Bone strength in multiple sclerosis: cortical midtibial speed-of-sound assessment

2004 ◽  
Vol 10 (5) ◽  
pp. 488-493 ◽  
Author(s):  
Anat Achiron ◽  
Shmuel Edelstein ◽  
Y Ziev-Ner ◽  
Uri Givon ◽  
Zeev Rotstein ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Bone Strength ◽  
Speed Of Sound ◽  
Normal Population ◽  
Ultrasound Measurement ◽  
Score Distribution ◽  
Population Norms ◽  
Female Patients ◽  
T Score ◽  
Increased Risk

It has been previously suggested that multiple sclerosis (MS) patients are at increased risk for osteoporosis due to reduced mobility, decreased exposure to sunlight and recurrent steroid treatment. In order to systematically evaluate bone strength we assessed 256 MS patients (171 females, 75 males) through quantitative ultrasound measurement of cortical bone. Tibial speed of sound (SOS, m/sec) was measured at midpoint of the tibial shaft using a Soundscan 2000 (Myriad Ultrasound Systems, Rehovot, Israel) and results were compared to age- and gender-matched population norms. T-score distribution in male MS patients was similar to normal population. In contrast, for female MS patients T-score distribution was significantly different from population norms, reflected by increased SOS in 30.4% (T-score intervals 1- and-2 above normal values;P/0.001), compared with 7.4% in controls. These findings held true for both female patients younger and older than 45 years of age. Increased neurological disability and specifically motor involvement were more frequent in female patients with increased SOS (PB/0.05). Bone strength was preserved in MS patients. In a subgroup of female patients increased SOS was conceivably related to spasticity.

scholarly journals Biomechanical Computed Tomography Captures Older Men at High Risk of Hip Fracture Despite Low Fracture Risk Calculation by FRAX

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A242-A243
Author(s):  
Polly Fu ◽  
Janet Chiang ◽  
Tony M Keaveny ◽  
Daniel D Bikle
Keyword(s):  
Hip Fracture ◽  
Fracture Risk ◽  
Bone Strength ◽  
Older Men ◽  
Ct Scans ◽  
Hip Fracture Risk ◽  
T Score ◽  
Increased Risk ◽  
Fragile Bone ◽  
Fracture Risks

Abstract Background: Biomechanical computed tomography (BCT) can be applied to hip-containing CT scans to estimate femoral bone strength using finite-element analysis and to measure DXA-equivalent femoral neck (FN) BMD. Current guidelines recommend osteoporosis pharmacotherapy initiation in men with BMD T-score ≤ -2.5 or T-score between -1.0 and -2.5 with 10-year hip fracture risk ≥ 3% by FRAX.1 Estimated femoral strength by BCT is associated with incident hip fractures in men, independent of BMD,2 and can be used in conjunction with clinical risk factors for consideration of therapy initiation per the International Society of Clinical Dosimetry.3 Aim: To determine how many men are at increased risk of fractures with fragile bone strength (≤ 3500N) despite normal-to-low BMD (T-score > -2.5) and low 10-year hip fracture risk (< 3%). Methods: 625 men age ≥ 65 with hip-containing CT scans were randomly selected for BCT analysis out of 4209 scans performed from 2017 to 2019 at a single academic hospital. Scans were excluded if an intact femur was not imaged. BCT was performed for 557 men after accounting for un-processable scans. Electronic health records were retrospectively reviewed by investigators blinded to BCT results. 10-year hip fracture risks were calculated by FRAX based on available clinical data and FN BMD T-score from BCT. Chi-squared and t-test were used to investigate differences in clinical parameters between men with and without fragile bone strength. Results: The mean age was 77 (± 7.6 years), and 69% of men were white. Out of 102 men (18.3%) who met criteria for fragile bone strength by BCT, 42 (7.5%) had low FN BMD (T-score between -1.0 and -2.5) and 2 (0.4%) had normal FN BMD (T-score ≥ -1.0). The percentage of men with fragile bone strength and discrepant BMD increased with age (5.4% in age 65–74; 8.2% in age 75–84; 13.0% in age ≥ 85). The average 10-year hip fracture risk by FRAX of men with fragile bone strength was 6.5% (± 4.0%). However, 13 out of 44 men with normal-to-low BMD had 10-year hip fracture risks < 3% despite fragile bone strength presence and did not meet recommendation for osteoporosis pharmacotherapy. Examining men with normal-to-low BMD (n=493), those with fragile bone strength tended to be older, have lower BMI, and of Hispanic ethnicity compared to those with normal-to-low bone strength (p<0.05). Conclusions: Our study showed that fragile bone strength is present in older men with normal-to-low BMD, and that inclusion of 10-year hip fracture risk by FRAX may capture some, but not all, men at increased risk of hip fractures. Skeletal fragility measured by BCT may serve as additional data to assist with clinical decision making for men with osteoporosis, though further prospective research is needed. Reference: 1. Watts et al, J Clin Endocrinol Metab. 2012 Jun;97(6):1802–22. 2. Adams et al, J Bone Miner Res 2018 Jul;33(7):1291–1301. 3. Shuhart et al, J Clin Densitom. 2019 Oct-Dec;22(4):453–471.

Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

2020 ◽  
pp. 135245852095231 ◽  
Author(s):  
Agostino Riva ◽  
Valeria Barcella ◽  
Simone V Benatti ◽  
Marco Capobianco ◽  
Ruggero Capra ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Seasonal Influenza ◽  
Careful Consideration ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Disease Modifying Drugs ◽  
Risks And Benefits ◽  
Modified Delphi ◽  
Increased Risk ◽  
Evidence Based Decision Making

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

827 Central Sleep Apnea in a patient with Multiple Sclerosis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A322-A323
Author(s):  
Rahul Dasgupta ◽  
Sonja Schütz ◽  
Tiffany Braley
Keyword(s):  
Multiple Sclerosis ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Progressive Multiple Sclerosis ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Demyelinating Lesions ◽  
The Brain

Abstract Introduction Sleep-disordered breathing is common in persons with multiple sclerosis (PwMS), and may contribute to debilitating fatigue and other chronic MS symptoms. The majority of research to date on SDB in MS has focused on the prevalence and consequences of obstructive sleep apnea; however, PwMS may also be at increased risk for central sleep apnea (CSA), and the utility of methods to assess CSA in PwMS warrant further exploration. We present a patient with secondary progressive multiple sclerosis who was found to have severe central sleep apnea on WatchPAT testing. Report of case(s) A 61 year-old female with a past medical history of secondary progressive multiple sclerosis presented with complaints of fragmented sleep. MRI of the brain, cervical spine, and thoracic spine showed numerous demyelinating lesions in the brain, brainstem, cervical, and thoracic spinal cord. Upon presentation, the patient noted snoring, witnessed apneas, and daytime sleepiness. WatchPAT demonstrated severe sleep apnea, with a pAHI of 63.3, and a minimum oxygen saturation of 90%. The majority of the scored events were non-obstructive in nature (73.1% of all scored events), and occurred intermittently in a periodic fashion. Conclusion The differential diagnosis of fatigue in PwMS should include sleep-disordered breathing, including both obstructive and central forms of sleep apnea. Demyelinating lesions in the brainstem (which may contribute to impairment of motor and sensory networks that control airway patency and respiratory drive), and progressive forms of MS, have been linked to both OSA and CSA. The present data illustrate this relationship in a person with progressive MS, and offer support for the WatchPAT as a cost-effective means to evaluate for both OSA and CSA in PwMS, while reducing patient burden. PwMS may be at increased risk for CSA. Careful clinical consideration should be given to ordering appropriate sleep testing to differentiate central from obstructive sleep apnea in PwMS, particularly for patients with demyelinating lesions in the brainstem. Support (if any) 1. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb 15;10(2):155–62. doi: 10.5664/jcsm.3442. PMID: 24532998; PMCID: PMC3899317.

