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Yazdan Panah M, Vaheb S, Moases Ghaffary E, Shaygannejad V, Zabeti A, Mirmosayyeb O. Bone loss and fracture in people with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 90:105773. [PMID: 39068819 DOI: 10.1016/j.msard.2024.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/29/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) exhibit reduced bone mineral density (BMD) across several anatomical regions. Studies have indicated that PwMS are at a heightened risk of fractures due to decreased BMD and increased prevalence of osteopenia and osteoporosis. This study aimed to investigate the prevalence and risk of osteopenia, osteoporosis, and fracture among PwMS. METHODS Relevant studies were identified through comprehensive searches of databases (PubMed/MEDLINE, Scopus, Embase, and Web of Science) from January 1, 2000, to January 21, 2024. R software version 4.4.0 and random-effects models were employed to estimate the pooled prevalence, odds ratio (OR), and risk ratio (RR) of osteopenia, osteoporosis, and fracture among PwMS, along with their respective 95 % confidence intervals (CIs). RESULTS From a total of 2039 articles, 51 studies with 1,503,785 PwMS met our inclusion criteria. The pooled prevalence of osteopenia, osteoporosis, and overall fracture among PwMS was 41.41 % (95 % CI: 36.14% to 46.69 %, I2=97 %), 14.21 % (95 % CI: 10.75 % to 17.68 %, I2=99 %), and 12.84 % (95 % CI: 8.49 % to 17.19 %, I2 = 100 %), respectively. The likelihood of osteopenia (OR=2.02, 95 % CI: 1.46 to 2.8, p-value<0.01, I2=17 %) and osteoporosis (OR=1.71, 95 % CI: 1.27 to 2.31, p-value<0.01, I2=74 %), as well as the probability of overall fracture (RR=1.86, 95 % CI: 1.61 to 2.14, p-value<0.01, I2=74 %) were significantly higher in PwMS than healthy controls (HCs). CONCLUSION PwMS were at a substantially increased risk of developing osteopenia (2-fold), osteoporosis (1.7-fold), and overall fractures (1.9-fold). Well-designed studies are needed to explore these associations further.
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Affiliation(s)
- Mohammad Yazdan Panah
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aram Zabeti
- Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Zhang Y, Zhao X, Ge D, Huang Y, Yao Q. The impact and mechanism of nerve injury on bone metabolism. Biochem Biophys Res Commun 2024; 704:149699. [PMID: 38412668 DOI: 10.1016/j.bbrc.2024.149699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
With an increasing understanding of the mechanisms of fracture healing, it has been found that nerve injury plays a crucial role in the process, but the specific mechanism is yet to be completely revealed. To address this issue and provide novel insights for fracture treatment, we compiled this review. This review aims to study the impact of nerve injury on fracture healing, exploring the role of neurotrophic factors in the healing process. We first revisited the effects of the central nervous system (CNS) and the peripheral nervous system (PNS) on the skeletal system, and further explained the phenomenon of significantly accelerated fracture healing under nerve injury conditions. Then, from the perspective of neurotrophic factors, we delved into the physiological functions and mechanisms of neurotrophic factors, such as nerve growth factor (NGF), Neuropeptides (NPs), and Brain-derived neurotrophic factor (BDNF), in bone metabolism. These effects include direct actions on bone cells, improvement of local blood supply, regulation of bone growth factors, control of cellular signaling pathways, promotion of callus formation and bone regeneration, and synergistic or antagonistic effects with other endocrine factors, such as Sema3A and Transforming Growth Factor β (TGF-β). Finally, we discussed the treatments of fractures with nerve injuries and the future research directions in this review, suggesting that the relationship between nerve injury and fracture healing, as well as the role of nerve injury in other skeletal diseases.
