title: Bone health in patients with multiple sclerosis.
abstract: Multiple sclerosis (MS) is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs) treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and resorption with depressed bone formation and a marked disruption of mechanosensory network of tightly connected osteocytes due to increase of osteocyte apoptosis. Patients with higher level of disability have also higher risk of falls that combined with a bone loss increases the frequency of bone fractures. There are currently no recommendations how to best prevent and treat osteoporosis in patients with MS. However, devastating effect of immobilization on the skeleton in patients with MS underscores the importance of adequate mechanical stimuli for maintaining the bone structure and its mechanical competence. The physical as well as pharmacological interventions which can counteract the bone remodeling imbalance, particularly osteocyte apoptosis, will be promising for prevention and treatment of osteoporosis in patients with MS.
authors: Department of Internal Medicine 3, Faculty of Medicine 1, Charles University, 128 00 Prague, Czech Republic.
authors: Vit
authors: V
authors: Zikan
references: Eur J Endocrinol. 2006 May;154(5):745-51
references: 16645023
references: Endocrinology. 2006 Dec;147(12):5592-9
references: 16935844
references: Clin Rheumatol. 1989 Jun;8 Suppl 2:95-103
references: 2667875
references: J Bone Miner Res. 2003 Dec;18(12):2083-94
references: 14672343
references: Ir J Med Sci. 2009 Mar;178(1):43-5
references: 19002746
references: Eur J Neurol. 2008 Sep;15(9):916-21
references: 18637953
references: Osteoporos Int. 2010 Sep;21(9):1457-69
references: 20204595
references: Rheumatology (Oxford). 2000 Dec;39(12):1383-9
references: 11136882
references: Mult Scler. 2004 Apr;10(2):170-5
references: 15124763
references: Clin Chim Acta. 2004 Oct;348(1-2):147-54
references: 15369748
references: Arthritis Rheum. 2009 Nov;60(11):3346-55
references: 19877063
references: Ned Tijdschr Geneeskd. 2008 Oct 25;152(43):2357-60
references: 19024069
references: Osteoporos Int. 2002 Oct;13(10):777-87
references: 12378366
references: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003980
references: 15674920
references: J Bone Miner Metab. 2005;23(4):309-13
references: 15981027
references: J Med Invest. 2001 Aug;48(3-4):147-56
references: 11694954
references: Arch Phys Med Rehabil. 2008 Feb;89(2):237-43
references: 18226646
references: Bone. 2010 Jan;46(1):4-12
references: 19591966
references: Biochem Pharmacol. 2009 Jun 15;77(12):1757-62
references: 19428330
references: Calcif Tissue Int. 2008 Apr;82(4):249-57
references: 18414920
references: Bone. 2005 Feb;36(2):331-9
references: 15780960
references: Calcif Tissue Int. 1997 Aug;61(2):129-33
references: 9236259
references: Am J Phys Med Rehabil. 2010 Jun;89(6):446-57
references: 20216060
references: Nature. 2009 Mar 26;458(7237):524-8
references: 19204730
references: Biochem Biophys Res Commun. 2010 Nov 12;402(2):173-6
references: 20920469
references: Nat Rev Immunol. 2009 Jun;9(6):440-7
references: 19444308
references: Crit Rev Oral Biol Med. 2004 Jun 04;15(3):126-36
references: 15187031
references: Arch Intern Med. 2007 Jun 25;167(12):1240-5
references: 17592096
references: J Bone Miner Res. 2004 Jul;19(7):1067-74
references: 15176988
references: Phys Med Rehabil Clin N Am. 1998 Aug;9(3):603-14, vii
references: 9894112
references: Lancet. 2008 Oct 25;372(9648):1502-17
references: 18970977
references: J Endocrinol Invest. 2008 Jul;31(7 Suppl):53-8
references: 18791353
references: Clin Neurol Neurosurg. 2002 Jul;104(3):182-91
references: 12127652
references: Osteoporos Int. 2011 Jan;22(1):271-9
references: 20358358
