Bone health in multiple sclerosis

Abstract

People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.

A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach

“…9,17 Similarly, even if the disability level and mineral density relationship have been reported as strongly related to each other, fracture risk is higher in patients with moderate rather than severe disability. 5,41,42 Therefore, reliable correlation between fall status and Expanded Disability Status Scale can be found only at intermediate levels of the scale, but not at the lower and upper extremities. In this regard, clinical 16,18,22,23,24,26,27 or computer-based assessments of balance [21][22][23]27 could be more useful for enhancing our diagnostic ability.…”

Effect of Tai Chi Chuan on balance in women with multiple sclerosis

“…A decrease in mobility is strongly associated with osteoporosis aggravation and muscle wasting as well as more frequent falls. Therefore, simply due to a fall, an MS patient may suffer from a major fracture leading to prolonged bed rest and experience further loss of bone density and muscle mass worsening the patients' disability [11].…”

“…Fall incidence was reported in 6 studies from 34% to 64% of MS patients with frequencies of two falls in the last 2 months [11]. Falls can cause physical injuries, such as fractures, soft tissue damage, activity restrictions and reduced mobility.…”

Falls in People With Multiple Sclerosis Who Use a Walking Aid: Prevalence, Factors, and Effect of Strength and Balance Interventions

“…7 Recent studies in the United Kingdom 8 and the Netherlands 9 found that the risk of hip fracture in people with MS was higher than in the general population, and that people with MS with a history of falling had double the risk of osteoporotic fracture. 8 The incidence of falls was significantly greater in people with Supported by Multiple Sclerosis Ireland through the Getting the Balance Right Project.…”