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Affiliation(s)
- Yongqiang Zhang
- Department of Orthopedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Key Lab of Additive Manufacturing Technology, Institute of Digital Medicine, Nanjing Medical University, Nanjing, China; Research Center of Digital Medicine and 3D Printing Technology of Jiangsu Province, Nanjing, China
| | - Xiao Zhao
- Department of Orthopedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Key Lab of Additive Manufacturing Technology, Institute of Digital Medicine, Nanjing Medical University, Nanjing, China; Research Center of Digital Medicine and 3D Printing Technology of Jiangsu Province, Nanjing, China
| | - Dawei Ge
- Department of Orthopedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Key Lab of Additive Manufacturing Technology, Institute of Digital Medicine, Nanjing Medical University, Nanjing, China; Research Center of Digital Medicine and 3D Printing Technology of Jiangsu Province, Nanjing, China
| | - Yang Huang
- International Innovation Center for Forest Chemicals & Materials and Jiangsu Co-Innovation Center of Efficient Processing & Utilization of Forest Resources, Nanjing Forestry University, Nanjing, China
| | - Qingqiang Yao
- Department of Orthopedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Key Lab of Additive Manufacturing Technology, Institute of Digital Medicine, Nanjing Medical University, Nanjing, China; Research Center of Digital Medicine and 3D Printing Technology of Jiangsu Province, Nanjing, China.
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Cahyadi M, Mesinovic J, Chim ST, Ebeling P, Zengin A, Grech L. Medication and bone health in multiple sclerosis: A systematic review and meta-analysis. J Manag Care Spec Pharm 2023; 29:1331-1353. [PMID: 38058136 PMCID: PMC10776270 DOI: 10.18553/jmcp.2023.29.12.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications incur decreases in areal bone mineral density (aBMD) and higher fracture risk in this population. OBJECTIVE To investigate the effects of commonly used medications on aBMD and fracture risk among people with MS. METHODS MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from their inception until February 5, 2023. We included randomized controlled trials as well as cross-sectional, retrospective, and prospective studies investigating whether glucocorticoids, immunomodulators, antidepressants, anticonvulsants, anxiolytics, opioids, or antipsychotics influenced aBMD or fracture risk in people with MS. Data were pooled using random effects meta-analyses to determine hazard ratios (HRs) and 95% CIs. RESULTS We included 22 studies (n = 18,193). Six studies were included in the meta-analyses of glucocorticoid use and aBMD, whereas 2 studies were included in the medication use and fracture risk meta-analyses. No studies assessed the effect of antidepressants, anxiolytics, anticonvulsants, opioids, and antipsychotics on aBMD, and no studies assessed the effect of immunomodulators on fracture risk. Glucocorticoid use was significantly negatively associated with femoral neck aBMD (correlation = -0.21 [95% CI = -0.29 to -0.13]), but not with lumbar spine aBMD (correlation = -0.21 [95% CI = -0.50 to 0.12]). There were no differences in fracture risk between users of glucocorticoids (HR = 1.71 [95% CI = 0.04 to 76.47]), antidepressants (HR = 1.84 [95% CI = 0.09 to 38.49]), or anxiolytics (HR = 2.01 [95% CI = 0.06 to 64.22]), compared with nonusers. CONCLUSIONS The available evidence is insufficient to support a relationship between greater fracture risk for people with MS taking glucocorticoid, antidepressant, or anxiolytic medication, compared with nonusers, and it is unclear whether these medications are associated with bone loss in people with MS, beyond that in the general population. Additional high-quality studies with homogenous methodology exploring how medications influence aBMD and fracture risk in people with MS are required.
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Affiliation(s)
- Michael Cahyadi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Sher Ting Chim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Lisa Grech
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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Zinganell A, Hegen H, Walde J, Bauer A, Berek K, Barket R, Auer M, Bsteh G, Donnemiller E, Egger A, Grams A, Griesmacher A, Kroiss AS, Rettenwander F, Tschallener M, Tschoner A, Berger T, Deisenhammer F, Di Pauli F. Screening for osteoporosis in people with MS: A new risk score. Mult Scler Relat Disord 2023; 74:104726. [PMID: 37098303 DOI: 10.1016/j.msard.2023.104726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/05/2023] [Accepted: 04/16/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Due to the demographic development and improved treatment options, the role of comorbidities is of increasing importance in the medical care of people with MS (pwMS). A higher risk of osteoporosis is well known in chronic autoimmune diseases, and is also described in MS. While there are several screening guidelines in the elderly or in patients with rheumatoid arthritis, there are no generally accepted recommendations when to perform bone mineral testing in pwMS under the age of 65 years. We aimed to determine risk factors of osteoporosis in pwMS and to develop a risk score which can be applied in daily clinical routine. METHODS Densitometry (hip and lumbar spine) was performed in 159 pwMS aged ≤65 years and in 81 age- and sex-matched healthy controls (HC). Osteoporosis was defined according to WHO criteria as a bone density 2.5 standard deviation or more below the mean of young adults. Risk factors were identified by logistic regression analysis. RESULTS Osteoporosis occurred more frequently in postmenopausal pwMS and male pwMS as compared to HC. Besides age, sex, menopausal status in females, body-mass-index and smoking, a higher degree of disability - as assessed by the Expanded Disability Status Scale - was identified as MS specific risk factor for osteoporosis, whereas the cumulative glucocorticoid dose was not associated with osteoporosis risk. Based on these risk factors, we developed an MS-specific risk score which allows to estimate the individual probability of osteoporosis. CONCLUSION This risk score enables individual screening recommendation for pwMS and, subsequently, early prevention of osteoporosis which probably should result in reduction of fractures and morbidity.
