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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Conflict of interest
B Weinstock-Guttman has participated in speaker’s bureaus and served as a consultant for Biogen Idec, Teva Neurosciences, EMD Serono, Pfizer, Novartis, Genzyme, Sanofi, Mylan, and Acorda. She has also received grant/research support from the agencies listed above as well as ITN, Questcor, and Shire. No other industry financial relationships exist.
Dr. Murali Ramanathan received research funding or consulting fees from EMD Serono, Biogen Idec, Pfizer, Novartis, Monsanto, the National Multiple Sclerosis Society, the Department of Defense, Jog for the Jake Foundation, and the National Institutes of Health and National Science Foundation. He received compensation for serving as an editor from the American Association of Pharmaceutical Scientists. These are unrelated to the research presented in this report.
Sahil Gupta has no disclosures.
Irfan Ahsan has no disclosures.
Naeem Mahfooz has no disclosures.
Noureldin Abdelhamid has no disclosures.
No funding was provided for preparing this manuscript.
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Gupta, S., Ahsan, I., Mahfooz, N. et al. Osteoporosis and Multiple Sclerosis: Risk Factors, Pathophysiology, and Therapeutic Interventions. CNS Drugs 28, 731–742 (2014). https://doi.org/10.1007/s40263-014-0173-3
- Bone Mineral Density
- Multiple Sclerosis
- Multiple Sclerosis Patient