references: Osteoporos Int. 2006 Feb;17(2):180-92
references: 16217589
references: J Bone Miner Res. 2010 Apr;25(4):734-45
references: 19821772
references: J Neuroimmunol. 2005 Jan;158(1-2):231-9
references: 15589058
references: Biochem Biophys Res Commun. 2004 Aug 6;320(4):1163-8
references: 15249211
references: Bone. 2008 Jul;43(1):149-155
references: 18467202
references: Int Rev Neurobiol. 2008;83:305-28
references: 18929090
references: J Bone Miner Res. 2009 Dec;24(12):1998-2006
references: 19453263
references: Bone. 2009 May;44(5):734-43
references: 19195497
references: Eur J Clin Invest. 1990 Jun;20(3):330-5
references: 2114994
references: Mult Scler. 2003 Dec;9(6):600-4
references: 14664473
references: Mult Scler. 2010 Sep;16(9):1031-43
references: 20551086
references: J Clin Endocrinol Metab. 2004 Oct;89(10):4923-8
references: 15472186
references: Osteoporos Int. 2005 Mar;16(3):263-72
references: 15338112
references: J Neurol Sci. 2009 Jan 15;276(1-2):41-4
references: 18845306
references: J Bone Miner Res. 2006 Apr;21(4):605-15
references: 16598381
references: Drug Saf. 2007;30(2):171-84
references: 17253881
references: Calcif Tissue Int. 1991 Feb;48(2):93-100
references: 2013018
references: Eur J Neurol. 2005 Jul;12(7):550-6
references: 15958096
references: J Musculoskelet Neuronal Interact. 2010 Jun;10(2):128-35
references: 20516629
references: Mult Scler. 2008 Apr;14(3):431-2
references: 18208894
references: Osteoporos Int. 1997;7 Suppl 3:S63-7
references: 9536305
references: Curr Neurol Neurosci Rep. 2010 Sep;10(5):407-12
references: 20567946
references: Bone. 2010 Sep;47(3):604-9
references: 20601295
references: J Bone Miner Metab. 2009;27(5):574-83
references: 19333678
references: Neurology. 1998 Oct;51(4):1161-5
references: 9781548
references: Curr Osteoporos Rep. 2010 Dec;8(4):185-91
references: 20809204
references: J Clin Densitom. 2008 Oct-Dec;11(4):511-7
references: 18639477
references: Bone. 2010 Mar;46(3):564-70
references: 19591965
references: Bone. 2007 Nov;41(5):745-51
references: 17855178
references: Autoimmun Rev. 2010 Sep;9(11):709-15
references: 20601202
references: Neurology. 1994 Sep;44(9):1687-92
references: 7936297
references: J Bone Miner Res. 2007 Jan;22(1):64-71
references: 17042715
references: Crit Rev Eukaryot Gene Expr. 2009;19(3):219-33
references: 19883366
references: Endocr Rev. 2007 Apr;28(2):151-64
references: 17200084
references: Arch Neurol. 2008 Feb;65(2):232-5
references: 18268193
references: Lancet Neurol. 2010 Jun;9(6):599-612
references: 20494325
references: Bone. 2005 Sep;37(3):287-95
references: 16006205
references: Mult Scler. 2011 Jan;17(1):32-42
references: 20921238
references: J Bone Miner Res. 2004 Jan;19(1):48-55
references: 14753736
references: Arch Neurol. 1996 Aug;53(8):753-7
references: 8759981
references: Clin Endocrinol (Oxf). 2010 Sep;73(3):277-85
references: 20796001
references: Eur J Endocrinol. 2005 Feb;152(2):199-205
references: 15745926
references: Bone. 2006 Aug;39(2):253-9
references: 16574519
references: Cell Metab. 2007 Jun;5(6):464-75
references: 17550781
references: N Engl J Med. 2006 May 25;354(21):2250-61
references: 16723616
references: Bone. 2011 Feb;48(2):197-201
references: 20850580
references: J Bone Miner Res. 2009 Oct;24(10):1651-61
references: 19419300
references: Arch Intern Med. 2007 Jun 25;167(12):1246-51
references: 17592097
references: J Rehabil Med. 2010 Oct;42(9):866-72
references: 20878048
references: Arthritis Rheum. 2007 Jan;56(1):208-14
references: 17195223
references: Endocrinol Metab Clin North Am. 2010 Jun;39(2):381-400, table of contents
references: 20511059
references: J Orthop Res. 2009 Nov;27(11):1521-7
references: 19437511
references: Neurology. 2009 Oct 27;73(17):1394-8
references: 19858462