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Affiliation(s)
- Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Janette Walde
- Department of Statistics, Faculty of Economics and Statistics, University of Innsbruck, Innsbruck, Austria
| | - Angelika Bauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Barket
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Evelin Donnemiller
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria
| | | | | | | | - Alexander Tschoner
- Clinical Division of General Internal Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Binks S, Dobson R. Risk Factors, Epidemiology and Treatment Strategies for Metabolic Bone Disease in Patients with Neurological Disease. Curr Osteoporos Rep 2016; 14:199-210. [PMID: 27525980 DOI: 10.1007/s11914-016-0320-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Metabolic bone disease is a major public health concern, especially when it manifests as hip fracture which carries significant morbidity and mortality. Individuals with neurological disease are at higher risk of osteopenia, osteoporosis and fragility fracture compared to age-matched controls, yet this is under-appreciated by these patients. Clinician attention to this topic is therefore of importance and should address the bone health of men as well as women, a group in whom it may be an under-recognised problem. Evidence for optimal management of bone health in neurological disease remains to be defined, but a growing literature provides some useful guidance. This review focuses on two conditions, multiple sclerosis and Parkinson's disease, where research has been active over recent years. In neuroinflammation, shared immunological pathways between bone and brain are a current domain of interest and it will be intriguing to interrogate the action of emerging immunotherapies on these dual compartments.
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Affiliation(s)
- S Binks
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - R Dobson
- Blizard Institute, Queen Mary University, 4 Newark St, London, E1 2AT, UK.
- St Georges Hospital, Blackshaw Rd, London, SW17 0QT, UK.
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Seeliger C, Schyschka L, Kronbach Z, Wottge A, van Griensven M, Wildemann B, Vester H. Signaling pathway STAT1 is strongly activated by IFN-β in the pathogenesis of osteoporosis. Eur J Med Res 2015; 20:1. [PMID: 25563300 PMCID: PMC4300729 DOI: 10.1186/s40001-014-0074-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/04/2014] [Indexed: 03/06/2023] Open
Abstract
Background Despite extensive research, the underlying pathological mechanisms of osteoporosis are not completely understood. Recent studies have indicated a distinct role for the IFN-β/STAT1 pathway in bone metabolism. An inhibitory effect of IFN-β on osteoclastogenesis has been detected and STAT1/2 has been shown to influence osteoblastic bone metabolism. So far, no data concerning the IFN-β/STAT1 pathways in osteoblasts and osteoclasts from osteoporotic and non-osteoporotic patients are available. The aim of the study was to analyze these pathways in both cell types. Methods Osteoblasts were isolated from the femoral heads of 12 osteoporotic and 11 non-osteoporotic patients and monocytes were differentiated into osteoclasts. After the differentiation period, cells were stimulated once with 20 and 100 ng/mL IFN-β for 4 days. Viability, activity, bone metabolism-related genes, and the proteins Fra1, SOCS1, STAT1, p-STAT1, and TRAF6 were analyzed. Results Viability, activity, and gene expressions were not affected by stimulating the osteoblasts. However, in osteoporotic osteoclasts, which display a significantly higher basal osteoclastic activity, the stimulation with IFN-β lead to significant inhibition. Further, an increased STAT1 activation was detected in both cell types with no significant differences between the groups. Regarding the phosphorylation of STAT1, no significant influence was detected in osteoblasts but the IFN-β stimulation led to a significant increase of p-STAT1 in osteoclasts of both groups. Conclusions IFN-β is a principal mediator in the pathogenesis of osteoporosis by inhibiting osteoclasts and inducing and activating STAT1. Our results also confirm this in cells from osteoporotic and non-osteoporotic patients. Strong inhibitory effects on the osteoclastogenesis of osteoporotic osteoclasts were detectable. Nevertheless, osteoblast activity was not negatively affected by IFN-β stimulation. These results may contribute to a better understanding of the underlying pathological signaling pathways of osteoporosis. Electronic supplementary material The online version of this article (doi:10.1186/s40001-014-0074-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudine Seeliger
