People with multiple sclerosis (MS) have many reasons to have low bone mineral density and an increased fracture risk. Osteoporosis is a major cause of morbidity and mortality, and is more common in people with MS than the general population. A number of studies have examined the relationship between multiple sclerosis and reduced bone mineral density. In this topical review we seek to address the risk of low bone mineral density, osteoporosis and fractures associated with MS, and make practical suggestions as to how this pertinent issue may be approached in clinical practice.
HolroydCCooperCDennisonE. Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab2008; 22: 671–685.
2.
RayNFChanJKThamerM. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res1997; 12: 24–35.
3.
HearnAPSilberE. Osteoporosis in multiple sclerosis. Mult Scler2010; 16: 1031–1043.
4.
UnnanuntanaAGladnickBPDonnellyE. The assessment of fracture risk. J Bone Joint Surg Am2010; 92: 743–753.
5.
KanisJAJohnellOOdenA. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int2008; 19: 385–397.
6.
Van den BerghJPvan GeelTALemsWF. Assessment of individual fracture risk: FRAX and beyond. Curr Osteoporos Rep2010; 8: 131–137.
7.
MungerKLLevinLIHollisBW. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA2006; 296: 2832–2838.
8.
HandelAEWilliamsonAJDisantoG. Smoking and multiple sclerosis: an updated meta-analysis. PLoS One2011; 6: e16149.
9.
RamagopalanSVDymentDACaderMZ. Rare variants in the CYP27B1 gene are associated with multiple sclerosis. Ann Neurol2011; 70: 881–886.
10.
CatenoixHMarignierRRitlengC. Multiple sclerosis and epileptic seizures. Mult Scler2011; 17: 96–102.
11.
SvalheimSRøsteLSNakkenKO. Bone health in adults with epilepsy. Acta Neurol Scand Suppl2011: 89–95.
12.
CrawfordP. Best practice guidelines for the management of women with epilepsy. Epilepsia2005; 46 (Suppl 9): 117–124.
13.
SandhuSKHampsonG. The pathogenesis, diagnosis, investigation and management of osteoporosis. J Clin Pathol2011; 64: 1042–1050.
14.
FinlaysonMLPetersonEWFujimotoKA. Rasch validation of the falls prevention strategies survey. Arch Phys Med Rehabil2009; 90: 2039–2046.
15.
GillespieWJGillespieLDParkerMJ. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev2010: CD001255.
16.
TriantafyllouNLambrinoudakiIThodaP. Lack of association between vitamin D levels and bone mineral density in patients with multiple sclerosis. J Neurol Sci2012; 313: 137–141.
17.
BazelierMTde VriesFBentzenJ. Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers. Mult Scler2012; 18: 622–627. Epub ahead of print 21 October 2011.
18.
BazelierMTvan StaaTUitdehaagBM. The risk of fracture in patients with multiple sclerosis: the UK general practice research database. J Bone Miner Res2011; 26: 2271–2279.
19.
MoenSMCeliusEGSandvikL. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology2011; 77: 151–157.
20.
MoenSMCeliusEGNordslettenL. Fractures and falls in patients with newly diagnosed clinically isolated syndrome and multiple sclerosis. Acta Neurol Scand Suppl2011: 79–82.
21.
SiokaCPapakonstantinouSFotopoulosA. Bone mineral density in ambulatory patients with multiple sclerosis. Neurol Sci2011; 32: 819–824.
22.
SteffensenLHJorgensenLStraumeB. Can vitamin D supplementation prevent bone loss in persons with MS? A placebo-controlled trial. J Neurol2011; 258: 1624–1631.
23.
SteffensenLHMellgrenSIKampmanMT. Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis. J Neurol2010; 257: 410–418.
24.
TerziTTerziMTanderB. Changes in bone mineral density and bone metabolism markers in premenopausal women with multiple sclerosis and the relationship to clinical variables. J Clin Neurosci2010; 17: 1260–1264.
25.
