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Osteoporosis in MS

Vicki Matthews, MS specialist nurse and MS Trust nurse advisor, MS Trust, Letchworth, UK.

Way Ahead 2012;16(3):8

Osteoporosis is characterised by reduced bone mass and disruption of bone micro architecture, resulting in reduced bone strength and increased risk of fragility fracture. In the UK, more than two million women are thought to have osteoporosis. Age-related bone loss affects both women and men, but women lose bone more rapidly during the menopause. At the age of 50, about two in 100 women have osteoporosis. This increases to one in four women by the age of 80. Over a third of women and one fifth of men aged 50 years in the UK will suffer one or more fragility fractures in their remaining lifetime. It is recognised that osteoporosis is likely to become a general major health issue with an increasingly elderly population.

Evidence exists to show that people diagnosed with MS are at increased risk of osteoporosis and fragility fractures1-4. There is currently little guidance on managing the risk of osteoporosis in people with MS in the UK and a paucity of evidence on the risk factors or incidence in MS.

Low vitamin D is a potential risk factor in MS and vitamin D mediates bone mineralisation. If vitamin D exerts a major effect on MS risk then skeletal consequences of hypovitaminosis D could manifest at the onset of MS. Some studies suggest that low bone mass could occur early in the MS trajectory5.

Currently, a team at the King's College, London and the MS Trust are bringing together experts in the field of MS and those in osteoporosis and biochemistry, to examine the available evidence, determine need and prepare content for two planned publications on osteoporosis in MS:

  • Guidelines for clinicians.
  • A factsheet for people with MS.

The rationale for these publications is to set out best practice guidance for prevention and management of osteoporosis in MS that utilises current general best practice for osteoporosis and incorporates those factors particularly relevant to people with MS.

The steering and advisory committee includes people living with MS, individuals with osteoporosis, MS specialist nurses and therapists, consultant neurologists, rheumatology consultants, clinical biology specialists, bone medicine specialists, rheumatology and osteoporosis nurse specialists, the MS Trust and National Osteoporosis Society. The project started with face to face meetings and has followed a governance process of inclusive reviews and revisions.

The professional guidance will be provided in easy to understand terminology designed to provide a holistic overview on managing osteoporosis risk in MS. The guidance includes general, as well as, MS specific risk factors, investigations, and treatments.

The guidance for clinicians will consider the risk factors for osteoporosis in MS and the importance of an annual assessment and review by a suitably trained health professional with in depth knowledge about MS.

The evidence points to the importance of taking a holistic approach to fracture risk in people with MS and to consider the:

  • range of contributory risk factors, and likelihood of an individual being at risk of fracturing
  • most appropriate point along the disease trajectory to assess bone health
  • optimum time to discuss and agree treatment decisions
    • .

The osteoporosis factsheet for people with MS will consist of a number of sections in a question and answer format that include advice on how best to safe-guard bone health. It will also provide advice for health professionals diagnosing and treating osteoporosis.

This innovative project remains a work in progress. It is exciting and challenging, but is indicative of how we can work best in the future; sharing expertise, knowledge and skills with those who live with a long-term condition so that good health choices can be made at the very beginning. Choices that impact later life and minimise the risk of "if only"...

References

  1. Bazelier MT, van Staa T, Uitdehaag BM, et al. The risk of fracture in patients with multiple sclerosis: the UK general practice research database. J Bone Miner Res 2011; 26(9):2271-9.
  2. Gibson JC, Summers GD. Bone health in multiple sclerosis. Osteoporos Int 2011; 22(12):2935-49.
  3. World Health Organization (WHO). Assessment of osteoporosis at the primary healthcare level. Summary meeting report of a WHO Scientific Group. WHO: Geneva, Switzlerand; 2007.
  4. Hearn AP, Silber E. Osteoporosis in multiple sclerosis. Mult Scler 2010;16(9):1031-43.
  5. Moen SM, Celius, EG, Sandvik L, et al. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology 2011; 77(2):151-7.