Risk of bone loss in men with multiple sclerosis

Weinstock‐Guttman, Bianca; Gallagher, Eileen; Baier, Monika; Green, Lydia; Feichter, Joan; Patrick, Kara; Miller, Carolyn; Wrest, Kathleen; Ramanathan, Murali

doi:10.1191/1352458504ms993oa

Cited by 102 publications

(106 citation statements)

References 21 publications

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“…For example, ambulatory women with MS had a mean ± SD Z-score of 0.0 ± 0.2 and had similar WB BMC as age-matched non-MS controls but had significantly greater Z-scores than nonambulatory women with MS (-0.6 ± 0.1, p < 0.01) [7]. Similar findings have been reported in other studies in which ambulatory status was an important determinant of bone loss, particularly in the hip region [2,5,[8][9][10]. This finding is in agreement with our finding that physical activity was positively associated with PF BMC in our ambulatory MS population.…”

Section: Discussionsupporting

confidence: 77%

“…This finding is in agreement with our finding that physical activity was positively associated with PF BMC in our ambulatory MS population. However, other studies indicate that ambulation is not a reliable protector of bone loss in an MS population, because a significant proportion of ambulatory MS individuals may be osteoporotic or osteopenic despite a normal mean T-score within the study [5,65]. Moreover, despite the fact that EDSS score and BMD and BMC at any site were not significantly correlated in this study, the ambulatory status of participants in our study and the physical activity levels may have been major factors in protecting against bone loss.…”

Section: Discussionmentioning

confidence: 98%

“…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: 92%

“…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%

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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: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Accuracy of FRAX® in People With Multiple Sclerosis

Bisson

Finlayson

Ekuma

et al. 2019

Journal of Bone and Mineral Research

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People with multiple sclerosis (MS) have a higher risk of low bone mineral density (BMD), osteoporosis, and osteoporotic fractures than healthy adults. The Fracture Risk Assessment tool (FRAX ® ) has been reported to underestimate fracture risk in people with MS when BMD is unknown. We tested FRAX performance for people with MS when BMD is known, and determined if MS is a risk factor for fracture independent of FRAX score. Using population-based databases in Manitoba, Canada, we identified people with MS who underwent BMD screening after MS diagnosis (n ¼ 744) and controls matched on age, sex, and first BMD screening date (n ¼ 3721). We calculated FRAX 10-year probabilities at the BMD screening date, and ascertained incident major osteoporotic fractures (MOF). Using Cox proportional hazards modeling we assessed the effect of MS on the hazard of MOF, adjusting for FRAX 10-year probabilities. MS cases had a higher mean FRAX 10-year probability of MOF calculated with BMD (8.32 AE 7.53) than controls (6.98 AE 5.18; p < 0.01). MS increased the risk for MOF after controlling for FRAX 10-year probability without BMD (HR 1.67; 95% confidence interval [CI], 1.29 to 2.16), and after controlling for FRAX individual risk factors (HR 1.45; 95% CI, 1.12 to 1.89). MS remained a risk factor for MOF even when controlling for FRAX 10-year probability of MOF with BMD (HR 1.48; 95% CI, 1.14 to 1.92). The FRAX 10-year probability with and without BMD underestimated the observed 10-year MOF risk in MS cases by 3% to 5%. Calibration improved when secondary osteoporosis was used to calculate FRAX without BMD. Calibration was best when the rheumatoid arthritis input was used to calculate FRAX probability along with BMD. Using secondary osteoporosis or rheumatoid arthritis as proxies for MS improves performance of FRAX and accurately predicts MOF outcomes in those with MS. This provides clinicians with a readily available approach to improve the accuracy of fracture prediction in MS.

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The risk of fracture in patients with multiple sclerosis: The UK general practice research

Bazelier

Staa

Uitdehaag

et al. 2011

Journal of Bone and Mineral Research

108

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Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We conducted a population-based cohort study using data from the UK General Practice Research Database linked to the National Hospital Registry (1997Registry ( -2008. Incident MS patients (n ¼ 5565) were matched 1:6 by year of birth, sex, and practice with patients without MS (controls). Cox proportional-hazards models were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5-and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost threefold increased risk of hip fracture [HR ¼ 2.79, 95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR ¼ 1.35, 95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR ¼ 1.85, 95% CI 1.14-2.98) or antidepressants (HR ¼ 1.79, 95% CI 1.37-2.35) in the previous 6 months. Absolute fracture risks were low in younger MS patients but became substantial when patients were older than 60 years of age. It is concluded that MS is associated with an increased risk of fracture. Fracture risk assessment may be indicated in patients with MS, especially those prescribed GCs or antidepressants. ß

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Risk of bone loss in men with multiple sclerosis

Cited by 102 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

Accuracy of FRAX® in People With Multiple Sclerosis

The risk of fracture in patients with multiple sclerosis: The UK general practice research

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