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Osteoporosis and Multiple Sclerosis

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Updated August 07, 2007

People with multiple sclerosis (MS) are at an increased risk for osteoporosis. This increased risk is not a direct result of the MS disease process, but as a secondary factor of some of the treatments used in MS, and a reduction in physical activity in people with MS due to disability.

What is Osteoporosis?

Osteoporosis is a loss of bone density. As a person ages, bone density (especially in women) decreases. A person with osteoporosis is at risk for fractures from falls due to the weakness of the bone. The decrease in bone density caused by osteoporosis can be slowed through physical activity. Each year, osteoporosis is responsible for over 1.5 million fractures, including 300,000 hip fractures and 700,000 back fractures. It is estimated that over half of all women and a quarter of all men over 50 years old will break a bone due to osteoporosis.

Osteoporosis and MS

In people with MS, disability can reduce the amount of physical activity which is possible, thereby increasing the risk of osteoporosis. In addition, people with MS often must take certain medications, like steroids, that can contribute to a higher osteoporosis risk.

As was mentioned before, people with osteoporosis have lower bone density than normal. Lower bone density means that bones can break more easily and more severely in the event of a fall. This is especially dangerous for people with MS because MS can cause symptoms that affect balance and coordination. People with MS are likely to suffer from more frequent falls. If osteoporosis is present in someone with MS, those falls are likely to be much more serious.

Steroids and Osteoporosis

Long-term steroid use is known to be a risk factor for osteoporosis. The steroids interfere with the ability of the bones to build up and with the ability of the body to absorb calcium. This combination results in reduction of bone density. People who take steroids long-term need to be carefully monitored for osteoporosis. Medications and supplements exist that can help slow bone loss.

What About Short-Term Steroids?

While most people with MS do not take prolonged courses of steroids, high doses of intravenous corticosteroids like Solu-Medrol are used to shorten the duration and intensity relapses. Some doctors also use these kinds of steroids as “pulse therapy,” where patients are given regular doses to reduce inflammation.

In studies, young people with MS who were not otherwise disabled showed a rapid reduction in bone density after a treatment with Solu-Medrol, followed by an increase in bone formation. Another study showed that using “pulses” of methylprednisolone did not lead to the development of osteoporosis. What does this mean? It seems that short-term use of steroids causes bones to first weaken and then recover. However, the studies also showed that people with more disability still had a greater risk of osteoporosis. In other words, your body needs physical activity to maintain strong bones.

Physical Activity and Osteoporosis

Bones need to be stimulated to grow stronger. Any activity that is weight-bearing will help your bones. People with MS with disabilities are often less active than other people. This seems to be the main cause of an increase in osteoporosis risk.

The Bottom Line

No matter what your disability level is, you still need physical activity to stay healthy. Seek out a physical therapist if you do not know how to get more exercise. This will not only decrease your risk for osteoporosis, but also decrease your risk for heart disease, diabetes and many other chronic illnesses. You’ll even sleep better, too.

Sources:

Zorzon M, Zivadinov R, Locatelli L, Giuntini D, Toncic M, Bosco A, Nasuelli D, Bratina A, Tommasi MA, Rudick RA, Cazzato G. Long-term effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis. Eur J Neurol. 2005 Jul;12(7):550-6.

Dovio A, Perazzolo L, Osella G, Ventura M, Termine A, Milano E, Bertolotto A, Angeli A. Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose, short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab. 2004 Oct;89(10):4923-8.

National Institute of Arthiritis and Musculosketetal and Skin Disease. Osteoporosis Overview.

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