Abstract
Multiple sclerosis (MS) is a chronic disease and a major cause of disability in young adults. The aims of this study were to assess bone mass in patients with MS in comparison to healthy age- and sex-matched controls, and to evaluate factors influencing bone mineral density (BMD), and the relationship of the pain threshold at peripheral and axial sites with BMD in MS. Thirty-one patients with MS and 30 matched healthy controls participated in the study. The Kurtzke expanded disability status scale (EDSS) and the functional independence measure (FIM) were used to scale disability, mobility, and functional status. Serum 25(OH) vitamin D levels were measured. BMD was measured using dual X-ray absorptiometry (DXA). MS patients had significantly lower BMD at the lumbar spine (L2-L4) and femur trochanter compared to the matched controls. BMD of the lumbar spine was nearly 1 SD lower in MS patients compared with the healthy reference population (Z scores). MS patients had significantly lower vitamin D levels (17.3 ng/ml vs 43.1 ng/ml; P < 0.001) compared to controls, and 19 patients (61%) had a serum level of vitamin D that was less than 20 ng/ml. EDSS scores in the patients were inversely correlated with proximal femur BMD but not with spinal BMD. There was a negative correlation with the cumulative steroid dose and BMD only for femur trochanter BMD. Total myalgia scores for paravertebral muscles correlated significantly with spinal BMD. In conclusion, BMD is significantly lower in MS patients than in healthy controls, vitamin D deficiency is prevalent in MS, and ambulatory status is a determinative factor for osteoporosis in MS. Patients should be encouraged to have adequate sunlight exposure and to increase their mobility. Specific strengthening exercises for hip and back muscles in MS patients would have a substantial impact on bone density, osteoporosis, fracture risk, and mobility.
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References
A Compston A Coles (2002) ArticleTitleMultiple sclerosis Lancet 359 1221–1231 Occurrence Handle10.1016/S0140-6736(02)08220-X Occurrence Handle11955556
CA Formica F Cosman J Nieves J Herbert R Lindsay (1997) ArticleTitleReduced bone mass and fat-free mass in women with multiple sclerosis: effect of ambulatory status and glucocorticoid use. Calcif Tissue Int 61 129–133 Occurrence Handle1:CAS:528:DyaK2sXltFWit7o%3D
RS Taylor (1996) Rehabilitation of persons with multiple sclerosis RL Braddom RM Buschbacher D Dimitru EW Johnson D Matthews M Sinaki (Eds) Physical Medicine and Rehabilitation WB Saunders Philadelphia 1101–1112
J Nieves F Cosman J Herbert V Shen R Lindsay (1994) ArticleTitleHigh prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis Neurology 44 1687–1692 Occurrence Handle1:STN:280:ByqD383is1U%3D Occurrence Handle7936297
F Cosman J Nieves L Komar G Ferrer J Herbert C Formica V Shen R Lindsay (1998) ArticleTitleFracture history and bone loss in patients with MS Neurology 51 1661–1665 Occurrence Handle9855519
SR Schwid AD Goodman EJ Puzas MP McDermott DH Mattson (1996) ArticleTitleSporadic corticosteroid pulses and osteoporosis in multiple sclerosis Arch Neurol 53 753–757 Occurrence Handle1:STN:280:BymA38nhslM%3D Occurrence Handle8759981
CM Poser DW Paty L Scheinberg WI McDonald FA Davis GC Ebers KP Johnson WA Sibley DH Silberberg WW Tourtellotte (1983) ArticleTitleNew diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13 227–231 Occurrence Handle1:STN:280:BiyB3c3ntlM%3D
JF Kurtzke (1983) ArticleTitleRating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS Neurology 33 1444–1452 Occurrence Handle1:STN:280:BiuD2c%2Fis1c%3D Occurrence Handle6685237
