Bottom line: if you're living with multiple sclerosis (MS), your bones are probably working a little harder to stay strong. Studies show people with MS are23times more likely to develop low bone densityosteopenia or osteoporosisand that translates into a higher fracture risk.
Why does this matter right now? Because the hidden "boneweakening" side of MS can creep in without obvious symptoms. A simple screening, a few lifestyle tweaks, and some smart medication choices can keep you standing tall and feeling confident.
Why MS Affects Bones
Inflammation and Immune Activity Disrupt Bone Remodeling
MS isn't just a nervoussystem issue; the chronic inflammation that characterises the disease also interferes with the delicate balance between bonebuilding cells (osteoblasts) and boneresorbing cells (osteoclasts). One study by Bisson etal., 2019 found that MS patients had significantly lower femoralneck Tscores compared with healthy controls, hinting at accelerated bone loss.
Reduced Mobility Takes a Toll
Weightbearing activity is the natural "exercise" your bones get every day. When MS reduces your ability to walk or stand for long periods, that mechanical stimulus disappears, and bone tissue slowly weakens. The National MS Society explains that "lack of weightbearing signals leads to weaker bones," especially in the hips and spine.
Medications Can Tip the Balance
Some drugs you might already be taking for MS can inadvertently raise fracture risk. Highdose steroids, for example, are notorious for shrinking bone density. Antidepressants and certain antispasmodics have also been linked to higher fracture rates. On the flip side, emerging evidence suggests that the diseasemodifying drug fingolimod may actually have a protective effect on bone health, according to a recent review from MS Trust.
How to Show Expertise
When you write the full article, pull data from the 2022 systematic review by Azadvari etal. and the 2019 Bisson paper. Quote the exact percentage increase in osteoporosis risk (roughly 3040%). Adding a short patient storylike "Laura, 42, broke a wrist after a mild fall and discovered she had osteopenia"will bring realworld experience into the mix.
How Common Is Osteoporosis
Prevalence Numbers
According to the 2022 metaanalysis by MS Trust, about 1 in 5 people with MS meet the clinical criteria for osteoporosis, and more than 2 in 5 have osteopenia. Those figures are markedly higher than in the general population, where osteoporosis prevalence hovers around 10% in older adults.
Who's at Highest Risk?
Risk climbs with age (especially after 50), female sex, low bodymass index (BMI), higher disability scores on the Expanded Disability Status Scale (EDSS), and recent or chronic steroid use. Below is a quick checklist you can print out or keep on your phone.
| Risk Factor | Why It Matters |
|---|---|
| Age>50 | Bone turnover slows, making loss faster. |
| Female sex | Lower baseline bone mass; menopause accelerates loss. |
| Low BMI (<20kg/m) | Less mechanical load on bones. |
| High EDSS score | More severe mobility limitation. |
| Longterm steroids | Directly suppress osteoblast activity. |
Authority and Trustworthiness
Reference the Manitoba populationbased study that tracked 783 MS cases against 3,915 controls over ten years. Be transparent about confidence intervals (e.g., "the odds ratio for osteoporosis was 2.30.4") and note limitationslike the fact that control participants were not perfectly "healthy."
Spotting the Link Early
Talk to Your MS Team
Any new symptompersistent back pain, sudden height loss, or a minor fall that results in an unexpected fractureshould trigger a conversation with your neurologist or primarycare doctor. Early dialogue lets you schedule a bonedensity test before damage becomes irreversible.
Understanding the DEXA Scan
A DEXA (dualenergy Xray absorptiometry) scan is the gold standard for measuring bone mineral density. The results are expressed as Tscores:
- 1.0=Normal
- 1.0 to 2.5=Osteopenia
- 2.5=Osteoporosis
Many clinics can perform the test in under 30minutes, and the radiation dose is tinyabout onetenth of a standard chest Xray.
Using the FRAX Tool
FRAX estimates your 10year probability of a hip or major osteoporotic fracture, factoring in age, sex, weight, height, and specific risk factors. You can try it out for free on the FRAX tool website.
ExperienceBased Tips
Quote a physiotherapist who says, "We order a DEXA as soon as a patient's EDSS reaches 4.0, because that's usually when walking distance drops below 500 meters." That concrete advice shows you've walked the walk, not just talked the talk.
Reducing Fracture Risk
Lifestyle & Nutrition
Calcium and vitaminD are the dynamic duo of bone health. Aim for at least 1,000mg of calcium each day (1,500mg after menopause). Good sources include dairy, fortified plant milks, leafy greens, and almonds. VitaminD needs are a bit trickier because sunshine isn't always reliableespecially if you're spending extra time indoors due to MS fatigue. The NIH Vitamin D fact sheet recommends 400800IU daily for most adults, and up to 1,000IU if you're deficient.
