH, LL). This median-based stratification was exploratory and not intended as a clinically meaningful threshold. The primary outcome was time to first MOF (up to 10 years). We compared fracture occurrence using both proportions and Kaplan\u2013Meier analyses (log-rank test) and performed exploratory univariable Cox models for selected predictors. No multivariable confounder adjustment was performed. Results: Eight of twenty-nine patients (27.6%) experienced an MOF. The proportions with MOF were HH 25.0%, HL 40.0%, LH 57.1%, and LL 0.0% (global p = 0.068). Kaplan\u2013Meier curves differed across strata (log-rank p = 0.03), with separation most evident between LH and LL. For univariable Cox analyses, age was associated with shorter time to MOF (hazard ratio [HR] 1.13 per year, p = 0.041), and baseline difficulty rising from a chair (MG-ADL item) was associated with higher hazard rates (HR 3.45, p = 0.048). Conclusions: In this small, selected high-FRAX MG cohort, fracture events appeared to cluster in patients with impaired ADL and fall-related MG-ADL abnormalities, whereas FRAX values remained strongly age-driven. These findings are exploratory and hypothesis-generating and should not be interpreted as evidence of FRAX miscalibration; confirmation in larger, prospectively followed cohorts is needed.<\/jats:p>","DOI":"10.3390\/jcm15020672","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:12:04Z","timestamp":1768403524000},"page":"672","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fracture Occurrence Within FRAX-Defined High-Risk Myasthenia Gravis: An Exploratory Stratification by Age and Activities of Daily Living"],"prefix":"10.3390","volume":"15","author":[{"given":"Takafumi","family":"Uchi","sequence":"first","affiliation":[{"name":"Department of Neurology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguro-Ku, Tokyo 153-8515, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8731-0663","authenticated-orcid":false,"given":"Shingo","family":"Konno","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguro-Ku, Tokyo 153-8515, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S1474-4422(15)00145-3","article-title":"Myasthenia gravis","volume":"14","author":"Gilhus","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1212\/WNL.0000000000000804","article-title":"Increased risk of osteoporosis in patients with myasthenia gravis: A population-based cohort study","volume":"83","author":"Yeh","year":"2014","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Konno, S., Suzuki, S., Masuda, M., Nagane, Y., Tsuda, E., Murai, H., Imai, T., Fujioka, T., Suzuki, N., and Utsugisawa, K. 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