- Department of experimental Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lilianna Schyschka
- Department of experimental Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Zienab Kronbach
- Berlin-Brandenburger Centrum für Regenerative Therapien, Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Angela Wottge
- Department of experimental Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Martijn van Griensven
- Department of experimental Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Britt Wildemann
- Berlin-Brandenburger Centrum für Regenerative Therapien, Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Helen Vester
- Department of experimental Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Gupta S, Ahsan I, Mahfooz N, Abdelhamid N, Ramanathan M, Weinstock-Guttman B. Osteoporosis and multiple sclerosis: risk factors, pathophysiology, and therapeutic interventions. CNS Drugs 2014; 28:731-42. [PMID: 24871932 DOI: 10.1007/s40263-014-0173-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease of the nervous system. There has been mounting evidence showing that MS is associated with increased risk of osteoporosis and fractures. The development of osteoporosis in MS patients can be related to the cumulative effects of various factors. This review summarizes the common risk factors and physiologic pathways that play a role in development of osteoporosis in MS patients. Physical inactivity and reduced mechanical load on the bones (offsetting gravity) is likely the major contributing factor for osteoporosis in MS. Additional possible factors leading to reduced bone mass are low vitamin D levels, and use of medications such as glucocorticoids and anticonvulsants. The role of the inflammatory processes related to the underlying disease is considered in the context of the complex bone metabolism. The known effect of different MS disease-modifying therapies on bone health is limited. An algorithm for diagnosis and management of osteoporosis in MS is proposed.
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Affiliation(s)
- Sahil Gupta
- Department of Neurology, State University of New York, Buffalo, NY, USA
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Tyblova M, Kalincik T, Zikan V, Havrdova E. Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis. Eur J Neurol 2014; 22:624-32. [PMID: 24931814 DOI: 10.1111/ene.12479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/25/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE The prevalence of osteopenia and osteoporosis is higher amongst patients with multiple sclerosis in comparison with the general population. In addition to the general determinants of bone health, two factors may contribute to reduced bone mineral density in multiple sclerosis: physical disability and corticosteroid therapy. The aim of this study was to examine the effect of physical disability and steroid exposure on bone health in weight-bearing bones and spine and on the incidence of low-trauma fractures in multiple sclerosis. METHODS In this retrospective analysis of prospectively collected data, associations between bone mineral density (at the femoral neck, total femur and the lumbar spine) and its change with disability or cumulative steroid dose were evaluated with random-effect models adjusted for demographic and clinical determinants of bone health. The incidence of low-trauma fractures during the study follow-up was evaluated with Andersen-Gill models. RESULTS Overall, 474 and 438 patients were included in cross-sectional and longitudinal analyses (follow-up 2347 patient-years), respectively. The effect of severely impaired gait was more apparent in weight-bearing bones (P ≤ 10(-15) ) than in spine (P = 0.007). The effect of cumulative steroid dose was relatively less pronounced but diffuse (P ≤ 10(-4) ). Risk of low-trauma fractures was associated with disability (P = 0.02) but not with cumulative steroid exposure and was greater amongst patients with severely impaired gait (annual risk 3.5% vs. 3.0%). Synergistic effects were found only between cumulative steroid dose in patients ambulatory without support (P = 0.02). CONCLUSIONS Bone health and the incidence of low-trauma fractures in multiple sclerosis are more related to impaired gait than to extended corticosteroid therapy.
