Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis

Abstract

The implications of having multiple sclerosis (MS) for bone health are incompletely understood. The aim of this population-based study is to identify past and current exposures that are associated with bone mass in fully ambulatory persons with MS up to age 50 years and to determine the prevalence of low bone mineral density (BMD) in this group. We measured BMD (hips, lumbar spine, forearms), physical function, BMI, and serum 25(OH) vitamin D in 55 women and 25 men with MS. Patients provided information on demographic variables and medical history, as well as past and current vitamin D and calcium intake, physical activity, and lifestyle habits. In regression analyses, BMD levels were adjusted for age, sex, and BMI. At the femoral neck, strong associations were found for walking distance (beta = 0.152; P < 0.001) and age (beta = -0.004; P = 0.003), and less certain associations for male sex (beta = 0.055; P = 0.014) and 10-foot timed tandem walk (-0.008; P = 0.013). At the lumbar spine, walking distance (beta = 0.013; P = 0.006) and possibly physical activity growing up (beta = 0.035; P = 0.028) and male sex (beta = -0.057; P = 0.042), were associated with BMD. At the ultradistal radius, strength of grip (beta = 0.001; P = 0.002), and, less certainly, summer outdoor activities age 16-20 (beta = 0.021; P = 0.009), and age at MS onset (beta = 0.002; P = 0.036) were associated with BMD. Low BMD (z score < or = -2) was present in 19 out of 80 patients. This study shows that MS-related variables as well as past exposures differentially affect BMD at three clinically important skeletal sites. Low BMD is prevalent in these young patients. Bone health should receive attention in care for persons with MS.

Bone health in multiple sclerosis

“…There seems to be no correlation between vitamin D levels and BMD in MS, although this may be due to the small numbers of patients included in the published studies and the different countries in which these studies were conducted [8][9][10]53]. One Australian case-control study found a strong negative correlation between the degree of disability, measured by EDSS, and serum 25-OHD levels, which were mathematically adjusted for the season [66].…”

Physical Exercise for Secondary Osteoporosis

“…Early findings in breast and prostate cancer, arthritis, stroke, heart transplantation, and weight loss studies require additional research to confirm early findings and to examine physiologic mechanisms of bone preservation given various possible disease and drug interactions with exercise and bone. Moreover, preliminary research with multiple sclerosis patients who are also susceptible to secondary osteoporosis, have preliminary research to suggest that exercise may improve fracture risk through physical fitness and physical activity [145]. However, intervention studies in these populations using bone outcomes are not available.…”

The nervous system's potential role in multiple sclerosis associated bone loss

“…Additionally, the early symptoms of MS can be hard to determine but early diagnosis and treatment leads to a better disease course (5). Although there are many risk factors for developing osteoporosis in the general population, the most extensively studied risk factors in MS patients are physical inactivity, treatment with glucocorticoids, and smoking (4,(6)(7)(8).…”