Skip to main content

The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis

Abstract  

Background

The prevalence of osteoporosis is reported differently. We designed this systematic review and meta-analysis to estimate pooled prevalence of osteoporosis and osteopenia in patients with MS.

Methods

Independently, two researchers searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature (conference abstracts and references of the references) up to March 2021. We collected data regarding first author, country of origin, number of enrolled patients, number cases with osteoporosis/ osteopenia, mean age, F/M ratio, mean EDSS, and mean duration of the disease.

Results

Literature search revealed 847 articles and 658 remained after deleting duplicates. Finally, 29 original articles and 6 conference papers remained for meta-analysis. A total of 13,906 patients were evaluated. The pooled prevalence of osteoporosis was 17% (95% CI: 14–20%) (I2 = 90.4%, p < 0.001). The pooled prevalence of osteopenia was 43% (95% CI: 35–51%) (I2 = 97.9%, p < 0.001).

Conclusion

Osteoporosis/osteopenia should be considered in patients with MS.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Askari, F., et al. 2014, Anxiety in patients with multiple sclerosis: association with disability, depression, disease type and sex. Acta Medica Iranica, 889–892.

  2. Moen SM et al (2012) Bone turnover and metabolism in patients with early multiple sclerosis and prevalent bone mass deficit: a population-based case-control study. PLoS One 7(9):e45703

    CAS  Article  Google Scholar 

  3. Moen S et al (2011) Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology 77(2):151–157

    CAS  Article  Google Scholar 

  4. Gibson J, Summers G (2011) Bone health in multiple sclerosis. Osteoporos Int 22(12):2935–2949

    CAS  Article  Google Scholar 

  5. Zikan, V., Bone health in patients with multiple sclerosis. Journal of osteoporosis, 2011. 2011.

  6. Moghaddasi M, Aghaei M (2013) Assessment of bone densitometry in Iranian patients with multiple sclerosis: a case-control study. Iran J Neurol 12(1):9

    PubMed  PubMed Central  Google Scholar 

  7. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281

    CAS  Article  Google Scholar 

  8. Kępczyńska K et al (2016) Bone metabolism and vitamin D status in patients with multiple sclerosis. Neurol Neurochir Pol 50(4):251–257

    Article  Google Scholar 

  9. Modesti PA et al (2016) Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PloS one 11(1):e0147601

    Article  Google Scholar 

  10. Marrie RA et al (2009) A cross-sectional study of bone health in multiple sclerosis. Neurology 73(17):1394–1398

    Article  Google Scholar 

  11. Niedziela, N., et al., Assessment of Biochemical and Densitometric Markers of Calcium-Phosphate Metabolism in the Groups of Patients with Multiple Sclerosis Selected due to the Serum Level of Vitamin D3. BioMed research international, 2018. 2018.

  12. Le, M.V., et al. Body composition and relation to age in patients with multiple sclerosis. in MULTIPLE SCLEROSIS JOURNAL. 2019. SAGE PUBLICATIONS LTD 1 OLIVERS YARD, 55 CITY ROAD, LONDON EC1Y 1SP, ENGLAND.

  13. Murphy O et al (2016) Bone health in patients with multiple sclerosis relapses. Mult Scler Relat Disord 6:75–80

    Article  Google Scholar 

  14. Zikan, V., et al., Bone mineral density and body composition in men with multiple sclerosis chronically treated with low-dose glucocorticoids. Physiological research, 2012. 61(4).

  15. Haggiag, S., et al., Bone mineral density assessment in a multiple sclerosis population (P06. 163). 2012, AAN Enterprises.

  16. Simonsen CS et al (2016) Bone mineral density in patients with multiple sclerosis, hereditary ataxia or hereditary spastic paraplegia after at least 10 years of disease-a case control study. BMC Neurol 16(1):1–8

    Article  Google Scholar 

  17. Terzi T et al (2010) Changes in bone mineral density and bone metabolism markers in premenopausal women with multiple sclerosis and the relationship to clinical variables. J Clin Neurosci 17(10):1260–1264

    Article  Google Scholar 

  18. Batista, S., et al. Cognitive impairment is associated with low bone mineral density in multiple sclerosis. in NEUROLOGY. 2011. LIPPINCOTT WILLIAMS & WILKINS 530 WALNUT ST, PHILADELPHIA, PA 19106–3621 USA.

  19. Hammond, N., et al. Comparison of bone effects with Copaxone (R) and interferon-beta in multiple sclerosis. in MULTIPLE SCLEROSIS. 2009. SAGE PUBLICATIONS LTD 1 OLIVERS YARD, 55 CITY ROAD, LONDON EC1Y 1SP, ENGLAND.

  20. El-Ghoneimy AT et al (2009) Contribution of vitamin D to the pathogenesis of multiple sclerosis and its effect on bone. Egypt J Neurol Psychiatry Neurosurg 46:209–222

    Google Scholar 

  21. Lo, L.M.P., et al. 2020, Estimating the relative contribution of comorbidities in predicting health-related quality of life of people with multiple sclerosis. Journal of Neurology, 1–13.

  22. Dovio A et al (2004) Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose, short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab 89(10):4923–4928

    CAS  Article  Google Scholar 

  23. Tyblova M et al (2015) Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis. Eur J Neurol 22(4):624–632

    CAS  Article  Google Scholar 

  24. Kirbas A et al (2013) Investigation of the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis. Acta Neurol Belg 113(1):43–47

    Article  Google Scholar 

  25. Karahan, S.Z., et al., Lack of association between pulse steroid therapy and bone mineral density in patients with multiple sclerosis. Multiple Sclerosis International, 2016. 2016.

