Low Bone Mass in Early-Stage Multiple Sclerosis

October 17, 2012

Low bone mass may manifest early in MS: this finding calls for an active approach to optimize bone health.

Patients with multiple sclerosis or with clinically isolated syndrome have been found to have low bone mass soon after the diagnosis is made.1
 

A recently published study looked at the mechanism for the low bone mass in early-stage MS patients.2 Here, lead researcher, Stine Marin Moen, MD, discusses key findings in that study and offers tips on optimizing bone health in patients with newly diagnosed MS.
 

What important findings did this new study reveal?
My colleagues and I previously found that low bone mass is frequent finding in patients with newly diagnosed MS or with clinically isolated syndrome (a first episode) suggestive of demyelinating disease.1 Patients may have had relatively low bone mass before disease onset, or high bone loss after disease onset-or a combination of these two. We further explored bone turnover and metabolism in these patients and found no significant differences compared with a control group.2 This finding indicates a long-standing bone mineral deficit rather than a recent acceleration of bone loss in patients with newly diagnosed disease. The finding is compatible with shared etiological factors between MS and low bone mass.

 
Please elaborate about the shared etiology of low bone mass and MS?
Suboptimal vitamin D levels constitute a key risk factor for MS, possibly operating through immunomodulatory effects.3,4 Vitamin D is also essential for bone mineralization and maintenance of bone health. Vitamin D deficiency may cause reduced acquisition of bone and enhanced bone loss in adults and may thus be a possible shared etiological factor between MS and low bone mass. More research is needed to further explore the mechanisms involved.
 

What “take home” message does your study offer physicians about bone health in patients with early MS?
Low bone mass may manifest early in MS: this finding calls for an active approach to optimize bone health. This includes mapping of risk factors for osteoporosis, dietary intervention, ensuring adequate vitamin D and calcium intake, promoting weight-bearing activity, and identifying patients with risk factors for osteoporosis and fractures and instituting prophylactic intervention.
 

References
1. Moen SM, Celius EG, Sandvik L, et al. Low bone mass in newly diagnosed multiple sclerosis and clinically isolated syndrome. Neurology. 2011;77:151-157.
http://www.neurology.org/content/77/2/151.short
2. Moen SM, Celius EG, Sandvik L, et al. Bone turnover and metabolism in patients with early multiple sclerosis and prevalent bone mass deficit: a population-based case-control study. PLoS One. 2012;7:e45703. doi:10.1371/journal.pone.0045703
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0045703
3. Ramagopalan S. The importance of bone health in multiple sclerosis. September 11, 2012. http://www.consultantlive.com/nervous-system-diseases/content/article/10162/2102076
4. Ramagopalan S. Vitamin D and multiple sclerosis: four things physicians should know. September 7, 2012.
http://www.consultantlive.com/nervous-system-diseases/content/article/10162/2101380