Fractures Should Be Concerning to Clinicians Caring for Patients With MS


A recent meta-analysis shows that a large proportion of people with multiple sclerosis have osteopenia or osteoarthritis. Lack of mobility and vitamin D deficiencies may play a causative role.

Many individuals with multiple sclerosis (MS) may have weak bones that predispose them to fractures, suggesting that bone health monitoring is important for people with this disease of the central nervous system, a new meta-analysis has shown.

Osteopenia — the medical term for bone mineral density that is lower than normal — affected 43% of MS patients included in the meta-analysis, which included 29 studies, six conference papers and almost 14,000 study subjects.

The meta-analysis also found that about 17% of MS patients have osteoporosis, which is characterized by lower bone density that osteopenia, so bones are even more fragile and susceptible to fracture.

The review study, “The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis,” was published in the journal Neurological Sciences.

“It’s helpful for clinicians to have a systematic review and meta-analysis demonstrating the prevalence of osteopenia and osteoporosis in the MS population,” says Julie Fiol, M.S.W., BSN, RN, MSCN, associate vice president of healthcare access at the National Multiple Sclerosis Society. “Hopefully, this helps raise awareness of the need for appropriate screening.”

Researcher have identified several factors that may make MS patients prone to developing osteopenia and osteoporosiss: prolonged, MS-related motor disability that diminishes mechanical loading of bone, vitamin D deficiency and the use of corticosteroids to treat MS relapses.

“Mobility impairment is a risk factor for decreased bone density, and it is also a risk factor for falls,” notes Fiol. “If someone with decreased bone density falls, they are more prone to bone fractures, which leads to further impaired mobility and other complications. “People with MS, even those with mobility impairment, should be encouraged to exercise regularly, particularly to engage in weight-bearing exercise, she adds.

Lead author Mohaddeseh Azadvari of the Department of Physical Medicine and Rehabilitation at Imam Khomeini Hospital in Tehran, Iran, sifted through studies published up to March 2021. The research included in the meta-analysis was published between 2004 and 2020.

Azadvari and his colleagues said that additional research would be necessary to further elucidate the occurrence of osteoporosis and osteopenia in MS patients. Res

Other research has drawn a connection between MS and vitamin D deficiency. A link between MS and low vitamin D levels would fit with the fact that MS is more common in northern latitudes. Vitamin D production relies on skin exposure to sunlight, so people residing farther away from the equator are at higher risk of deficiency.

Fiol recommends that clinicians measure vitamin D level with a blood test and recommend supplementation when appropriate. A bone density scan also can be performed, especially for those with risk factors, such as mobility impairment and frequent corticosteroid use.

Beyond that, “people should ensure they are getting adequate calcium intake in their diet or supplement if needed,” she says. “Limiting alcohol intake and smoking cessation can also improve bone health.”

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