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Risk of Osteoporosis When You Have MS

osteoporosis and MS

People with Multiple Sclerosis have a greater risk of osteoporosis and poor bone health. Have you talked to your doctor about osteoporosis and how to improve your bone health?


Recent research indicates that people with multiple sclerosis are at increased risk of osteoporosis. What does a bone-loss disease have to do with a neurodegenerative condition, and how can you protect yourself?

At State University of New York (SUNY), Buffalo, a team of researchers recently wrote that “There has been mounting evidence showing that MS is associated with increased risk of osteoporosis and fractures.” This news certainly is not welcome for the millions of people who suffer with Multiple Sclerosis, but awareness of the possibility means individuals can take action to prevent or lessen the impact of this association.

Osteoporosis and Multiple Sclerosis
For example, the SUNY report points out the factors that appear to be associated with this risk; namely,

  • Lack of sufficient physical activity, especially weight-bearing exercise, which helps strengthen bone. This is believed to be the major factor involved in the development of osteoporosis in men and women with MS. Adequate exercise can be a challenge for people with MS because of limited mobility and fatigue
  • Use of medications that can contribute to loss of bone, such as glucocorticoids and anticonvulsants. These drugs are often prescribed for people who have MS. For now, experts are not fully certain of the severity of the impact of these disease-modifying therapies for Multiple Sclerosis on bone health.

These factors, and probably more, are known as secondary causes. That means they contribute to the primary cause of a disease or condition. Primary osteoporosis is usually related to advancing age and the decline of levels of estrogen or related to an insufficiency of calcium and vitamin D.

One review explored the prevalence, development, and treatment of osteoporosis in individuals with Multiple Sclerosis. The authors reported that

  • Low bone mineral density (BMD) in individuals shortly after they were diagnosed with clinically isolated syndrome and MS showed that BMD declined as MS-related disability increased
  • MS is a cause of secondary osteoporosis, and therefore doctors should evaluate people with MS for bone loss. Specifically, BMD should be measured shortly after a diagnosis of MS and vitamin D status should be watched

Steroid use and bone health
What impact does steroid use in people with MS have on their bone health? A recent (June 2014) report in the European Journal of Neurology points out the dangers. The authors conducted a retrospective analysis that looked at bone mineral density and the effect of steroid use and severely impaired gait among more than 900 patients.

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They discovered that patients were at greater risk of poor bone health and low-trauma fractures associated with impaired gait than with steroid use. However, steroid use does contribute to bone loss and should not be overlooked as a factor.

In fact, as noted by the University of Maryland Medical Center, both oral and inhaled steroids may cause bone loss. Other drugs associated with bone loss are loop diuretics (e.g., furosemide), proton pump inhibitors (e.g., omeprazole, lansoprazole, esomeprazole), heparin, and hormonal drugs that suppress estrogen.

Fractures and bone health in MS
The risk of fractures is greater among people who have MS, and there are several factors that contribute to this problem. They include problems with walking, frequent falls, long periods of inactivity, and a high percentage of vitamin D deficiency.

A team of investigators evaluated 20 years of data from the Nationwide Inpatient Sample and looked for information on hip fractures among patients with MS. They found that

  • Prevalence of MS among patients with hip fractures was more than twofold than predicted
  • People with MS were more likely to experience an acute fracture at a younger age than those without MS

Bottom line
If you have MS, you may be at increased risk of developing osteoporosis. Therefore, it is important for you to address questions about bone health and osteoporosis with your healthcare provider, review your use of steroids and other medications, have your vitamin D and calcium levels monitored, and evaluate your physical activity to help promote better bone health.

Bhattacharya RK et al. Is there an increased risk of hip fracture in multiple sclerosis? Analysis of the Nationwide Inpatient Sample. Journal of Multidisciplinary Healthcare 2014 Feb 13; 7:119-22
Gupta S et al. Osteoporosis and multiple sclerosis: risk factors, pathophysiology, and therapeutic interventions. CNS Drugs 2014 Aug; 28(8): 731-42
Kampman MT et al. Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications? Acta Neurologica Scandinavica 2011; (191): 44-49
Tyblova M et al. Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis. European Journal of Neurology 2014 Jun 16
University of Maryland Medical Center

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