Fracture history and bone loss in patients with MS

被引:144
作者
Cosman, F [1 ]
Nieves, J
Komar, L
Ferrer, G
Herbert, J
Formica, C
Shen, V
Lindsay, R
机构
[1] Helen Hayes Hosp, Clin Res Ctr, Reg Bone Ctr, W Haverstraw, NY 10993 USA
[2] Columbia Univ, Dept Med, New York, NY USA
[3] Columbia Univ, Dept Epidemiol, New York, NY USA
[4] Columbia Univ, Dept Pathol, New York, NY USA
[5] Helen Hayes Hosp, Multiple Sclerosis Ctr, W Haverstraw, NY USA
关键词
D O I
10.1212/WNL.51.4.1161
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives: We have previously shown that MS patients have significantly reduced bone mass and a high prevalence of abnormal vitamin D status. The object of this study was to characterize the frequency of adulthood fractures in MS patients, prospectively determine rates of bone loss in MS, and determine whether vitamin D status is a predictor of bone loss. Methods: MS patients (36 women, 18 men) were compared with age- and gender-matched healthy controls (35 women, 14 men). Bone mass was performed by dual x-ray absorptiometry at baseline and at 12-month intervals over 2 years. Results: Fractures in the absence of major trauma had occurred in 2% of controls and 22% of MS patients (p < 0.002), Over the 2 years of prospective follow-up, both women and men with MS lost substantially more bone in the femoral neck than did controls (3% and 6% per year in pre- and postmenopausal women with MS versus 0.5% and 0.8% per year in controls; 7.3% per year in men with MS versus 1.6% per year in controls). Bone loss in the spine was also greater in women with MS than in controls (1.6 to 3.5% per year loss in MS patients versus no change in controls). Duration of steroid treatment beyond 5 months and ambulatory status were both predictors of bone loss. Bone loss in the spine occurred faster in MS patients with low (<20 ng/mL) 25-hydroxyvitamin D levels (1.9% per year, p < 0.04), whereas in those with normal 25-hydroxyvitamin D levels, bone loss was insignificant. At the femoral neck, bone loss was substantial in all patients, but was somewhat faster in the group with low levels of 25-hydroxyvitamin D (5.6% per year, p < 0.0001) compared with the group with high levels of 25-hydroxyvitamin D (4.3% per year, p = 0.03). Conclusions: MS patients have more frequent fractures and lose bone mass more rapidly than do their healthy age- and gender-matched peers, in part related to insufficient vitamin D. Vitamin D repletion in MS patients who are deficient might reduce, to some extent, the rate of bone loss and decrease osteoporosis-related fractures.
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页码:1161 / 1165
页数:5
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