University at Buffalo (UB)
Published June 29, 2011 This content is archived.
Multiple sclerosis appears to be associated with loss of bone mineral density (BMD), but that may not be due to lack of weight-bearing activity, the usual cause of osteoporosis.
A new UB study conducted with ambulatory MS patients shows that 40 percent had osteopenia or osteoporosis—an indication that the brain inflammation associated with MS also may impair bone density.
It is well understood that MS patients have more severe bone reabsorption and less bone formation, resulting in osteoporosis.
While decreased mobility and steroids can cause osteoporosis, the new study points to additional factors that affect bone homeostasis in chronic inflammatory diseases, including MS.
"The new data imply that the associated MS-related inflammatory and degenerative processes may directly impair not only the central nervous system with secondary cognitive dysfunction, but also bone homeostasis," says Bianca Weinstock-Guttman, MD, UB professor of neurology and senior author on the study.
“Surprisingly, the study findings suggest that cognitive impairment is independently associated with reduced BMD in MS patients,” she adds.
The new findings are raising awareness of the high risk of bone loss in individuals with MS, including those who are ambulatory.
“Physicians who treat MS patients should prescribe DEXA scan studies in addition to recommending calcium and vitamin D supplements in all MS patients over 40, especially if they have cognitive concerns,” says Weinstock-Guttman.
The case-controlled study involved 58 MS patients consecutively enrolled at Baird Multiple Sclerosis Center in the Department of Neurology, located at Buffalo General Hospital.
All participants were younger than 50 and had an EDSS disability score equal to or less than 4.5. The EDSS score is an average number derived from measures of various functions of the central nervous system, based on a scale from zero to 10, the most severe.
All participants also had a bone density test within one year of their neuropsychological testing.
Patients were divided into cognitively impaired (27) and cognitively intact (31) groups.
The average age was 43: 76 percent were women and 86 percent were diagnosed with relapsing-remitting MS, the most prevalent form of the disease.
The study results were presented at the 2011 American Academy of Neurology meeting.
Sonia Batista, MD, a neurology resident from Portugal's Coimbra University Hospital, worked with Weinstock-Guttman and is first author.
Additional researchers on the study are Barbara Teter, PhD, Sowmya Josyula, MD, Karen Sequeira, MD, Marietta Hoogs, PhD student working with Ralph Benedict, PhD, all from UB. Joao Freitas, MD, from Coimbra University Hospital, also contributed.