AA Kucukdeveci G Yavuzer AH Elhan B Sonel A Tennant (2001) ArticleTitleAdaptation of the Functional Independence Measure for use in Turkey Clin Rehabil 15 311–319 Occurrence Handle10.1191/026921501676877265 Occurrence Handle1:STN:280:DC%2BD38%2FhtFClsw%3D%3D Occurrence Handle11386402
M Peacock L Hordon (1989) Femoral fracture: the role of vitamin D M Kleerekoper SM Krane (Eds) Clinical Disorders of Bone and Mineral Metabolism Mary Ann Liebert New York 265–272
TL Clemens (1989) Vitamin D: nutrition and metabolism in aging and osteoporosis M Kleerekoper SM Krane (Eds) Clinical Disorders of Bone and Mineral Metabolism Mary Ann Liebert New York 273–285
G Demirel H Yilmaz N Paker S Onel (1998) ArticleTitleOsteoporosis after spinal cord injury Spinal Cord 36 822–825 Occurrence Handle10.1038/sj.sc.3100704 Occurrence Handle1:STN:280:DyaK1M%2Fps1SmtQ%3D%3D Occurrence Handle9881730
F Biering-Sorenson H Bohr O Schaadt (1988) ArticleTitleBone mineral content of the lumbar spine and lower extremities years after spinal cord injuries Paraplegia 26 293–301 Occurrence Handle3205570
S Goemaere M Van Laere P De Neve JM Kaufman (1994) ArticleTitleBone mineral status in paraplegic patients who do or do not perform standing Osteoporos Int 4 138–143 Occurrence Handle10.1007/BF01623058 Occurrence Handle1:STN:280:ByuA2cfit1A%3D Occurrence Handle8069052
Y Sato H Kuno T Asoh Y Honda K Oizumi (1999) ArticleTitleEffect of immobilization on vitamin D status and bone mass in chroni cally hospitalized disabled stroke patients. Age Ageing 28 265–269 Occurrence Handle10.1093/ageing/28.3.265 Occurrence Handle1:STN:280:DyaK1MzhsVylsA%3D%3D
Y Sato M Kikuyama K Oizumi (1997) ArticleTitleHigh prevalence of vitamin D deficiency and reduced bone mass in Parkinson’s disease Neurology 49 1273–1278 Occurrence Handle1:STN:280:DyaK1c%2FjvFWktA%3D%3D Occurrence Handle9371907
K Lucas R Hohlfeld (1995) ArticleTitleDifferential aspects of cytokines in the immunopathology of multiple sclerosis Neurology 45 S4–S5 Occurrence Handle1:STN:280:ByqA3czjtFY%3D
A Gur A Denli K Nas R Cevik M Karakoc AJ Sarac F Erdogan (2002) ArticleTitlePossible pathogenetic role of new cytokines in postmenopausal osteoporosis and changes during calcitonin plus calcium therapy Rheumatol Int 22 194–198 Occurrence Handle10.1007/s00296-002-0223-x Occurrence Handle1:CAS:528:DC%2BD38XovVejt70%3D Occurrence Handle12215865
MF Holick (2003) ArticleTitleVitamin D deficiency: what a pain it is. Mayo Clin Proc 78 1457–1459
RD Simmons AL Ponsonby IA van der Mei P Sheridan (2004) ArticleTitleWhat affects your MS? Responses to an anonymous, Internet-based epidemiological survey Mult Scler 10 202–211 Occurrence Handle10.1191/1352458504ms1006oa Occurrence Handle15124768
Y Sato M Kaji K Oizomi (1999) ArticleTitleAn alternative to vitamin D supplementation to prevent fractures in patients with MS Neurology 53 437 Occurrence Handle1:STN:280:DyaK1MzlslGhsw%3D%3D
Y Sato N Metoki J Iwamoto K Satoh (2003) ArticleTitleAmelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients Neurology 61 338–342 Occurrence Handle1:CAS:528:DC%2BD3sXlslGktbk%3D Occurrence Handle12913194
M Birdane H Tuna G Ekuklu D Demirbag F Tuna S Kokino (2004) ArticleTitlePressure-induced pain on the tibia: an indicator of low bone mineral density. J Bone Miner Metab 22 456–461
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Ozgocmen, S., Bulut, S., Ilhan, N. et al. Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity. J Bone Miner Metab 23, 309–313 (2005). https://doi.org/10.1007/s00774-005-0604-9
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DOI: https://doi.org/10.1007/s00774-005-0604-9