It is increasingly being recognized that patients with multiple sclerosis (MS) have lower bone mineral density and a higher risk of fractures than do matched controls. This is true for both male and female patients.
Patients with MS are at risk for disability caused by the disease itself, by the resultant immobility, and by the use of corticosteroids during relapses. They are also at greater risk for falls secondary to weakness and/or ataxia compared with the general population.
Recent studies have shown that even at disease onset, patients with MS have significantly lower bone mineral density than healthy controls.1 This implies that factors other than disability are acting at an early stage to reduce bone mineral density.
It is therefore clear that close attention needs to be paid to the bone health of patients with MS. This means offering patients dual-energy x-ray absorptiometry (DEXA) screening early on in the disease’s course and at regular intervals. Interventions to improve bone health need to be provided when indicated.
The treatment of reduced bone mineral density in MS should follow locally agreed guidelines. Lifestyle advice, smoking cessation, and correction of low serum levels of vitamin D appear to be a logical approach for all patients. Combined calcium and vitamin D supplementation is the mainstay of bone health promotion in healthy adults.
1. Moen SM, Celius EG, Sandvik L, et al. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology. 2011;77:151-157.