PREVALENCE AND PREDICTORS OF LOW BONE MINERAL DENSITY IN PATIENTS WITH MULTIPLE SCLEROSIS IN YOUNG AGE

Cover Page

Cite item

Abstract

Background: Multiple sclerosis is a chronic autoimmune progressing disease of the nervous system characterized by increased fracture risk due to a series of causes including the low bone mineral density (BMD). According to the literature data, the multiple sclerosis patients of a young age can already have BMD under the age norm. Factors associated with low BMD in such patients need to be investigated. Aim: Assessment of the prevalence of the low BMD level in young multiple sclerosis patients and revealing factors enabling its decrease. Materials and methods: Age was a patient criterium for including into the study: 18 to 50 years for men and 18 to menopause – for women. Under examination there were 163 patients with multiple sclerosis, 111 women (68.1%) and 52 men (31.9%) with mean age of 36.1±7.6 years. Relapsing-remitting multiple sclerosis was diagnosed in 121 (74.2%) patients, secondary progressive multiple sclerosis – in 37 (22.7%), and primary progressive multiple sclerosis – in 5 (3.1%). Score median according to the Expanded Disability Status Scale (EDSS) was 3.5 (25% and 75% quartiles – [2,0; 5,5]). The median of the disease duration was 8.5 [5.0; 14.0] years. BMD measuring was carried out using dual-energetic roentgen absorptiometry. Investigation was performed on two skeleton points: on the lumbar spine and proximal hip. Results: Decrease of BMD to under the age norm according to Z-criterion was revealed in 30 (18.4%) patients. The results obtained has shown that the body mass index (odds ratio (OR) 0.8; 95% confidence interval (CI) 0.7-0.9, p=0.001), disease duration (OR 1,1; 95% CI 1.0-1.2, p=0.023), the number of gluco-corticosteroid therapy courses (ОR 1.3; 95% CI 1.0-1.6, р=0.03), and smoking (ОR 2.7; 95% CI 1.0-7.2, р=0.04) are independent factors causing low BMD values in the patient population of multiple sclerosis studied. Conclusion. Every forth multiple sclerosis patient has decreased BMD in young age. Disease duration, low body mass index, gluco-corticosteroid taking, and smoking are significant factors influencing BMD in the young population of multiple sclerosis studied.

About the authors

E. L. Turova

Sverdlovsk Regional Clinical Hospital No.1; 185 Volgogradskaya ul., Yekaterinburg, 620102, Russian Federation

Author for correspondence.
Email: eturova@mail.ru
PhD, physician-neurologist,  Sverdlovsk Regional Clinical Hospital No.1. Russian Federation

E. V. Kozhemyakina

Ural State Medical University, 3 Repin’s ul., Yekaterinburg, 620028, Russian Federation

Email: fake@neicon.ru
intern of the Chair of Family Medicine, Ural State Medical University Russian Federation

P. S. Pukhtinskaya

Ural State Medical University, 3 Repin’s ul., Yekaterinburg, 620028, Russian Federation

Email: fake@neicon.ru

PhD, Assistant of the Chair of Family Medicine, Ural State Medical University

Russian Federation

O. M. Lesnyak

Ural State Medical University, 3 Repin’s ul., Yekaterinburg, 620028, Russian Federation

Email: fake@neicon.ru

MD, PhD, Professor, Head of the Chair of Family Medicine, Ural State
Medical University

Russian Federation

References

  1. Гусев ЕИ, Бойко АН, Демина ТЛ. Рассеянный склероз. М.: Нефть и газ; 1997. (Gusev EI, Boyko AN, Demina TL. [Multiple sclerosis]. Moscow: Neft’ i gaz; 1997. Russian).
  2. Bazelier M, van Staa T, Leufkens H, Vestergaard P, Cooper C, Uitdehaag B, Lalmohamed A, de Criers F. Risk of fracture in patients with multiple sclerosis: a population-based cohort study. Osteoporos Int. 2010;21 (Suppl 3):S450-1.
  3. Bazelier MT, de Vries F, Bentzen J, Vestergaard P, Leufkens HG, van Staa TP, Koch-Henriksen N. Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers. Mult Scler. 2012;18(5):622-7.
  4. Cosman F, Nieves J, Komar L, Ferrer G, Herbert J, Formica C, Shen V, Lindsay R. Fracture history and bone loss in patients with MS. Neurology. 1998;51(4):1161-5.
  5. Nilsagård Y, Lundholm C, Denison E, Gunnarsson LG. Predicting accidental falls in people with multiple sclerosis – a longitudinal study. Clin Rehabil. 2009;23(3):259-69.
  6. Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil. 2008;89(6):1031-7.
  7. Steffensen LH, Mellgren SI, Kampman MT. Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis. J Neurol. 2010;257(3):410-8.
  8. International Society for Clinical Densitometry (ISCD). ISCD Official Positions (Updated 2007). ISCD; 2007.
  9. Cosman F, Nieves J, Komar L, Ferrer G, Herbert J, Formica C, Shen V, Lindsay R. Fracture history and bone loss in patients with MS. Neurology. 1998;51(4):1161-5.
  10. Tüzün S, Altintaş A, Karacan I, Tangürek S, Saip S, Siva A. Bone status in multiple sclerosis: beyond corticosteroids. Mult Scler. 2003;9(6):600-4.
  11. Ozgocmen S, Bulut S, Ilhan N, Gulkesen A, Ardicoglu O, Ozkan Y. Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity. J Bone Miner Metab. 2005;23(4):309-13.
  12. Terzi T, Terzi M, Tander B, Cantürk F, Onar M. Changes in bone mineral density and bone metabolism markers in premenopausal women with multiple sclerosis and the relationship to clinical variables. J Clin Neurosci. 2010;17(10):1260-4.
  13. Zorzon M, Zivadinov R, Locatelli L, Giuntini D, Toncic M, Bosco A, Nasuelli D, Bratina A, Tommasi MA, Rudick RA, Cazzato G. Longterm effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis. Eur J Neurol. 2005;12(7):550-6.
  14. Hotermans C, Dive D, Rinkin C, Leroy M, Malaise M, Moonen G, Franchimont N. Hip bone mineral density is correlated with EDSS in patients with multiple sclerosis. J Neurol. 2006; 257(3):410-8.
  15. De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16(11):1330-8.
  16. Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, Fujiwara S, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005;16(2):155-62.
  17. Dovio A, Perazzolo L, Osella G, Ventura M, Termine A, Milano E, Bertolotto A, Angeli A. Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose, short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab. 2004;89(10): 4923-8.
  18. Then Bergh F, Kümpfel T, Schumann E, Held U, Schwan M, Blazevic M, Wismüller A, Holsboer F, Yassouridis A, Uhr M, Weber F, Daumer M, Trenkwalder C, Auer DP. Monthly intravenous methylprednisolone in relapsing-remitting multiple sclerosis – reduction of enhancing lesions, T2 lesion volume and plasma prolactin concentrations. BMC Neurol. 2006;6:19.
  19. Shuhaibar M, McKenna MJ, Au-Yeong M, Redmond JM. Favorable effect of immunomodulator therapy on bone mineral density in multiple sclerosis. Ir J Med Sci. 2009;178(1):43-5.
  20. Varoglu AO, Varoglu E, Bayraktar R, Aygul R, Ulvi H, Yildirim K. The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients. J Back Musculoskelet Rehabil. 2010;23(1):25-9.

Copyright (c) 2016 Turova E.L., Kozhemyakina E.V., Pukhtinskaya P.S., Lesnyak O.M.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies