Some people with multiple sclerosis (MS) experience a loss of bone density (referred to as osteopenia). This lower bone density puts people with MS at a higher risk of developing osteoporosis — a condition in which the bones are weak and porous — than those without multiple sclerosis. “I had a bone density test last week,” wrote one MyMSTeam member, “and results show that I have osteoporosis.”

Osteoporosis progresses over time, causing the bones to become more and more brittle. When the bones weaken and thin, they become more susceptible to breaking. If you have osteoporosis with MS, there are several ways you can manage the bone disease and help prevent fractures from occurring.

What Is Osteoporosis?

Bone is a living, regenerating tissue. It normally has a honeycomb- or sponge-like structure when viewed under a microscope. In people with osteoporosis, the body does not produce enough bone, too much bone loss has occurred, or both. This causes the “honeycombs,” or spaces, in the bone to become larger. The bone weakens and becomes more porous. The name osteoporosis means “porous bone.”

Osteopenia, or low bone mineral density (BMD), may progress into osteoporosis. Osteoporosis can also worsen without treatment. Eventually, a person with osteoporosis may experience fractures — particularly in the wrists, hips, and spine. Severe cases of osteoporosis may even result in broken bones after minor bumps or sudden movements, such as sneezing.

Symptoms of Osteoporosis

Osteoporosis is sometimes referred to as a silent disease because it typically doesn’t cause any symptoms or pain in its early stages. People don’t usually know they have osteoporosis until the condition has caused them to experience a fracture.

When osteoporosis has progressed and led to considerable bone loss, a person may experience the following:

• Frequent or unexpected fractures (broken bones)
• Gradual loss of height by an inch or more
• Bent or stooped-forward posture
• Lower back pain due to collapsed or fractured vertebra
• Decreased lung capacity from compressed disks, leading to shortness of breath

Talk to your health care team as soon as possible if you start experiencing any of the symptoms of osteoporosis.

The Connection Between Osteoporosis and MS

There are several reasons why people with MS are at an increased risk of osteoporosis compared to the general population.

MS Inflammation and Osteoporosis

Multiple sclerosis is a chronic autoimmune disease in which the immune response targets the central nervous system (CNS), including the brain and spinal cord. In people with MS, the body’s defenders (white blood cells) attack the central nervous system, damaging the nerve cells and causing inflammation. Experts believe this inflammation may disrupt the bones’ regeneration, resulting in the loss of bone density seen in people of all ages with multiple sclerosis.

Mobility and Osteoporosis

Mobility can be difficult for some people living with multiple sclerosis. If you have trouble performing weight-bearing activities, your bones may not receive signals telling them to stay strong. This causes the bones to weaken over time. Conversely, weight-bearing exercise — and physical activity in general — can help reduce the risk of osteoporosis.

MS Medications and Bone Health

Certain medications used to manage MS symptoms and slow disease progression — including steroids and antidepressants — may have an impact on the health of your bones, increasing your risk of osteoporosis.

As one MyMSTeam member wrote, “I have been on most therapies, including monthly steroids. I now have osteoporosis and the steroids can have an effect on your bones.” Another member had a similar experience: “I am suffering today from the effects of steroids: very thin skin, bruising all over, and osteoporosis. I used to be 5’8” tall — now I am 5’3” tall … Because of the osteoporosis, which is caused by the prednisone, I can’t do what I was able to do pre-lupus and MS.”

Other Osteoporosis Risk Factors

Several genetic and environmental factors play a role in a person’s risk of developing osteoporosis. Women, for instance, are much more likely than men to develop the disease. That said, research has found that having multiple sclerosis also increases men’s risk of osteoporosis.

There are also non-MS-related factors that can make you more likely to have osteoporosis. As one MyMSTeam member wrote, “I am already prone to osteoporosis due to a radical hysterectomy.” One of the biggest risk factors for osteoporosis is age — both men and women face an increased likelihood of developing the condition over time. Calcium and vitamin D deficiency also put a person at risk of osteoporosis, as do cigarette smoking, alcohol abuse, and having a small, thin frame.

Screening for Osteoporosis

If you have multiple sclerosis, your health care team may recommend testing for osteoporosis using a painless, noninvasive baseline screening procedure known as dual-energy X-ray absorptiometry (DXA or DEXA). This painless imaging test is used to evaluate bone mineral density. Results from this test are known as a T-score.

