title: Osteoporosis and multiple sclerosis: risk factors, pathophysiology, and therapeutic interventions.
abstract: Multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease of the nervous system. There has been mounting evidence showing that MS is associated with increased risk of osteoporosis and fractures. The development of osteoporosis in MS patients can be related to the cumulative effects of various factors. This review summarizes the common risk factors and physiologic pathways that play a role in development of osteoporosis in MS patients. Physical inactivity and reduced mechanical load on the bones (offsetting gravity) is likely the major contributing factor for osteoporosis in MS. Additional possible factors leading to reduced bone mass are low vitamin D levels, and use of medications such as glucocorticoids and anticonvulsants. The role of the inflammatory processes related to the underlying disease is considered in the context of the complex bone metabolism. The known effect of different MS disease-modifying therapies on bone health is limited. An algorithm for diagnosis and management of osteoporosis in MS is proposed.
authors.affiliation: Department of Neurology, State University of New York, Buffalo, NY, USA.
authors.forename: Sahil
authors.initials: S
authors.lastname: Gupta
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahsan
authors.forename: Naeem
authors.initials: N
authors.lastname: Mahfooz
authors.forename: Noureldin
authors.initials: N
authors.lastname: Abdelhamid
authors.forename: Murali
authors.initials: M
authors.lastname: Ramanathan
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
mesh_terms: D000818:Animals; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D012307:Risk Factors