Weak Bones That Are Prone to Fractures May Affect Many With MS

Almost half of multiple sclerosis (MS) patients show reduced bone density (osteopenia) and about 17% have osteoporosis, a progressive disease characterized by weak bones that are prone to fractures, a review study of data covering almost 14,000 patients reported.

These findings suggest that people with MS should be monitored for bone health, its researchers noted.

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.

Previous studies have suggested that MS patients are at an increased risk of osteopenia and osteoporosis due to several factors known to reduce bone mass.

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These include the prolonged motor disability associated with MS that reduces mechanical loading of bone, vitamin D deficiency — suggested as a disease risk factor — and the use of corticosteroids, the standard immunosuppressive treatment for MS relapses.

However, the reported frequency of osteoporosis in patients varies among studies.

In an attempt to estimate the real frequency of osteoporosis and osteopenia in this population, a team of researchers in Iran systemically reviewed studies published up to March 2021 reporting the occurrence of these bone disorders in people with MS.

From a total of 658 studies analyzed for eligibility, 35 — covering 13,906 patients — were included in the meta-analysis.

These studies were published between 2004 and 2020, and included 29 full studies and six conference abstracts or posters. About half (51%) were conducted in Europe, and 31.4% in Turkey or the U.S.

The number of patients in each study ranged from 10 to over 9,300, and their mean age ranged from 25 to 56.

More than a third of the studies (37.1%)  were considered to be high quality, defined as scores of 7–9 in the Newcastle-Ottawa quality assessment scale. The others showed at least some risk of bias, meaning that their features or design provided a lower confidence in their results.

Analysis showed the pooled prevalence of osteopenia among MS patients to be 43% and that of osteoporosis 17%. These prevalences were similar to those seen in older adults of the general population, suggesting that people with MS have a higher risk of these bone disorders at earlier ages.

Findings indicate that “osteoporosis/osteopenia should be considered in patients with MS,” the researchers wrote.

They noted, however, that further studies are needed to assess the occurrence of osteoporosis and osteopenia in MS patients, while considering the differences in vitamin D deficiency rates between nations closer or farther away from the equator.

Vitamin D production is dependent on skin exposure to sunlight, with people living in areas farther away from the equator making less of this vitamin.