#ClinicSpeak: bone health in MS

Are you a faller? This post is for you. #ClinicSpeak #MSBlog 

This Finnish study confirms work done in England and other parts of the world showing that MSers are at increased risk of osteoporosis (thin bones) and fractures. This is not surprising as MS is associated with thinning of the bones for several reasons; reduced exercise, higher rate of smoking and alcohol use, low vD levels and the frequent use of steroids. Another factor is falls; MS causes balance and walking problems and we frequently prescribe sedating medication (baclofen, etc.), which all increase your risk of falls. 

We have shown that in MS the biggest predictor of falls is the need for a walking aid. Therefore, if you have a walking aid (FES, foot splint, stick, etc.) you are at increased risk of falls you need to optimise your bone health. We would recommend getting a bone density scan to see if you have osteopaenia and if yes you may need medication to help strengthen your bones. At the same time you need to make sure you are taking vD supplements, are doing regular exercise, have stopped smoking, reduced your alcohol intake and have taken precautions to avoid unnecessary falls. For the latter you may need to attend a falls clinic or to see a physiotherapist. 

Falls and fractures are such a problem in MS that we have piloted a group clinic to address this issue. We are hoping to test the group clinic format as part of a formal service development audit over the next few years. The latter is pending the outcome of a small research grant with our charity. You may also find the following two NMSS videos helpful. 

Åivo et al. Risk of osteoporotic fractures in multiple sclerosis patients in southwest Finland. Acta Neurol Scand. 2016. doi: 10.1111/ane.12623.

OBJECTIVES: Increased risk of osteoporotic fractures in multiple sclerosis (MS) patients compared with general population has been reported. The purpose of this study was to assess the risk of osteoporotic and other low-energy fractures in an MS cohort from a large hospital district in southwest Finland. Age-adjusted total and gender-specific prevalence for definite MS per 100 000 in a population of 472 139 was calculated as a point prevalence in December 31, 2012.

MATERIALS AND METHODS: Patients with MS and comorbid fractures were identified by searching for ICD-9 and ICD-10 codes during a period from 2004 to 2012 from hospital administrative data in Turku University Hospital (TYKS) in southwest Finland Case ascertainment was performed by review of medical records. Osteoporotic fracture was defined as a low-energy fracture of the pelvis, hip, femur, tibia, humerus, collar bone, ulna/radius, vertebrae, or rib. The control population was a 10-fold age- and gender-matched population.

RESULTS: The point prevalence (N 1004) of MS was 212.6/105 (CI 199.5-225.8) in December 31, 2012. A total of 100 (9.9%) of 1004 confirmed MS cases experienced at least one fracture during the study period. Relative risks (RRs) for all fractures (1.33, 95% CI 1.10-1.60) and osteoporotic fractures (1.50, 95% CI 1.18-1.90) were significantly increased in patients with MS compared with controls. In particular, RRs for hip fractures (5.00, 95% CI 2.96-8.43) and fractures of humerus (2.36, 95% CI 1.32-4.42) were elevated in patients with MS vs controls.

CONCLUSIONS: We observed high prevalence of MS in southwest Finland and confirmed increased age-adjusted comorbid risk for osteoporotic fractures and other low-energy fractures compared with individually matched controls.

One thought on “#ClinicSpeak: bone health in MS”

  1. I have read that some anti-seizure medications and steroids can lower the absorption of vitamin D, what are your thought on this please? As many MSers take anti-seizure medication for spasticity.

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