Bone mineral density in patients with multiple sclerosis, hereditary ataxia or hereditary spastic paraplegia after at least 10 years of disease - a case control study

Abstract

BackgroundAlthough disability is considered the main cause of low bone mineral density (BMD) in multiple sclerosis (MS), other factors related to the disease process or treatment could also be involved. The aim of this study was to assess whether patients with MS are more likely to develop low BMD (osteopenia or osteoporosis) than patients with the non-inflammatory neurological diseases Hereditary Spastic Paraplegia (HSP) and Hereditary Ataxia (HA).MethodsWe performed a case control study comparing BMD (spine, hip and total body) and biochemical measures of bone metabolism in 91 MS patients and 77 patients with HSP or HA, matched for age, gender and disability. Both patient groups had lived with the disease for at least 10 years.ResultsIn total 74.7% of the patients with MS and 75.3% of the patients with HSP or HA had osteopenia (−2.5 < T- score < −1.0) or osteoporosis (T- score ≤ −2.5) in one or more sites. Osteoporosis was more common in patients with MS than with HSP/HA (44.0 vs 20.8%, p =0.001). This difference was not significant after correction for confounders (p = 0.07), nor were any of the biochemical markers.ConclusionMost patients with disabling neurological diseases like MS and HSP/HA develop osteopenia or osteoporosis. MS patients had osteoporosis more frequently than HA/HSP patients, though the difference was not significant after adjusting for confounders. Osteoporosis and bone health should be considered in all patients with both inflammatory and degenerative chronic neurological diseases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0771-4) contains supplementary material, which is available to authorized users.

Efficacy of denosumab in two cases with multiple-system atrophy and osteoporosis

“…However, disabling neurological diseases like spinocerebellar degeneration or multiple sclerosis, which are similar to MSA, are considered to have likely low BMD and high fracture incidence. 3 , 4 Thus, osteoporosis and bone health should be considered in all patients with both inflammatory and degenerative chronic neurological diseases.…”

Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

“…In a case-control study examining the association between MS and likelihood of developing osteopenia or osteoporosis, a total of 91 men ( n = 45) and women ( n = 46) with MS (mean [SD] age: 52.0 [10.3] years) had a total body bone mineral density of 1.12 g/cm 2 and T-score of −0.6, indicating total bone density was not in the range of osteopenia or osteoporosis according to the World Health Organization classification. However, patients with MS in this analysis had bone density in the lumbar spine (bone density: 1.07 g/cm 2 ; T-score: −1.09) and the left femoral hip (bone density: 0.69–0.86 g/cm 2 ; T-score: −1.43 to −1.56) indicative of osteopenia, suggesting bone loss may be more prominent in certain areas of the body among MS patients ( 56 ). The North American Menopause Society recommends bone mineral density be tested in postmenopausal women who are at a higher risk of osteoporosis due to medical conditions, such as MS, and provides guidance for pharmaceutical management strategies ( 61 ).…”

“…In all women, the risk of osteoporosis and related fractures increases post menopause ( 53 , 54 ). However, osteoporosis is more common in patients with MS compared with healthy populations; bone loss starts early during MS disease course, and increases as the disease progresses ( 55 , 56 ). Moreover, there is evidence showing that chronic use of glucocorticosteroids reduces bone formation and is a risk factor for osteoporotic fractures ( 57 ), although data from studies in MS patients are conflicting ( 58 – 60 ).…”

Effects of Neurological Disorders on Bone Health

“…This study also found a correlation between CAG expansion and low femoral neck score, providing further evidence that gene alterations may be related to lower BMD. Simonsen et al found that 75.3% of patients with hereditary ataxia had osteopenia or osteoporosis (Simonsen et al, 2016). These studies suggest the need for routine BMD measurements in ataxia patients to initiate prophylactic osteoporosis treatments.…”