Bone Loss with Multiple Sclerosis: Effect of Glucocorticoid Use and Functional Status

Emerging data suggest a significantly increased prevalence of low bone mineral density (BMD) in men and women with multiple sclerosis (MS) compared to age matched controls. This study was performed to evaluate bone mineral mass in patients with MS in comparison to healthy age-and sex matched controls and to determine association of glucocorticoid use or ambulation ability with changing in bone mass in these individuals. Eighty two patients with MS and 328 age-sex matched healthy controls participated in the study. The Kurtzke expanded disability status scale (EDSS) was used to evaluate disability and functional capacity. Bone mineral density was measured using Dual X-ray absorptiometry. Serum calcium, phosphorus and 25(OH) vitamin D levels were assessed. The MS patients had significantly lower BMD at the lumbar spines, neck and total femur compared to age-sex matched controls. EDSS scores were inversely correlated with total femur and spinal BMD. There was a negative correlation with cumulative steroid dose and BMD only for femoral neck. BMD was significantly lower in MS patients. Decreased ambulatory status and glucocorticoid usage were associated with low BMD in MS patients. These patients should be encouraged to increase mobility and to have protective measures to maintain bone mass.