Past environmental sun exposure and risk of multiple sclerosis: a role for the Cdx-2 Vitamin D receptor variant in this interaction

2009 ◽  
Vol 15 (5) ◽  
pp. 563-570 ◽  
Author(s):  
JL Dickinson ◽  
DI Perera ◽  
AF van der Mei ◽  
A-L Ponsonby ◽  
AM Polanowski ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Vitamin D Receptor ◽  
Significant Interaction ◽  
Important Determinant ◽  
Sun Exposure ◽  
Population Based ◽  
Vdr Gene ◽  
Increased Risk ◽  
Group 2

Multiple studies have provided evidence for an association between reduced sun exposure and increased risk of multiple sclerosis (MS), an association likely to be mediated, at least in part, by the vitamin D hormonal pathway. Herein, we examine whether the vitamin D receptor ( VDR), an integral component of this pathway, influences MS risk in a population-based sample where winter sun exposure in early childhood has been found to be an important determinant of MS risk. Three polymorphisms within the VDR gene were genotyped in 136 MS cases and 235 controls, and associations with MS and past sun exposure were examined by logistic regression. No significant univariate associations between the polymorphisms, rs11574010 ( Cdx-2A > G), rs10735810 ( Fok1T >  C), or rs731236 ( Taq1C > T) and MS risk were observed. However, a significant interaction was observed between winter sun exposure during childhood, genotype at rs11574010, and MS risk ( P = 0.012), with the ‘G’ allele conferring an increased risk of MS in the low sun exposure group (≤2 h/day). No significant interactions were observed for either rs10735810 or rs731236, after stratification by sun exposure. These data provide support for the involvement of the VDR gene in determining MS risk, an interaction likely to be dependent on past sun exposure.

Efficacy of Self-Hypnosis in Pain Management in Female Patients with Multiple Sclerosis

2016 ◽  
Vol 65 (1) ◽  
pp. 86-97 ◽  
Author(s):  
Fariba Hosseinzadegan ◽  
Moloud Radfar ◽  
Ali Reza Shafiee-Kandjani ◽  
Naser Sheikh
Keyword(s):  
Multiple Sclerosis ◽  
Pain Management ◽  
Female Patients

scholarly journals Subclinical Hypothyroidism in PCOS: Impact on Presentation, Insulin Resistance, and Cardiovascular Risk

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Qun Yu ◽  
Jin-Bei Wang
Keyword(s):  
Cardiovascular Risk ◽  
Subclinical Hypothyroidism ◽  
Polycystic Ovarian Syndrome ◽  
Normal Population ◽  
Statistical Significance ◽  
Cardiovascular Disorder ◽  
Control Subjects ◽  
Increased Risk ◽  
Pcos Group ◽  
Ovarian Syndrome

Aim of Study. To assess status of thyroid function and thyroid disorders particularly subclinical hypothyroidism (SCH) in subjects with polycystic ovarian syndrome (PCOS) and impact of SCH on various clinical and biochemical parameters and cardiovascular risk in PCOS.Methods. Hundred females diagnosed with PCOS as per Rotterdam criteria and 100 normal controls were recruited and were subjected to elaborate anthropometric, clinical, and biochemical assessment.Results. Notable findings included significantly higher frequency of subjects with subclinical hypothyroidism (p=0.0002), autoimmune thyroiditis (p<0.001), and goitre (p=0.02) in polycystic ovarian syndrome subjects compared to control subjects. Further SCH PCOS subjects were found to harbor significantly higher HOMA-IR (p<0.05) and frequency of subjects with dyslipidemia (p<0.05) compared to both euthyroid PCOS and euthyroid control subjects. Though frequency of subjects with cardiovascular risk factors was higher in SCH PCOS group than euthyroid PCOS group, it failed to reach statistical significance.Conclusion. We concluded that PCOS is associated with high incidence of SCH and AIT compared to normal population and SCH poses increased risk of cardiovascular disorder in PCOS.

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