Bone loss and fractures in multiple sclerosis: focus on epidemiologic and physiopathological features

Abstract

Multiple sclerosis (MS) affects the central nervous system leading to disability and is complicated by bone loss and fractures. Despite the acceptance of osteoporosis and fractures as two major public health problems, in people with MS the mechanisms have not been investigated adequately. Physicians and patients usually focus on the major cause of disability and neglect the multiple risk factors for osteoporosis and fractures in this specific population. This review updates the epidemiology and physiopathological mechanisms in MS.

Body Composition in Disabilities of Central Nervous System

“…Reduced physical activity (and probably reduced energy expenditure) in MS need to be accompanied by a reduction in energy intake otherwise body fat will increase (Lambert et al, 2002). Subjects with those motor disorders often face problems of depression and limit mobility (Dionyssiotis, 2011b). Moreover, in children with cerebral palsy (CP) studies suggest that increased stretch reflexes and muscle tone, weakness of involved musculature, and severe limitation of movement reduce the capacity to perform normal movements creating ambulation barriers limiting physical activity.…”

“…could be similar; i.e. a severe form of MS can result in a wheelchair bound patient a clinical figure equivalent to paraplegia or a MS patient may have a more appropriate walking gait pattern vs. a patient with incomplete paraplegia but may also be unable to walk at all, is bedridden and vice versa (Dionyssiotis, 2011b;2011c;2011d). In addition to these differences and according to osteoporosis the role of factors which do not change, such as race or gender of patients has not been yet clarified, although there are few studies in women debating that bone mass in women with disabilities is more affected than men (Smeltzer et al, 2005;Coupaud et al, 2009).…”

Bone And Soft Tissue Changes In Patients With Spinal Cord Injury And Multiple Sclerosis

“…18,19 SCI always results in substantial and rapid bone loss predominately in areas below the neurological level of injury. The predominant finding in bone in SCI patients is a large loss of bone during the first year of injury and an ongoing demineralization at 3 years thereafter in the tibiae.…”

Neurological Osteoporosis in Disabilities

“…However, the high proportion of ambulatory patients with bone loss suggest additional non-mechanical factors (Cosman et al, 1998;Dionyssiotis, 2011b). There is a high incidence of vitamin D deficiency in MS patients and is determined by levels of 25-hydroxy vitamin D <20ng/ml (Nieves et al, 1994).…”

“…Prevention with calcium rich foods and dietary supplements containing vitamin D and antiosteoporotic drugs is necessary for these patients. Particular attention should be paid to transfers and falls prevention in this population to prevent fractures which occur easily and heal slowly (Cattaneo et al, 2007;Dionyssiotis, 2011b). In osteoporosis molecular mechanisms leading to bone loss are inadequately explained.…”