Fractures should be a concern for clinicians caring for MS patients

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

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

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

The meta-analysis also revealed that approximately 17% of MS patients have osteoporosis, which is characterized by lower bone density than osteopenia, making bones 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 is 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, MSW, BSN, RN, MSCN, Associate Chair of Health Care Access at the National Multiple Sclerosis Society. “I hope this will help raise awareness of the need for proper screening.”

Researchers have identified several factors that may make MS patients susceptible to developing osteopenia and osteoporosis: MS-related prolonged motor disability that decreases the mechanical load on the bones, vitamin D deficiency and l use of corticosteroids to treat MS relapses.

“Reduced mobility is a risk factor for decreased bone density, and it’s also a risk factor for falls,” notes Fiol. “If someone with reduced bone density falls, they are more prone to bone fractures, leading to even more reduced mobility and other complications.” People with MS, even those with limited mobility, should be encouraged exercise regularly, especially weight-bearing exercises, she adds.

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

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

Other research has linked MS to 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 is dependent on skin exposure to sunlight, so people residing farther from the equator are at higher risk of deficiency.

Fiol recommends clinicians measure vitamin D levels with a blood test and recommend supplementation if appropriate. A bone density test may also be done, especially for people with risk factors, such as reduced mobility and frequent use of corticosteroids.

Beyond that, “people need to make sure they’re getting enough calcium in their diet or in supplements if needed,” she says. “Limiting alcohol intake and quitting smoking may also improve bone health.”


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