  26. Triantafyllou N et al (2012) Lack of association between vitamin D levels and bone mineral density in patients with multiple sclerosis. J Neurol Sci 313(1–2):137–141

    CAS  Article  Google Scholar 

  27. Zorzon M et al (2005) Long-term effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis. Eur J Neurol 12(7):550–556

    CAS  Article  Google Scholar 

  28. Stepan JJ et al (2004) Markers of bone remodeling predict rate of bone loss in multiple sclerosis patients treated with low dose glucocorticoids. Clin Chim Acta 348(1–2):147–154

    CAS  Article  Google Scholar 

  29. Bisson EJ et al (2019) Multiple sclerosis is associated with low bone mineral density and osteoporosis. Neurol Clin Pract 9(5):391–399

    Article  Google Scholar 

  30. Slouma M et al (2013) THU0383 osteoporosis in epilepsy and multiple sclerosis patients. Ann Rheum Dis 72(Suppl 3):A295–A295

    Article  Google Scholar 

  31. Faulkner M et al (2005) Osteoporosis in long-term care residents with multiple sclerosis. Consult Pharm 20(2):128–136

    Article  Google Scholar 

  32. Smeltzer SC, Zimmerman V, Capriotti T (2005) Osteoporosis risk and low bone mineral density in women with physical disabilities. Arch Phys Med Rehabil 86(3):582–586

    Article  Google Scholar 

  33. Murphy O et al (2013) Patients with an acute multiple sclerosis relapse: a high risk group for osteopenia and osteoporosis. J Neurol Neurosurg Psychiatry 84(11):e2–e2

    Article  Google Scholar 

  34. Kampman, M., et al. Persons with MS are at increased risk of osteopenia and osteoporosis. A ten-year longitudinal study. in MULTIPLE SCLEROSIS JOURNAL. 2018. SAGE PUBLICATIONS LTD 1 OLIVERS YARD, 55 CITY ROAD, LONDON EC1Y 1SP, ENGLAND.

  35. Coskun Benlidayi I et al (2015) Prevalence and risk factors of low bone mineral density in patients with multiple sclerosis. Acta Clin Belg 70(3):188–192

    CAS  Article  Google Scholar 

  36. Boz, C. and S.Z. Karahan. Risk factors of reduced bone mass in patients with multiple sclerosis. in MULTIPLE SCLEROSIS JOURNAL. 2012. SAGE PUBLICATIONS LTD 1 OLIVERS YARD, 55 CITY ROAD, LONDON EC1Y 1SP, ENGLAND.

  37. Weinstock-Guttman B et al (2004) Risk of bone loss in men with multiple sclerosis. Mult Scler J 10(2):170–175

    Article  Google Scholar 

  38. Olsson A et al (2015) Short-term, high-dose glucocorticoid treatment does not contribute to reduced bone mineral density in patients with multiple sclerosis. Mult Scler J 21(12):1557–1565

    CAS  Article  Google Scholar 

  39. Varoglu AO et al (2010) The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients. J Back Musculoskelet Rehabil 23(1):25–29

    Article  Google Scholar 

  40. Lambrinoudaki I et al (2013) Vitamin D receptor Bsm1 polymorphism, calcium metabolism and bone mineral density in patients with multiple sclerosis: a pilot study. Neurol Sci 34(8):1433–1439

    Article  Google Scholar 

  41. Bazelier MT et al (2011) The risk of fracture in patients with multiple sclerosis: the UK general practice research. J Bone Miner Res 26(9):2271–2279

    Article  Google Scholar 

  42. Dennison EM et al (2012) Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 50(6):1288–1293

    Article  Google Scholar 

  43. prevention, R.f.t. and t.o.g.i.o. update., American College of Rheumatology Ad Hoc Committee on Glucocorticoid‐Induced Osteoporosis. Arthritis Rheum, 2001 44(7) 1496–1503.

  44. Canalis E et al (2007) Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 18(10):1319–1328

    CAS  Article  Google Scholar 

  45. Hayashi K et al (2009) Bone fragility in male glucocorticoid-induced osteoporosis is not defined by bone mineral density. Osteoporos Int 20(11):1889–1894

    CAS  Article  Google Scholar 

  46. Sioka C et al (2011) Bone mineral density in ambulatory patients with multiple sclerosis. Neurol Sci 32(5):819–824

    Article  Google Scholar 

  47. Ghajarzadeh M et al (2019) The effect of vitamin D supplements on clinical and Para-clinical outcomes in patients with multiple sclerosis: protocol for a systematic review. JMIR Res Protoc 8(4):e12045

    Article  Google Scholar 

  48. Ascherio A (2013) Environmental factors in multiple sclerosis. Expert Rev Neurother 13(sup2):3–9

    Article  Google Scholar 

  49. Clarke B (2008) Normal bone anatomy and physiology. Clin J Am Soc Nephrol 3(Supplement 3):S131–S139

    CAS  Article  Google Scholar 

  50. Takayanagi H (2007) Osteoimmunology: shared mechanisms and crosstalk between the immune and bone systems. Nat Rev Immunol 7(4):292–304

    CAS  Article  Google Scholar 

  51. Kanis JA et al (2009) Assessment of fracture risk. Eur J Radiol 71(3):392–397

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seyede Zahra Emami Razavi.

Ethics declarations

Conflict of Interest

None.

Ethical approval

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Azadvari, M., Mirmosayyeb, O., Hosseini, M. et al. The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis. Neurol Sci 43, 3879–3892 (2022). https://doi.org/10.1007/s10072-022-05871-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-022-05871-w

Keywords

  • Multiple sclerosis
  • Prevalence
  • Osteoporosis
  • Osteopenia