title: BMI levels with MS Bone mineral density levels in adults with multiple sclerosis: a meta-analysis.
abstract: BACKGROUND
  Multiple sclerosis (MS) and osteoporosis (OP) affect a substantial proportion of the population. Accumulating evidence suggests that MS patients are at high risk for OP. We performed a meta-analysis to identify risk factors for lowered bone mineral density (BMD) in MS patients.
  
  
  METHODS
  We searched for articles within the Medline, Embase and Cochrane Library databases, published up to March 2014, pertaining to associations between MS and BMD. A total of 11 studies was included in the meta-analysis.
  
  
  RESULTS
  The analysis indicated that MS patients have reduced lumbar spine, femur neck, and hip BMD compared with healthy controls (lumbar spine, standardized mean difference (SMD) = -0.76, 95% CI: -1.07, -0.45; femur neck, SMD = -0.56, 95% CI: -0.84, -0.29; and hip, SMD = -0.62, 95% CI: -0.96, -0.29). Further subgroup analysis revealed that a disease duration of >7 years, total steroid dose during the disease of >15 g, and an Expanded Disability Status Scale (EDSS) score of > 3, increased the risk of reduced BMD in the lumbar spine and femoral neck, but not in the hip. Meta-regression analysis did not explain the heterogeneity in the clinical characteristics or outcome definitions.
  
  
  CONCLUSIONS
  Our meta-analysis suggests that MS patients have reduced overall BMD compared with healthy controls. Furthermore, disease duration (>7 years), total steroid dose (>15 g), and EDSS score (>3) are risk factors for reduced BMD in MS patients.
authors.affiliation: a Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.
authors.forename: Zhongming
authors.initials: Z
authors.lastname: Huang
authors.affiliation: a Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.
authors.forename: Yiying
authors.initials: Y
authors.lastname: Qi
authors.affiliation: a Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Du
authors.affiliation: a Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.
authors.forename: Guangnan
authors.initials: G
authors.lastname: Chen
authors.affiliation: a Department of Orthopedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.
authors.forename: Weiqi
authors.initials: W
authors.lastname: Yan
mesh_terms: D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology*; D001847:Bone Diseases / Q000209:etiology*; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications*
keywords: bone mineral density; meta-analysis; multiple sclerosis; osteoporosis