Fracture history and bone loss in patients with MS

Cosman, Felicia; Nieves, Jeri W.; Komar, L.; Ferrer, Gerardo; Herbert, Joseph; Formica, Carmelo; Shen, Victor; Lindsay, Robert

doi:10.1212/wnl.51.4.1161

Cited by 169 publications

(162 citation statements)

References 21 publications

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“…Also, glucocorticoid use has not been found to be associated with bone architecture as measured by quantitative ultrasound, a measure of bone strength [18]. Nevertheless, osteopenia and osteoporosis are more prevalent in the MS population than in controls [2,5]. To our knowledge, no research has evaluated the capacity of physical activity to attenuate the negative impact of glucocorticoid use on BMD or bone quality as measured by ultrasound attenuation in the MS population.…”

Section: Introductionmentioning

confidence: 99%

“…The resulting demyelination and transection of axons cause disruption of neural impulses, and neuropathic changes yield functional impairments such as abnormal walking mechanics, poor balance, muscle weakness, and fatigue. The resultant functional impairments lead to an increased risk of falling that, combined with low bone mass, can increase the frequency of bone fracture in individuals with MS [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…However, evidence exists that BMD is related to the level of ambulatory function in individuals with MS [2,5,[7][8][9][10]. Importantly, physical activity and ambulatory function are separate constructs and the association between physical activity and bone must be examined independent of ambulatory function in those with MS.…”

Section: Introductionmentioning

confidence: 99%

“…High doses of glucocorticoids, such as those typically used in treatment of MS exacerbations, have been shown to increase bone resorption and decrease bone formation [14][15]. Research suggests that the use of glucocorticoids is a predictor of bone loss in individuals with MS [2,7]; however, most studies do not assess the effect of long-term use of glucocorticoids on BMD in those with MS [9,[15][16]. The association between long-term glucocorticoid use and BMD is still somewhat unclear because only one study has reported long-term effects and reported no association of high dose methylprednisolone on BMD in MS patients [17].…”

Section: Introductionmentioning

confidence: 99%

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Bone health in ambulatory individuals with multiple sclerosis: Impact of physical activity, glucocorticoid use, and body composition

Mojtahedi

Snook

Motl³

et al. 2008

JRRD

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Abstract-This study examined the relationships among physical activity, glucocorticoid use, body composition, and bone health in ambulatory women with multiple sclerosis (MS). Twenty-nine white women (mean +/-standard deviation: age 45.1 +/-9.0 yr, Expanded Disability Status Scale 2.9 +/-1.2) diagnosed with MS were assessed for whole body (WB), proximal femur (PF) and lumbar spine (LS) bone status (bone mineral content [BMC], bone mineral density [BMD], and quantitative ultrasound index [QUI] by calcaneal quantitative ultrasound) and body composition by dual energy X-ray absorptiometry; for physical activity by pedometer and accelerometer; and for glucocorticoid medication exposure by selfreport. Accelerometer counts were related to PF BMC (r = 0.50, p = 0.010) when we controlled for age, fat and lean mass, MS disease duration, and glucocorticoid use. Glucocorticoid use was not associated with bone measures. When we controlled for age and fat mass, lean mass was associated with WB BMC (r = 0.41, p = 0.04), PF BMC (r = 0.61, p = 0.001), and speed of sound (SOS) (r = 0.44, p = 0.02), whereas fat mass was associated with SOS and QUI (r =0.43, p = 0.03, and r = 0.44, p = 0.02, respectively). Lean mass was an independent predictor of WB BMC (p = 0.04) and PF BMC (p = 0.001), whereas fat mass was an independent predictor of LS BMD (p = 0.05). In conclusion, physical activity and lean mass are associated with femoral bone mass in women with MS who are ambulatory.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bone health in ambulatory individuals with multiple sclerosis: Impact of physical activity, glucocorticoid use, and body composition

Mojtahedi

Snook

Motl³

et al. 2008

JRRD

View full text Add to dashboard Cite

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“…57 MS patients appear to have decreased bone density and increased fracture risk; this situation may be underrecognized. 56,[58][59][60][61] Risk factors for osteoporosis that may be common in MS patients include female gender (especially postmenopausal women), immobility, decreased weight, and steroid treatment. 56 Vitamin D and calcium supplements should be considered for these patients.…”