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Affiliation(s)
- M Tyblova
- Department of Neurology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
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Dobson R, Leddy SG, Gangadharan S, Giovannoni G. Assessing fracture risk in people with MS: a service development study comparing three fracture risk scoring systems. BMJ Open 2013; 3:bmjopen-2012-002508. [PMID: 23482989 PMCID: PMC3612805 DOI: 10.1136/bmjopen-2012-002508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Suboptimal bone health is increasingly recognised as an important cause of morbidity. Multiple sclerosis (MS) has been consistently associated with an increased risk of osteoporosis and fracture. Various fracture risk screening tools have been developed, two of which are in routine use and a further one is MS-specific. We set out to compare the results obtained by these in the MS clinic population. DESIGN This was a service development study. The 10-year risk estimates of any fracture and hip fracture generated by each of the algorithms were compared. SETTING The MS clinic at the Royal London Hospital. PARTICIPANTS 88 patients with a confirmed diagnosis of MS. OUTCOME MEASURES Mean 10-year overall fracture risk and hip fracture risk were calculated using each of the three fracture risk calculators. The number of interventions that would be required as a result of using each of these tools was also compared. RESULTS Mean 10-year fracture risk was 4.7%, 2.3% and 7.6% using FRAX, QFracture and the MS-specific calculator, respectively (p<0.0001 for difference). The agreement between risk scoring tools was poor at all levels of fracture risk. CONCLUSIONS The agreement between these three fracture risk scoring tools is poor in the MS population. Further work is required to develop and validate an accurate fracture risk scoring system for use in MS. TRIAL REGISTRATION This service development study was approved by the Clinical Effectiveness Department at Barts Health NHS Trust (project registration number 156/12).
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Affiliation(s)
- Ruth Dobson
- Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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10
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Kirbas A, Kirbas S, Anlar O, Turkyilmaz AK, Cure MC, Efe H. Investigation of the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis. Acta Neurol Belg 2013; 113:43-7. [PMID: 22895896 DOI: 10.1007/s13760-012-0123-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/23/2012] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis (MS) and to compare results with data from healthy controls. A total of 60 subjects, including 30 patients with MS, newly diagnosed and untreated (18 females, 12 males, at 18-40 years of age) and 30 healthy controls (20 female, 10 male) were enrolled in this study. Bone mineral density (BMD) of the lumbar spine and left femoral neck region were measured by dual-energy X-ray absorptiometry (DEXA). Serum levels of 25-hydroxyvitamin D (25OHD) were measured by chemiluminescence microparticle immunoassay (CMIA) on the Architect-i2000(®) (Abbott) system. 25OHD levels of MS patients were significantly lower than in controls. 25OHD levels were 27.2 ± 14.1 ng/ml in MS patients and 42.6 ± 8.8 ng/ml in controls (p = 0.001). Twenty-six (86.6 %) of our patients had a reduced BMD in lumbar spine or femoral neck region; of these 24 patients (80 %) had osteopenia and 2 patients (6.6 %) had osteoporosis. Interestingly, there was no significant correlation between 25OHD and BMD in lumbar spine and femoral neck region (r = 0.454, p = 0,074; r = 0.636, p = 0.082). Interestingly, a significant reduction of bone density in female MS patients was observed. In our study, 25OHD deficiency and lower BMD appeared in newly diagnosed multiple sclerosis. This is compatible with shared etiologic or pathogenic factors in MS and osteopenia/osteoporosis, and calls for an active approach to optimize bone health in early stages of MS.
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Affiliation(s)
- Aynur Kirbas
- Deparment of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53100, Turkey.
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11
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Abstract
People with multiple sclerosis (MS) have many reasons to have low bone mineral density and an increased fracture risk. Osteoporosis is a major cause of morbidity and mortality, and is more common in people with MS than the general population. A number of studies have examined the relationship between multiple sclerosis and reduced bone mineral density. In this topical review we seek to address the risk of low bone mineral density, osteoporosis and fractures associated with MS, and make practical suggestions as to how this pertinent issue may be approached in clinical practice.
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Affiliation(s)
- Ruth Dobson
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, UK.
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12
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Zikán V, Týblová M, Raška I, Havrdová E, Luchavová M, Michalská D, Kuběna AA. Bone mineral density and body composition in men with multiple sclerosis chronically treated with low-dose glucocorticoids. Physiol Res 2012; 61:405-17. [PMID: 22670701 DOI: 10.33549/physiolres.932299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of the study was to compare the bone mineral density (BMD) and body composition between ambulatory male MS patients and control subjects and to evaluate the relationships among body composition, motor disability, glucocorticoids (GC) use, and bone health. Body composition and BMD were measured by dual-energy X-ray absorptiometry in 104 ambulatory men with MS (mean age: 45.2 years) chronically treated with low-dose GC and in 54 healthy age-matched men. Compared to age-matched controls, MS patients had a significantly lower total body bone mineral content (TBBMC) and BMD at all measured sites except for the radius. Sixty five male MS patients (62.5 %) met the criteria for osteopenia and twenty six of them (25 %) for osteoporosis. The multivariate analysis showed a consistent dependence of bone measures (except whole body BMD) on BMI. The total leg lean mass % was as an independent predictor of TBBMC. The Expanded Disability Status Scale (EDSS), cumulative GC dose and age were independent determinants for BMD of the proximal femur. We conclude that decreasing mobility in male MS patients is associated with an increasing degree of osteoporosis and muscle wasting in the lower extremities. The chronic low-dose GC treatment further contributes to bone loss.