• A T-score greater than or equal to -1.0 indicates normal bone mineral density.
• A T-score between -1.0 and -2.5 indicates osteopenia (low bone density that has not yet progressed into osteoporosis).
• A T-score of -2.5 or lower indicates a diagnosis of osteoporosis.

Managing Osteoporosis With MS

There are several ways you can help reduce your risk of fractures and maintain bone health with osteoporosis and MS. As always, your health care team can work with you to come up with the best plan of action.

Weight-Bearing Exercise

“I had a bone density test, and the findings were osteopenia (the start of osteoporosis) — in other parts, arthritis and osteoporosis. The only medical instructions were to exercise! Huh?”

As this MyMSTeam member shared, it may seem counterintuitive to exercise when your bones are weakened. However, weight-bearing exercises — such as walking, jogging, and weight training — can help improve strength and balance and correct your posture, reducing the risk of falls and fractures. The National Osteoporosis Foundation recommends performing 30 minutes of weight-bearing exercises each day.

As another member pointed out, however, exercising with MS can be difficult: “I hear that weight-bearing exercise helps with osteoporosis, but it is hard for a lot of us with MS to do weight-bearing exercise!” Ultimately, the right exercise routine depends on your specific MS symptoms, your mobility, your type of MS, and your treatment plan. Your doctor is your best resource for determining which exercises will be safe and beneficial for your well-being. Always consult your health care provider before beginning a new exercise routine.

Reduce Your Risk Factors

You may be able to decrease your likelihood of developing osteoporosis by altering the risk factors you can control, such as quitting smoking and limiting your alcohol consumption. Smoking cigarettes can cause low vitamin D levels, so quitting can have many benefits if you have osteoporosis. Alcohol can prevent bone-forming cells from functioning properly, weakening the tissues. Excessive alcohol consumption can also increase your risk of falling and experiencing a fracture.

If you are a woman with low estrogen levels or if you have gone through menopause, your risk of osteoporosis is higher. Your doctor may recommend hormone replacement therapy or other methods of maintaining bone strength.

Reducing Fall Risk

One member said, “I have osteoporosis. If I fall, which is more likely with MS, I could get a fracture. This is most devastating, I think, since I have both MS and osteoporosis.” As this member pointed out, osteoporosis puts you at a greater risk of bone fractures. This risk is compounded by the fact that people with MS are also more likely to experience fall-related injuries. “I had a small break on my left ankle 10+ years ago,” wrote another member. “It still hurts, at times. Now, I have osteoporosis, and use a power wheelchair to prevent falls. Sometimes, I still fall when I transfer to the toilet or bed, but so far, no breaks.”

According to the Mayo Clinic, you can reduce your risk of falls by wearing comfortable, non-slip shoes, securing loose wires or area rugs, keeping your home well-lit, and ensuring that you can get in and out of your bed safely. You may also want to install supportive grab bars in high-risk areas, such as in and around your shower.

Dietary Changes and Supplements

Research has suggested that not getting enough fruits and vegetables can put a person at greater risk of fractures. If you have osteoporosis, make sure to eat plenty of plants and plant-based foods — they supply essential nutrients that help support bone strength and health.

It is also important to consume enough vitamin D and calcium with osteoporosis. If you cannot get sufficient amounts of these nutrients from your diet, your doctor may recommend taking dietary supplements. As one MyMSTeam member wrote, “I have also been taking vitamin D3 for a number of years. My neurologist suggests the same thing for the fact that I have MS. He checked my vitamin D level on my last round of blood tests — it is good.”

Another member found that getting more vitamin D had several benefits: “Also, vitamin D3 is extremely important for helping with fatigue … My vitamin D3 was on the low side of normal, and my neurologist still advised taking 2,000 units of vitamin D3 daily. It really makes a big difference.”

Medications for Osteoporosis With MS

If the above treatments and lifestyle changes are not enough to help manage osteoporosis, your doctor may recommend medications to help increase your bone mass. Medications known as bisphosphonates, including Actonel (risedronate), Boniva (ibandronate), and Fosamax (alendronate), may be used. Other drugs used to treat osteoporosis include Tymlos (abaloparatide), Evenity (romosozumab), and Forteo (teriparatide).

Find Your Support System

MyMSTeam is the social network for people living with multiple sclerosis and their loved ones. On MyMSTeam, more than 167,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS and osteoporosis? Share your experience in the comments below or by posting on MyMSTeam.