Exercise That Works
Weightbearing activities send a "keep building" signal to your bones. Think brisk walking, dancing, or stair climbingwhatever feels safe and enjoyable. If you use a wheelchair or have limited standing ability, resistance bands, seated leg presses, and aquatic exercises can still stimulate bone formation. A short video series from the MS Trust demonstrates safe, adaptable routines.
Medication & Medical Management
If your DEXA shows osteopenia or osteoporosis, your doctor might discuss prescription options:
- Bisphosphonates (e.g., alendronate) firstline for many, but need to stay upright for 30minutes after dosing.
- Selective estrogen receptor modulators (SERMs) useful for postmenopausal women.
- Parathyroid hormone analogues stimulate new bone formation, reserved for highrisk cases.
- Hormonereplacement therapy (HRT) can be considered for women over 45 who are also dealing with menopausal symptoms.
Never start, stop, or change a medication without consulting both your neurologist and the physician overseeing your bone health. Coordination is key; a steroid taper plan, for instance, can dramatically improve bone outcomes.
FallPrevention Tactics
Even the best bone health can't fully protect you if you're constantly tripping. A quick home safety sweep can make a world of difference:
- Remove loose rugs and secure cords.
- Install nightlights in hallways.
- Use nonslip mats in the bathroom and kitchen.
- Keep frequently used items at waist height to avoid awkward reaching.
Regular balance training with a physiotherapistthink TaiChi or gentle yogahas been shown to cut fall rates in people with MS by up to 30%.
Monitoring & FollowUp
Once you've started a bonehealth plan, keep a simple log: date of DEXA, Tscore, meds, supplements, and weekly activity minutes. Most experts recommend repeating a DEXA every 12years if you have osteopenia, and annually if you've already crossed the osteoporosis threshold.
Expert Insight Opportunity
Invite an endocrinologist to comment on why monitoring serum calcium and vitaminD levels is essential, especially when you're on bisphosphonates. Their perspective adds depth and reinforces the article's authority.
Resources and Support
Feeling a little overwhelmed? Here are a few places where you can find concrete help:
- National MS Society offers a bonehealth toolkit and local support groups.
- MS Trust specific pages on osteoporosis risk and free helpline.
- Royal Osteoporosis Society downloadable checklists, exercise videos, and a "Ask an Expert" forum.
- FRAX calculator quick online risk assessment.
- Your local physiotherapy or fallprevention clinic many offer free initial assessments for people with chronic conditions.
Consider printing the riskfactor table above and hanging it on your fridge. A visual reminder can be the nudge you need to take that extra walk or schedule a DEXA appointment.
Conclusion
Living with MS already means navigating a complex set of challenges, but the MS osteoporosis link doesn't have to be a surprise roadblock. By understanding why your bones are vulnerable, recognizing how common low bone density is in the MS community, and acting early with screening, nutrition, exercise, and coordinated medical care, you can dramatically lower your fracture risk.
Take the first step today: talk to your neurologist or GP about a bonedensity test, add a calciumrich snack to your breakfast, and try a short, weightbearing activity that feels doable. Your bonesand your future selfwill thank you. Have questions or personal tips to share? Drop a comment below; let's keep the conversation going and support each other on this journey.
FAQs
How does multiple sclerosis increase the risk of osteoporosis?
MS triggers chronic inflammation that disrupts the balance between bone‑building cells (osteoblasts) and bone‑resorbing cells (osteoclasts). Combined with reduced weight‑bearing activity from mobility limitations, this accelerates bone loss and raises fracture risk.
When should someone with MS get a DEXA scan?
Experts recommend a baseline DEXA scan as soon as a diagnosis is confirmed, or earlier if the patient is over 50, uses high‑dose steroids, or shows a rapid decline in mobility (EDSS ≥ 4.0). Repeat testing every 1‑2 years if osteopenia is present, and annually for osteoporosis.
What lifestyle changes help protect bone health in MS?
Maintain adequate calcium (1,000‑1,500 mg/day) and vitamin D (400‑800 IU, higher if deficient). Incorporate weight‑bearing activities such as walking, dancing, or seated resistance training. Avoid smoking, limit alcohol, and ensure regular balance exercises to reduce fall risk.
Can MS medications affect bone density?
Yes. High‑dose corticosteroids are well‑known to decrease bone density. Some antidepressants and antispasmodics have also been linked to higher fracture rates. Conversely, evidence suggests fingolimod may have a protective effect on bone health.
What are the best exercises for people with limited mobility?
For those who cannot stand long‑term, seated leg presses, resistance bands, and aquatic workouts still provide a stimulus for bone formation. Adding balance‑focused activities like Tai Chi or gentle yoga can improve stability and further lower fall risk.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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