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Affiliation(s)
- V Zikán
- Third Department of Medicine, Department of Endocrinology and Metabolism, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
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13
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Josyula S, Mehta BK, Karmon Y, Teter B, Batista S, Ostroff J, Weinstock-Guttman B. The nervous system's potential role in multiple sclerosis associated bone loss. J Neurol Sci 2012; 319:8-14. [PMID: 22579137 DOI: 10.1016/j.jns.2012.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 01/29/2023]
Abstract
Osteoporosis is a degenerative bone disease that causes significant morbidity and mortality in multiple sclerosis (MS) patients; the pathogenesis of this disease being poorly understood in the context of MS. Osteoporosis is seen more frequently in MS patients than in healthy controls matched for age and sex. Extensively studied factors, including impaired ambulation and the use of steroids, do not appear to completely account for the phenomenon. This review summarizes common risk factors, physiologic and genetic, that may contribute to the etiology and progression of osteoporosis in MS patients as well as providing insight into nervous system control of bone metabolism and homeostasis.
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Affiliation(s)
- Sowmya Josyula
- Dept. of Neurology, SUNY Buffalo, 100 High Street, Buffalo, NY 14203, USA
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14
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McKenna MJ, Murray B, Lonergan R, Redmond JMT. Immunomodulators for multiple sclerosis may ameliorate spinal bone loss. Ir J Med Sci 2012; 182:29-32. [PMID: 22484845 DOI: 10.1007/s11845-012-0818-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 03/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of immunomodulator therapy (IMT) for multiple sclerosis (MS) on bone turnover is unknown. AIM The aim of this study was to assess bone turnover in MS patients on IMT. METHODS MS patients (n = 29) on maintenance IMT had repeat measurement of bone mineral density (BMD) after a 4.0 ± 0.4 years; bone turnover markers (BTM) were measured at the time of repeat BMD. RESULTS BMD was unchanged at the spine but declined at the hip. BTMs, both resorption and formation, were reduced compared to normative range that may indicate an anti-resorptive action of IMT. Significant negative correlations were noted between BTMs and changes in BMD at spine but not hip. CONCLUSION These observations suggest that IMT may have a beneficial effect on spinal bone by an antiresorptive action. A prospective study of the effect of IMT on BMD and bone turnover is warranted.
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Affiliation(s)
- M J McKenna
- DXA Unit, St. Vincent's University Hospital, Dublin, 4, Ireland.
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15
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Abstract
People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.
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Affiliation(s)
- J C Gibson
- Level 2, Department of Rehabilitation Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
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16
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Dionyssiotis Y. Bone loss and fractures in multiple sclerosis: focus on epidemiologic and physiopathological features. Int J Gen Med 2011; 4:505-9. [PMID: 21845056 PMCID: PMC3150171 DOI: 10.2147/ijgm.s22255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) affects the central nervous system leading to disability and is complicated by bone loss and fractures. Despite the acceptance of osteoporosis and fractures as two major public health problems, in people with MS the mechanisms have not been investigated adequately. Physicians and patients usually focus on the major cause of disability and neglect the multiple risk factors for osteoporosis and fractures in this specific population. This review updates the epidemiology and physiopathological mechanisms in MS.
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Affiliation(s)
- Yannis Dionyssiotis
- Rehabilitation Department, Physical and Social Rehabilitation Center, Amyntæo, Florina, Greece
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17
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Zikan V. Bone health in patients with multiple sclerosis. J Osteoporos 2011; 2011:596294. [PMID: 21603140 PMCID: PMC3096310 DOI: 10.4061/2011/596294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/02/2011] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis (MS) is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs) treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and resorption with depressed bone formation and a marked disruption of mechanosensory network of tightly connected osteocytes due to increase of osteocyte apoptosis. Patients with higher level of disability have also higher risk of falls that combined with a bone loss increases the frequency of bone fractures. There are currently no recommendations how to best prevent and treat osteoporosis in patients with MS. However, devastating effect of immobilization on the skeleton in patients with MS underscores the importance of adequate mechanical stimuli for maintaining the bone structure and its mechanical competence. The physical as well as pharmacological interventions which can counteract the bone remodeling imbalance, particularly osteocyte apoptosis, will be promising for prevention and treatment of osteoporosis in patients with MS.
