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Bone Loss Evident in MS & Other Neurological Disorders Due to Immobility

December 20, 2016

Patients with multiple sclerosis and other neurological diseases may be at risk of developing problems with bone mineral density, researchers found.

In a case-control study of 91 people with MS versus 77 with the non-inflammatory neurological diseases Hereditary Spastic Paraplegia (HSP) or Hereditary Ataxia (HA), about 75% in each group had osteopenia or osteoporosis in one or more sites, Cecilia Simonsen, MD, of Oslo University Hospital in Norway, and colleagues reported online in BMC Neurology.

Although osteoporosis was twice as common in the MS group compared with the HSP/HA group, the difference did not reach significance after correction for confounders. While HA and HSP affect locomotion to the same extent as MS, these diseases are considered primarily neurodegenerative rather than inflammatory and are not treated with glucocorticoids, making them relevant comparators for charting the possible impact of inflammation and glucocorticoid treatment on bone health in MS, the researchers explained.

"Although inflammation may be an integral part of bone loss in early MS, our current results suggest that the systemic inflammation in MS is not sufficient to increase bone loss over time as is seen in other systemic inflammatory diseases such as inflammatory bowel disease," the researchers wrote.

Given that the level of disability in both groups was "fairly equal in our study, immobility is likely the main reason for high levels of osteoporosis and osteopenia in both groups," they said.

The mean age of participants was 55, with equal numbers of men and women in each group. More than half of the MS group had relapsing-remitting (RRMS), with 37% and 7% diagnosed with secondary progressive MS and primary progressive MS, respectively.

While limited or no ambulation is a primary factor, these findings coincide with Weinstock-Guttman's 2012 study that found that cognitively impaired MS patients without walking disability had lower bone density, suggesting potential involvement of a central control of the complex path influencing bone homeostasis.

"Assessing bone status in women and men with MS is necessary, especially given that they also have a higher risk for falls and sure fractures," she said.

Gaurav Guliani, MD, of the University of Minnesota, who was not involved in the study, added that bone health is an "important consideration for all chronic disease patients, especially those on chronic medications and in chronic disabling neurological diseases. Dr. Simonsen and her team continue to do important work and we look forward to further studies."