title: High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis.
abstract: BACKGROUND
  Female patients with multiple sclerosis (MS) are at risk for osteoporosis because of gender, immobility, and corticosteroid use.
  
  
  METHODS
  Bone mineral density (BMD) was measured by dual x-ray absorptiometry in 80 female MS patients admitted to a tertiary care hospital. All patients completed a questionnaire that included measurements of dietary intake and sunlight exposure. Biochemical indices of bone metabolism and turnover were measured in a random sample of 52 patients.
  
  
  RESULTS
  BMD of the lumbar spine and femoral neck was 1 to 2 SDs lower in MS women compared with a healthy reference population. BMD was lower in patients with more severe MS. The mean 25(OH)D level of the sample population (43 nmol/l) was in the insufficient range, and 12 patients (23%) had frank vitamin D deficiency (< 25 nmol/l). BMD and age-related BMD (z scores) at all skeletal sites measured were lowest when 25(OH)D levels were deficient. Parathyroid hormone (PTH) was frankly elevated in 13% of patients. PTH levels were negatively correlated with 25(OH)D levels and with BMD. Dietary intake of vitamin D was below the recommended level in 80% of patients, and 40% reported no weekly sunlight exposure. After controlling for age, cumulative steroid use was not a determinant of BMD.
  
  
  CONCLUSIONS
  BMD was significantly reduced in female MS patients, which might increase fracture risk two- to threefold. Vitamin D deficiency with secondary hyperparathyroidism is prevalent and is probably a significant cause of low BMD in this population. Vitamin D deficiency in the female MS patient might be safely and inexpensively corrected by the routine use of vitamin D supplements.
authors.affiliation: Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY.
authors.forename: J
authors.initials: J
authors.lastname: Nieves
authors.forename: F
authors.initials: F
authors.lastname: Cosman
authors.forename: J
authors.initials: J
authors.lastname: Herbert
authors.forename: V
authors.initials: V
authors.lastname: Shen
authors.forename: R
authors.initials: R
authors.lastname: Lindsay
mesh_terms: D000328:Adult; D015519:Bone Density; D002112:Calcifediol / Q000378:metabolism; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000378:metabolism; D010281:Parathyroid Hormone / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications* / Q000378:metabolism
chemical_list: D010281:Parathyroid Hormone; D002112:Calcifediol