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Affiliation(s)
- Vit Zikan
- Department of Internal Medicine 3, Faculty of Medicine 1, Charles University, 128 00 Prague, Czech Republic
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18
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Hossein-Nezhad A, Nikoo MK, Mirzaei K, Mokhtarei F, Meybodi HA. Comparison of the Bone Turn-over Markers in Patients with Multiple Sclerosis and Healthy Control Subjects. EUR J INFLAMM 2010. [DOI: 10.1177/1721727x1000800203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One of the major concerns for patients with multiple sclerosis (MS) is developing osteoporosis, especially when corticosteroid treatment is used. The aim of the present study is to compare the bone turnover markers in patients with multiple sclerosis and healthy control subjects. A total of 176 subjects were enrolled in this case-control. Ninety-one MS patients with mean age of 35.26 ± 8.76 yrs were randomly selected from the Committee on Multiple Sclerosis Registry. The control group was composed of 85 healthy subjects who were recruited from the Iranian Multicenter Osteoporosis Study (IMOS). Fasting serum levels of parathyroid hormone (PTH), 25 (OH) D3, osteocalcin and cross laps were measured in two groups. Hip and spine BMD were measured using DXA. Our findings showed significant differences in hip BMD and its T-score and Z-score values between MS patients and the control group. Osteoporosis prevalence at hip area of the MS patients was almost 5 times higher than the control group [OR=4.66, (95% CI 0.97 to 22.27), RR=4.29, (95% CI 0.95 to l9.32), p value=0.03]. No significant difference was found in BMD L2-L4, BMD T-score and BMD Z-score of lumbar area between two groups. The PTH and cross laps serum concentrations in MS patients were significantly higher than the control group. We did not find significant difference in serum osteocalcin level between the two groups. We concluded that in our study the serum levels of bone resorbtion markers in MS patients were significantly higher than the healthy control group. This may explain, at least in part, the elevated susceptibility of MS patients for developing osteoporosis.
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Affiliation(s)
- A. Hossein-Nezhad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M. Khoshniat Nikoo
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - K. Mirzaei
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - F. Mokhtarei
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - H.R. Aghaei Meybodi
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
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19
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Sioka C, Kyritsis AP, Fotopoulos A. Multiple sclerosis, osteoporosis, and vitamin D. J Neurol Sci 2009; 287:1-6. [PMID: 19800081 DOI: 10.1016/j.jns.2009.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 08/25/2009] [Accepted: 09/10/2009] [Indexed: 11/24/2022]
Abstract
Multiple sclerosis (MS) is associated with reduced bone mass and higher frequency of osteoporosis. Although high-dose short-term intravenous glucocorticoid regimens cause a decrease in bone formation, this effect is usually reversible and osteoporosis in MS patients may be independent of the short-term corticosteroid treatment. Clinical evidence suggests an important role of vitamin D as a modifiable risk factor in MS. Low circulating levels of vitamin D have been found in MS patients, especially during relapses, suggesting that vitamin D could be involved in the regulation of the clinical disease activity. Vitamin D mediates its function through a single vitamin D receptor (VDR). Polymorphisms of the VDR have major effects on vitamin D function and metabolism, and some VDR genotypes have been linked to osteoporosis and MS. Because the safety of high doses of vitamin D has not been established yet, vitamin D hasn't been used in enough doses to increase the serum level to a desired therapeutic target. Future clinical trials should determine the upper limit of vitamin D intake in order to achieve therapeutic benefit in MS patients.
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Affiliation(s)
- Chrissa Sioka
- Department of Nuclear Medicine, University Hospital of Ioannina, Ioannina, Greece
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20
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Comment on Shuhaibar et al.: Favourable effect of immunomodulator therapy on bone mineral density in multiple sclerosis. Ir J Med Sci 2009; 178:235-6; author reply 237-8. [PMID: 19184608 DOI: 10.1007/s11845-009-0275-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
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