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MS research update - What affects bone health and strength in people with MS? - 25 November 2014

Summary

Losing bone density is a natural part of the aging process, but some people develop osteoporosis where bones become thin and brittle and more prone to breaking. Previous research has shown that people with MS are at increased risk of developing osteoporosis. This study pulled together the results from previous research studies to investigate the relationship between MS and osteoporosis and factors which may affect bone density to see if they could find any relationships or patterns.

The study found that when compared to healthy controls, people with MS had significantly reduced bone density in their lower spine, neck of the femur bone, (the part of the thigh bone that connects it to the hip joint) and hip. This risk of reduced bone density was found to be higher the longer someone has lived with a diagnosis of MS and seemed to also be related to the total level of steroids taken in their treatment.

The authors conclude that future studies would need to work out exactly why bone density at these specific locations is reduced in people with MS so steps can be taken to prevent density loss in these bones and reduce the risk of breaks.

Background

Losing bone density is a natural part of the aging process, but some people develop osteoporosis which is a condition where bones lose more of their density than they should, leaving bone thin and brittle and more prone to breaking. Previous research has shown that people with MS are at increased risk of developing osteoporosis, due to several factors including problems with mobility, long-term exposure to steroids and vitamin D deficiency. This study pulled together the results of previous research to investigate the relationship between MS and osteoporosis and factors which may affect bone density.

How this study was carried out

This study was a review which pooled the results from previous studies which had measured bone density in people with MS. 11 studies were examined and several items of information were extracted. These included the number and age of the participants with MS, duration of living with MS, EDSS scores, bone density, number of breaks and total steroid dose, which is the total level of steroids they have ever taken. In total these 11 studies included over 600 people with MS and 1,300 control participants. The researchers then looked at all of this information to see if they could find any relationships or patterns.

What was found

The study found that when compared to healthy controls, people with MS had significantly reduced bone density in their lower spine, neck of the femur bone, (the part of the thigh bone that connects it to the hip joint) and hip.

Additional analysis of the information found that there was an increased risk of reduced bone density in people who had been diagnosed with MS for more than seven years, had an EDSS score of greater than three and had taken more than 15g of steroids in total during their treatment.

What does it mean?

The study shows that people with MS can be at risk of reduced bone density and osteoporosis. This risk is increased the longer someone has lived with a diagnosis of MS and seems to also be related to the total level of steroids taken in their treatment. The authors do comment that their study is limited as they have not examined all of the factors that may influence MS disease course and bone health, including smoking, vitamin D and physical activity. They conclude that future studies would need to work out exactly why bone density at these specific locations is reduced in people with MS so steps can be taken to prevent density loss in these bones and reduce the risk of breaks

Huang Z, Qi Y, Du S et al.
Bone mineral density levels in adults with multiple sclerosis: A meta-analysis.
Int J Neurosci. 2014 Nov 18:1-21. [Epub ahead of print]
abstract

More about healthy bones

Osteoporosis is a progressive condition that causes the bones to become thin and brittle, making them more prone to fractures. Factors that increase the risk of osteoporosis in people with MS include problems with mobility and weight bearing, long-term exposure to corticosteroids (sometimes used for short periods to treat MS relapses), antidepressants or anxiolytics (used to treat anxiety) and age.

Losing some bone density is a natural part of aging and not everyone will get osteoporosis, but the advice given to help prevent it, is useful for anyone wanting to look after their bone health:

  • Consume sufficient vitamin D and calcium both are needed for building strong bones.
  • Eat a balanced diet, too much protein and salt can affect calcium levels in the body and weaken bones.
  • Exercise or be active, as bones will stay strong if you use them.

NHS choices has further information on how to maintain strong healthy bones.

Falling and the risk of breaking a bone

Weaker bones are at more risk of breaking when the person has a slip, trip or fall. Falls can happen for a variety of reasons and are common irrespective of age or medical condition. However, there are a few factors that can be more common in people with MS that can make falls more likely:

There are a number of things you can do to reduce the risk of falling:

  • Have regular eye tests. If you do have eye problems, there are a number of special lenses that could help.
  • Ensure your path is clear and free of obstacles, such as removing loose rugs, which could be a trip or slip hazard.
  • If you feel unsteady talk to your physiotherapist about walking aids or other techniques for improving your balance and walking technique.
  • If you get tired easily, pace yourself, and consider some fatigue management techniques.

You can read more suggestions in Falls: managing the ups and downs of MS which can be read online, downloaded as a pdf file or ordered as a printed version.

Research by topic areas...

Assessment tools

Motl RW, Learmonth YC, Pilutti LA, et al.
Validity of minimal clinically important difference values for the multiple sclerosis walking scale-12?
Eur Neurol. 2014;71(3-4):196-202.
abstract

Causes of MS

Oliveira AC, Maria Henrique da Mota L, Dos Santos-Neto LL, et al.
Occurrence of autoimmune diseases related to the vaccine against yellow fever.
Autoimmune Dis. 2014;2014:473170.
abstract
Read the full text of this paper

Disease modifying treatments

Arvin AM, Wolinsky JS, Kappos L, et al.
Varicella-zoster virus infections in patients treated with fingolimod: risk assessment and consensus recommendations for management.
JAMA Neurol. 2014 Nov 24. [Epub ahead of print]
abstract

Kavaliunas A, Stawiarz L, Hedbom J, et al.
The influence of immunomodulatory treatment on the clinical course of multiple sclerosis.
Adv Exp Med Biol. 2015;822:19-24.
abstract

Nixon R, Bergvall N, Tomic D, et al.
No evidence of disease activity: indirect comparisons of oral therapies for the treatment of relapsing-remitting multiple sclerosis.
Adv Ther. 2014 Nov 21. [Epub ahead of print]
abstract
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Teriflunomide (Aubagio) (14 mg Film-coated Tablet): teriflunomide is indicated as monotherapy for the treatment of patients with relapsing-remitting multiple sclerosis to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability [internet].
Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Oct.
abstract
Read the full text of this paper

Doerner M, Beckmann K, Knappertz V, et al.
Effects of inhibitors of the renin-angiotensin system on the efficacy of interferon beta-1b: a post hoc analysis of the BEYOND study.
Eur Neurol. 2014;71(3-4):173-9.
abstract

Physical activity

Motl RW.
Benefits, safety, and prescription of exercise in persons with multiple sclerosis.
Expert Rev Neurother. 2014 Nov 21:1-8. [Epub ahead of print]
abstract

Pregnancy and childbirth

Bove R, Alwan S, Friedman JM, et al.
Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review.
Obstet Gynecol. 2014 Dec;124(6):1157-68.
abstract

Coyle PK.
Multiple sclerosis and pregnancy prescriptions.
Expert Opin Drug Saf. 2014 Dec;13(12):1565-8.
abstract
Read the full text of this paper

Provision of care

Brand J, Köpke S, Kasper J, et al.
Magnetic resonance imaging in multiple sclerosis - patients' experiences, information interests and responses to an education programme.
PLoS One. 2014;9(11):e113252.
abstract
Read the full text of this paper

Self-management

Fragoso YD.
Modifiable environmental factors in multiple sclerosis.
Arq Neuropsiquiatr. 2014 Nov;72(11):889-94.
abstract
Read the full text of this paper

Symptoms and symptom management

Fragalà E, Russo GI, Di Rosa A, et al.
Relationship between urodynamic findings and sexual function in multiple sclerosis patients with lower urinary tract dysfunction.
Eur J Neurol. 2014 Nov 19. [Epub ahead of print]
abstract

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