Section: Vitamin D and Calciummentioning

confidence: 99%

Alternative Medicine and Multiple Sclerosis: An Objective Review from an American Perspective

Bowling

Ibrahim

Stewart

2000

International Journal of MS Care

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The use of complementary and alternative medicine (CAM), or unconventional medicine, may be challenging for health care providers in the United States. There are several definitions of CAM, and therapies that are considered alternative in one country may be conventional in other countries. Unconventional medical practices may be used instead of, or in addition to, conventional medical therapy. It may be difficult for people with multiple sclerosis (MS) to obtain reliable MS-relevant CAM information, and there may be conflicts between the values of patients and those of health care providers. These issues may create problems in the clinical decision-making process. The relevance to MS of some commonly used CAM therapies is discussed: herbal medicine, vitamins and minerals, marijuana, and a histamine and caffeine transdermal gel patch. Current information about the efficacy and safety of CAM therapies is extremely variable. Some therapies appear promising, others are unsafe or ineffective, and nearly all need to be studied further.In the United States, complementary and alternative medicine (CAM) are increasing in popularity 1 and appears to be widely used by multiple sclerosis (MS) patients. 2,3 However, there are limitations to the MS-relevant CAM information that is currently available. In addition, addressing issues raised by patients interested in CAM may be particularly challenging for mainstream health care professionals.This review article discusses CAM issues that are important to health professionals who are specialized in MS care. CAM therapy is defined, and the demographics of CAM users are discussed. The clinical decision-making process is considered as it applies specifically to MS patients. Differing and potentially clashing value systems of MS patients and health care providers are highlighted. Information provided in this article is limited to CAM therapies and selected MS-relevant information. More detailed information may be found in the literature about CAM, [4][5][6][7]8 and dietary supplements. [9][10][11][12][13][14][15][16] Definition Controversy and confusion surround alternative medicine, and even the definition itself is controversial. Alternative medicine (also known as unconventional or unorthodox medicine) is often defined by what it is not: It generally refers to medical therapies that typically are not taught in medical schools or are not readily available in community hospitals. 1 According to this definition, the term means one thing in the United States, another in Germany, and something completely different in China. In the United States, the definition is a "moving target," since increasingly alternative medicine therapies are provided in hospitals and alternative medicine courses are offered in medical schools. 17 To define alternative medicine by what it is, the National Institutes of Health (NIH) has developed a classification system for alternative medicine (Table 1) Alternative use means that they are used instead of conventional medicine, while complementary use ...

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Beliefs, Perceptions, and Practices Related to Osteoporosis Risk Reduction Among Women with Multiple Sclerosis

Sharts‐Hopko

Sullivan

2002

Rehabilitation Nursing

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Women with multiple sclerosis (MS) are at increased risk for osteoporosis and fracture; in turn, osteoporosis has the potential to exacerbate the physical limitations imposed by MS. This qualitative study explored the understanding of osteoporosis risk and risk reduction, strategies being used to reduce risk, and related beliefs among 27 women with MS. Participants were recruited at a regional MS Society meeting. The women completed personal data forms, and responded to open-ended questions during taped interviews, which were transcribed and subjected to comparative content analysis. Five themes emerged from the data: knowledge about osteoporosis, sense of vulnerability, interactions with healthcare providers, preventive actions, and sense of control. All of the women had some knowledge about osteoporosis risk reduction, and most of the women were actively attempting to reduce their risk. However, few of the women had full knowledge, or were doing all that they might do, to minimize their risk. Few of their healthcare providers had discussed the issue or responded to their concerns, even when women had histories of multiple fractures. The women did comprehened their increased risk and most attempted to manage it, although input was lacking from healthcare providers about osteoporosis risk reduction.

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Fracture history and bone loss in patients with MS

Cited by 169 publications

References 21 publications

Bone health in ambulatory individuals with multiple sclerosis: Impact of physical activity, glucocorticoid use, and body composition

Bone health in ambulatory individuals with multiple sclerosis: Impact of physical activity, glucocorticoid use, and body composition

Alternative Medicine and Multiple Sclerosis: An Objective Review from an American Perspective

Beliefs, Perceptions, and Practices Related to Osteoporosis Risk Reduction Among Women with Multiple Sclerosis

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