ShuhaibarMMcKennaMJAu-YeongM. Favorable effect of immunomodulator therapy on bone mineral density in multiple sclerosis. Ir J Med Sci2009; 178: 43–45.
26.
MojtahediMCSnookEMMotlRW. Bone health in ambulatory individuals with multiple sclerosis: impact of physical activity, glucocorticoid use, and body composition. J Rehabil Res Dev2008; 45: 851–861.
27.
OzgocmenSBulutSIlhanN. Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity. J Bone Miner Metab2005; 23: 309–313.
28.
ZorzonMZivadinovRLocatelliL. Long-term effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis. Eur J Neurol2005; 12: 550–556.
29.
DovioAPerazzoloLOsellaG. Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose, short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab2004; 89: 4923–4928.
30.
Weinstock-GuttmanBGallagherEBaierM. Risk of bone loss in men with multiple sclerosis. Mult Scler2004; 10: 170–175.
31.
TuzunSAltintasAKaracanI. Bone status in multiple sclerosis: beyond corticosteroids. Mult Scler2003; 9: 600–604.
32.
CosmanFNievesJKomarL. Fracture history and bone loss in patients with MS. Neurology1998; 51: 1161–1165.
33.
SchwidSRGoodmanADPuzasJE. Sporadic corticosteroid pulses and osteoporosis in multiple sclerosis. Arch Neurol1996; 53: 753–757.
34.
NievesJCosmanFHerbertJ. High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology1994; 44: 1687–1692.
35.
HotermansCDDRinkinCLeroyM. Hip bone mineral density is correlated with EDSS in patients with multiplesclerosis. J Neurol2006; 253: 126.
36.
El-GhoneimyATGadAHSamirH. Contribution of vitamin D to the pathogenesis of multiple sclerosis and its effect on bone. Egyptian Journal of Neurology, Psychiatry and Neurosurgery2009; 49: 209–222.
37.
Weinstock-GuttmanBHongJSantosR. Interferon-beta modulates bone-associated cytokines and osteoclast precursor activity in multiple sclerosis patients. Mult Scler2006; 12: 541–550.
38.
BatistaSTeterBSequeiraK. Cognitive impairment is associated with reduced bone mass in multiple sclerosis. Mult Scler.Epub ahead of print 14 March2012.
39.
HerndonRMohandasN. Osteoporosis in multiple sclerosis: a frequent, serious, and under-recognized problem. In J MS Care2000; 2: 5–12.
40.
VarogluAOVarogluEBayraktarR. The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients. J Back Musculoskelet Rehabil2010; 23: 25–29.
41.
GibsonJCSummersGD. Bone health in multiple sclerosis. Osteoporos Int2011; 22: 2935–2949.
42.
LoganWCJrSloaneRLylesKW. Incidence of fractures in a cohort of veterans with chronic multiple sclerosis or traumatic spinal cord injury. Arch Phys Med Rehabil2008; 89: 237–243.
43.
SibleyWABamfordCRClarkK. A prospective study of physical trauma and multiple sclerosis. J Neurol Neurosurg Psychiatry1991; 54: 584–589.
44.
TroianoRAJotkowitzACookSD. Rate and types of fractures in corticosteroid-treated multiple sclerosis patients. Neurology1992; 42: 1389–1391.
45.
DennisonEMCompstonJEFlahiveJ. Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 2012; 50: 1288–1293. Epub ahead of print 9 March 2012.
46.
MarrieRACutterGTyryT. A cross-sectional study of bone health in multiple sclerosis. Neurology2009; 73: 1394–1398.
47.
KampmanMTEriksenEFHolmoyT. Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications?Acta Neurol Scand Suppl2011: 44–49.
48.
MarcusJFShalevSMHarrisCA. Severe hypercalcemia following vitamin D supplementation in a patient with multiple sclerosis: a note of caution. Arch Neurol2012; 69: 129–132.
49.
National Institute for Health and Clinical Excellence. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women, http://www.nice.org.uk/guidance/TA160 (2011, accessed 20/05/2012.
