Multiple Sclerosis and Osteoporosis

People with multiple sclerosis are at increased risk for low bone density and osteoporosis.  The further the MS is advanced, the greater the risk for osteoporosis

Anecdotal evidence from doctors is that osteoporosis is underdiagnosed and undertreated in MS patients.  The multiple sclerosis takes everyone’s attention. 

And the idea that osteoporosis is a disease of older women is a problem. Males and pre-menopausal women with MS can get osteoporosis.  Some of the effects of advanced osteoporosis can look like the symptoms of MS.  If a joint hurts, it is MS or osteoporosis, or both?

There is no guideline adopted by the medical profession on whether MS patients should undergo bone density tests or at what point in the progression of the MS an osteoporosis screening should happen.  Some physicians have proposed screening heuristics and criteria 

Osteoporosis of this sort is secondary osteoporosis.  The effect of MS is that the person does not move as much as a healthy person of the same age.  At advanced stages, MS patients use wheelchairs.  This limited movement and lack of exercise raises the risk that bone density will decline.  Low body weight common in MS patients is a risk for osteoporosis.  There is also some evidence that the MS itself contributes to the osteoporosis because the sclerostin proteins produced in MS augment osteocyte apoptosis.

Some MS patients also take steroid drugs, which can increase the risk of osteoporosis.  Most patients do not take steroids for a long time, but one common regimen – called pulse therapy – is short-term high dosage steroid use to reduce inflammation.  Methylprednisolone is a glucosteroid given orally and intravenously to control outbreaks of MS, and can be detrimental to bone health.  Some scientists think the steroids used for treatment have little impact on lower bone density in MS patients and instead blame the disease itself. 

Because MS affects balance and coordination, patients are more likely to fall over than healthy people are in the same circumstances.  This makes osteoporosis even more risky for MS patients.

Nurses have found that younger people with MS tend to have some knowledge of osteoporosis but are not fully aware of their risks.  This suggests an avenue for healthcare workers to do some education.


Multiple sclerosis patients are treated the same way as other osteoporosis patients.  Exercise may be difficult for MS patients with thinning bones.  But bisphosonates and other medicines are employed.  Vitamin D is of special interest because it has been shown MS patients have lower than normal levels in their bodies, perhaps due to staying out of the sun.

The Journal of Osteoporosis has a good description of the diagnosis and treatment of the condition in MS patients:

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