title: Bone health in patients with multiple sclerosis relapses.
abstract: OBJECTIVE
  To evaluate the bone health and vitamin D levels of a cohort of patients with relapses of multiple sclerosis (MS) and to propose an algorithm for the management of bone health in this patient group.
  
  
  METHODS
  We prospectively studied 56 consecutive patients from our acute relapse clinic. 3 patients were excluded from analysis as they were not deemed to have experienced an acute MS relapse. Bone health was assessed with vitamin D levels and Dual Energy X-ray Absorptiometry (DEXA) scanning (10 patients failed to attend for DEXA). Statistical analyses were used to compare groups and identify predictive variables. A review of the literature led to a proposed management protocol.
  
  
  RESULTS
  Pre-relapse the baseline EDSS was ≤6.5 in all subjects, and <4.0 in the majority (66%). Most received corticosteroids. 51% had low bone mineral density (BMD) as defined by a T-score less than -1.0 on DEXA scanning. Three were osteoporotic (T-score less than -2.5). Thirty one of fifty (62%) subjects were Vitamin D deficient (25(OH)D less than 50nmol/L). A range of variables, including previous corticosteroid usage, were not significantly predictive of reduced BMD.
  
  
  CONCLUSIONS
  There was a high frequency of both low BMD and Vitamin D deficiency in this cohort of relatively young and largely ambulatory patients experiencing MS relapses. Current tools, such as the WHO FRAX algorithm, are inadequate in assessing bone status and fracture risk in this patient group, predominantly as they are focused on older age groups. We propose a simple clinical management algorithm.
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland. Electronic address: murphy.olwen@gmail.com.
authors.forename: Olwen
authors.initials: O
authors.lastname: Murphy
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Zandi
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Nitzan
authors.initials: N
authors.lastname: Lindenberg
authors.affiliation: Charles Dent Metabolic Unit, University College London and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Elaine
authors.initials: E
authors.lastname: Murphy
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chataway
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000465:Algorithms; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D011446:Prospective Studies; D058996:Quality Improvement; D012306:Risk; D012720:Severity of Illness Index; D014808:Vitamin D Deficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: Bone mineral density; Metabolic bone disease; Multiple sclerosis; Vitamin D