Osteoporosis Risk Factors and Bone Mineral Density in Women With MS

Purpose: To describe the results of bone mineral density (BMD) screening in women with multiple sclerosis (MS) and to identify risk factors for osteoporosis in women with MS and their use of preventive strategies. Methods: BMD screening was performed at the os calcis. A self-administered survey, formatted as a checklist, asked women with MS about their risk factors for osteoporosis and their use of osteoporosis prevention strategies. Findings: 142 women with MS completed the study. Using a modified classification system suggested for use with peripheral measurements of BMD, 44.4% of women in the sample were categorized as having normal BMD, 35.2% were osteopenic, and 20.4% were osteoporotic. The number of risk factors for osteoporosis reported by women with MS ranged from zero to 10 with a mean of 4.6 ± 1.8. Relatively few women were using strategies to minimize their risks for osteoporosis. Of those who did employ a risk-minimization strategy, the lowest number of women in the sample (4.3%) used raloxifene, and the highest number of women (38.6%) used calcium supplementation. Conclusions: Low BMD is common in women with MS, increasing their risk for osteoporosis and osteoporotic fractures. Greater awareness is needed among health care providers regarding the increased risk and high incidence of osteoporosis in women with MS. Strategies to detect and prevent osteoporosis are warranted in women with MS in order to prevent further disability caused by osteoporosis-related fractures. (Int J MS Care. 2002; 4: 17–23, 29)

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Osteoporosis in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458510368985 ◽

2010 ◽

Vol 16 (9) ◽

pp. 1031-1043 ◽

Cited By ~ 47

Author(s):

Andrew P Hearn ◽

Eli Silber

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Bone Mineral Density ◽

Bone Mineral ◽

Significant Risk ◽

Mineral Density ◽

Increased Risk ◽

Review Management ◽

Multiple Sclerosis Patients ◽

Reduced Mobility

Fractures resulting from osteoporosis are a major cause of morbidity and mortality in the developed world. People with multiple sclerosis experience reduced mobility and are susceptible to falls. Glucocorticoid use and reduced mobility are known risk factors for osteoporosis. This paper is a review of osteoporosis in people with multiple sclerosis, looking at its prevalence, risk factors and possible mechanisms. We also review management guidelines for osteoporosis in the general population and use these to propose guidelines for osteoporosis management amongst multiple sclerosis patients. A number of studies have examined the incidence of reduced bone mineral density amongst people with multiple sclerosis; the majority provide convincing evidence that bone mineral density is significantly reduced in multiple sclerosis patients. The most significant risk factors appear to arise from the chronic disease process of multiple sclerosis and not from glucocorticoid use. There are currently no guidelines or consensus as how best to treat osteoporosis amongst multiple sclerosis patients despite their being at an increased risk. We propose an algorithm for the screening and treatment of osteoporosis in people with multiple sclerosis.

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Fragility fractures and bone remodeling in type 2 diabetes mellitus

Obesity and metabolism ◽

10.14341/omet2017311-18 ◽

2017 ◽

Vol 14 (3) ◽

pp. 11-18 ◽

Cited By ~ 1

Author(s):

Tatiana O. Yalochkina ◽

Zhanna E. Belaya

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Type 2 Diabetes ◽

Bone Tissue ◽

Bone Mineral ◽

Bone Fragility ◽

Mineral Density ◽

Severe Diabetes ◽

Increased Risk

Fracture risk is significantly increased in both type 1 and type 2 diabetes and individuals with diabetes experience worse fracture outcomes compared to normoglycemic individuals. Patients with T1DM have decreased bone mineral density (BMD), whereas patients with T2DM demonstrate increased BMD compared to healthy control. The latest studies show increased incidence of low-traumatic fractures in patients with T2DM instead of high bone mineral density (BMD). The risk of osteoporotic fractures in patients with T2DM can be explained by disease complications and increased risk of falls and consequent trauma. However, the most important cause of bone fragility in T2DM is the deterioration in bone microarchitecture, the mechanism of which is not completely understood. High BMD in patients with T2DM does not allow us to use dual-energy X-ray-absorptiometry as a gold standard test for diagnosticsof osteoporosis. Consequently,new risk factors and diagnostic algorithm as well as treatment strategy should be developed for patients with T2DM. In addition to this, some researchers considered that the group of T2DM is geterogenous and physicians might face patients with osteoporosis and mild diabetes that add very little to bone fragility; patients with osteoporosis and moderate or severe diabetes which also affects bone tissue diabetoosteoporosis; and patients without osteoporosis but severe diabetes which cause bone tissue deterioration with the development of diabetic bone disease. New diagnostic tools and algorithm and new experimental research are needed for better understanding bone deterioration in patients with T2DM. This review summarizes our current knowledge on fracture rate, risk factors for fractures and causes of bone deterioration in subjects with T2DM.

