A person with multiple sclerosis (MS) can also have other health conditions, known as comorbidities. One of these is osteoporosis — a condition in which bones weaken from losing mass (also called low bone density or low bone mineral density). Weak bones are more fragile and more likely to break. The increased risk for osteoporosis — as well as falls related to MS — can put you at a greater risk of fractures (broken bones).
Here is what you need to know about the risk of osteoporosis associated with MS, including how to maintain bone health and how to heal from broken bones.
A few factors can cause poor bone health among people with MS. Some are related directly to MS, while others are linked to multiple sclerosis treatments.
People with MS are more likely to trip and fall than those in the general population. In many cases, this is due to symptoms of MS that affect mobility, including:
These symptoms together can cause falls that may lead to broken bones, regardless of overall bone health.
MS itself seems to be a risk factor for osteoporosis, at least in some people.
This may simply occur because people with MS don’t move as much as others do. Pain and neurological problems can make weight-bearing movement difficult. Movement, however, is necessary for bone growth and maintenance. When bones are not put under some stress from normal movement, they tend to deteriorate. This can lead to deconditioning — a decline in physical and cognitive function.
However, people with MS who don’t have limited mobility may still experience bone loss. One reason may be low vitamin D levels, which can also cause osteoporosis. However, vitamin D deficiency alone also does not account for the number of people diagnosed with MS who also develop osteoporosis.
At this time, researchers are not entirely clear on the particular connection between MS and osteoporosis. More studies are needed to better understand this connection.
Many people with MS take glucocorticoid (or corticosteroid) medications to help manage symptom flare-ups. These steroids can cause osteoporosis, especially when taken in high doses over extended periods of time.
Several MyMSTeam members have dealt with this. One wrote, “I am suffering today from the effects of the prednisone: very thin skin, bruising all over, and osteoporosis.” Another shared, “My bones are so soft that if I bump them, I fracture them now. Thus, my broken ribs, wrist, and hip. My doctor says it’s normal with so many years of steroid use.”
Steroids interfere with the ways the body can utilize both vitamin D and calcium to build and maintain bones. People who do experience bone-density loss due to steroid medications will typically see the most loss in the first six months. After that, bone loss usually slows and may stabilize.
Note that bone loss due to steroid use may not be a reason to avoid these medications. You should talk to your health care provider about the pros and cons and make the choice that is best for you.
A number of MyMSTeam members have described dealing with osteoporosis on top of MS. For many, it means adding other medical treatments to their current ones. “I was informed I have osteoporosis, which means another pill in the pile,” one member wrote.
Another added, “Tomorrow, I have to have an IV medication that I get once a year for my osteoporosis.”
A third member shared, “I now have osteoporosis and need to take Forteo medication (injectable).”
For some, osteoporosis has caused broken bones and other problems. One member shared their long journey with the condition: “I was diagnosed in my 40s with a fracture of the lumbar spine. It now has progressed to osteoporosis. At 79, it’s a hard fight to stand up straight. I use my walker more than usual to straighten up.”
One member shared, “I now have osteoporosis. I fractured two vertebrae in my back last month, and two weeks ago, I fell into a snowbank and fractured two ribs on the upper right side. My bones are so brittle.”
Another wrote, “I have osteoporosis and had bilateral hip replacements. I’ll have a knee replacement soon also.”
Clearly, osteoporosis can make life with MS even more complicated, whether due to added medications and treatments or the risk of broken bones. Therefore, it’s important to know how to manage the condition along with multiple sclerosis.
If you do get a fracture, there are a few things you can do. Note that you should always ask your doctor what you can do to help your bones heal well. Your medical team will help you come up with a plan that will not interfere with your neurological treatments for MS and will help you get back to full health.
Taking vitamin D and calcium can help with new bone formation and reduce any additional bone loss you might suffer because of the trauma. These likely won’t make your bone tissue stronger than it was before, but they may help you get your body back to normal faster.
You will need to rest the broken bone and the area around it. Avoiding undue strain helps prevent reinjury and gives the body plenty of time to heal properly. Make sure you ask your doctor how long you will need to rest the affected bones. Even if your pain goes away before that period of time is up, continue resting. New bone growth can be fragile, and resting gives it time to get stronger again.
Don’t smoke while you are healing. Smoking can limit the supply of blood to your healing bones. Bones need this blood supply to heal as quickly as possible and to provide new bone growth with all the minerals necessary to be as strong as possible.
The best way to help your bones is to avoid breaking them in the first place. Here are some ways to help prevent injury and ensure bone strength and health. Note that you should not take on any new treatments for bone health without talking to your neurology team first. They should be able to help you find safe ways to protect your bones and care for your body with MS.
Supplementing vitamin D and calcium may help maintain your bone strength. Work with your doctor to determine the amount of calcium and vitamin D supplementation that is right for you. You may need regular blood work to see how well your body is absorbing these minerals.
Certain types of exercise may help maintain bone strength and prevent even more weakening. If you struggle with exercise because of MS, talk to a physical therapist. They may be able to develop an exercise plan that is specific to you and your needs.
There are a number of medications that have been approved for preventing further bone loss due to osteoporosis. Some of these can be taken orally, some are injections, and some are IV infusions. You and your doctor can work together to find the medication or combination of medications that is right for you.
Are you or a loved one living with multiple sclerosis? Consider joining MyMSTeam today. On the online social network for people with MS and those who love and care for them, you’ll find a team of people who know what it’s like to live with MS. You can share your story, ask questions, and connect with others from around the world who are here to listen.
Are you dealing with dual diagnoses of MS and osteoporosis? Are you worried about developing osteoporosis? Share your thoughts in the comments below or by posting on MyMSTeam.