Latest on Bone Health and Multiple Sclerosis

bone health and multiple sclerosis

Two recent studies offer some important information on bone health for individuals who have multiple sclerosis. If you have MS and haven’t had a talk with your doctor about osteoporosis and your bones, it’s high time you did.

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With all of the challenges multiple sclerosis presents, it can be easy to pass over issues that are not bothering you or are out of sight, like your bone health. After all, most people don’t even know they have weak bones or osteoporosis until they experience a break or fracture.

However, evidence is strong that people with multiple sclerosis are at significant risk for low bone mineral density (BMD), which is used as an indirect indicator of risk of osteoporosis and fracture risk. In a new report, a team evaluated 67 individuals (average age, 41) with multiple sclerosis for their bone health using data from dual-energy X-ray absorptiometry and other factors such as duration of MS, lifetime steroid use, and expanded disability status scale (EDSS).

Here’s what the authors found:

  • 20.9% of the participants had a low bone mineral density for their age
  • Nearly all (86.6%) of the patients had insufficient vitamin D levels (less than 20 ng/ml). Sufficient vitamin D is critical for bone health.
  • Comorbidity and EDSS scores of patients who had low bone mineral density were significantly higher than those of participants who had better BMD
  • Having MS for a longer period of time also was associated with lower BMD values

The findings of this study serve as a reminder for individuals with multiple sclerosis to take care of their bone health and to talk to their doctors about it.

Bone health and steroid use
One factor that may contribute to low bone mineral density among people with multiple sclerosis is the use of glucocorticoids, which are a common treatment for MS. A team in Denmark recently evaluated the impact of short-term, high-dose glucocorticoid use and other risk factors for low BMD in MS patients.

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The bone mineral density of 260 individuals with multiple sclerosis was measured using dual x-ray absorptiometry and compared with that of healthy, age-matched controls. Here’s what the authors found:

  • 38 percent of the MS patients had osteopenia, which is reduced bone mass that is less severe than seen in osteoporosis
  • 7 percent had osteoporosis
  • No significant association was seen between use of glucocorticoids and bone mineral density

The authors of this study concluded that treatment with glucocorticoids did not appear “to be the primary underlying cause of secondary osteoporosis in MS patients.”

However, considerable previous research has shown that use of these steroids is associated with development of osteoporosis. Thus, the finding concerning glucocorticoid use should be examined.

According to the American College of Rheumatology, glucocorticoids have a direct, negative impact on bone cells, leading to a reduced rate of new bone formation. These steroids also can interfere with how the body manages calcium as well as sex hormone levels. All of these issues can result in increased bone loss.

Therefore, it seems wise to take time to consult with your doctor about your bone health, especially if you are using steroids.

Also read about alternative treatments for multiple sclerosis

Sources
American College of Rheumatology
Coskun Benlidayi I et al. Prevalence and risk factors of low bone mineral density in patients with multiple sclerosis. Acta Clinica Belgica 2015 Jun; 70(3): 188-92
Olsson A et al. Short-term, high-dose glucocorticoid treatment does not contribute to reduced bone mineral density in patients with multiple sclerosis. Multiple Sclerosis 2015 Jan 26

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