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Risk Factors for Systemic Reduced Bone Mineral Density in Premenopausal Female Patients with Early Untreated Rheumatoid Arthritis

Aktuelle Rheumatologie ◽

10.1055/a-0591-2364 ◽

2018 ◽

Vol 45 (04) ◽

pp. 334-340

Author(s):

Hamada S. Ahmed ◽

Sherif E. Farrag ◽

Amr E. Okasha ◽

Gamal Othman ◽

Ibrahim Shady

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Bone Mineral Density ◽

Rheumatoid Factor ◽

Bone Mineral ◽

Early Rheumatoid Arthritis ◽

Mineral Density ◽

T Score ◽

Increased Risk ◽

Treatment Naïve

Abstract Background Systemic osteoporosis (OP) is evident among patients with early rheumatoid arthritis (ERA). This study aimed to investigate the OP risk factors in patients with ERA and who was treatment-naïve at inclusion. Subjects and Methods Systemic bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN) and total hip (TH) was measured in 135 treatment-naïve premenopausal females with early Rheumatoid Arthritis (ERA). For all patients, demographic data, vitamin D status, and the specific parameters of the disease, including disease activity, serum levels of rheumatoid factor and anti-citrullinated protein antibodies (ACPA) were evaluated. Results T score was<−1.0 in the LS in 16.2%, in the FN in 22.2% and in the TH in 23.7%. Among our patients, 29.6% had below normal T score at any site. Demographic characteristics, RA duration, diseases activity did not significantly impact BMD. However, patients with decreased BMD were more prevalent ACPA- and rheumatoid factor (RF)-positive than patients with normal BMD. Also, high titer ACPA or RF is associated with more marked reduction in BMD. In regression analysis, after adjustment for possible confounders, patient stratification according to ACPA status and RF status (into negative, low-positive and high positive) still a significant independent variable associated with lower BMD values. Conclusion Presence of ACPA or RF is associated with increased risk for development of reduced systemic BMD from very early stage of rheumatoid arthritis. Furthermore, this risk increases more with higher levels of ACPA or RF. Measurement of BMD should be performed for ACPA- or RF-positive patients with early RA.

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Physiological Factors of Female Runners With and Without Stress Fracture Histories: A Pilot Study

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120919331 ◽

2020 ◽

Vol 12 (4) ◽

pp. 334-340

Author(s):

Therese E. Johnston ◽

Colleen Dempsey ◽

Frances Gilman ◽

Ryan Tomlinson ◽

Ann-Katrin Jacketti ◽

...

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Bone Turnover ◽

Bone Mineral ◽

Bone Turnover Markers ◽

Mineral Density ◽

Physiological Factors ◽

Physiological Factor ◽

Increased Risk ◽

Turnover Markers

Background: Female runners are at increased risk of stress fractures (SFs) compared with men. Literature is lacking with regard to best practice for preventing and treating SFs in women. The purpose of the study was to compare physiological measures and running-related factors between women of various ages and running abilities with and without a history of running-related SFs. Hypothesis: Women with and without SF histories will differ with regard to medical and menstrual history, bone health, body composition, nutrition, and running history. Study Design: Prospective cohort study. Level of Evidence: Level 2. Methods: A total of 20 female runners with SF histories were matched based on age and running distance with 20 women without SF histories. Data included medical, menstrual, running, injury, and nutritional histories; blood histology related to nutritional, hormonal, and bone-related risk factors; and bone density, fat, and lean tissue using dual energy x-ray absorptiometry. Paired t tests were used to examine differences between women with and without SF histories, and Spearmen correlations were conducted to examine relationships between physiological factors. Results: Women with SF histories had lower hip bone mineral density compared with women without SF histories ( P < 0.05). SF history was moderately correlated with menstrual changes during increased training times ( r = 0.580; P < 0.0001) but was not correlated with any other physiological factor. There was a moderate correlation within the SF group ( r = 0.65; P = 0.004) for bone markers for resorption and formation both increasing, indicating increased bone turnover. Conclusion: Female runners with low hip bone mineral density, menstrual changes during peak training, and elevated bone turnover markers may be at increased risk of SF. Clinical Relevance: Female runners need routine screening for risks associated with SF occurrence. As bone mineral density and bone turnover markers are not routinely assessed in this population, important risk factors may be missed.

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