Bone Health in Multiple Sclerosis

Multiple sclerosis (MS) is associated with multifactorial compromise of skeletal integrity. Reduced mechanical loading due to mobility impairment, cumulative exposure to glucocorticoids, vitamin D insufficiency and chronic inflammation converge to accelerate bone resorption and suppress formation. As a result, many people with MS exhibit osteopenia or osteoporosis at an earlier age than the general population, leading to heightened fracture risk, particularly of the hip, spine and distal femur. Fall propensity linked to sensory deficits and muscle weakness further compounds fracture incidence. Emerging evidence also highlights biochemical crosstalk between adipose-derived hormones and bone remodelling in MS, suggesting shared immunometabolic pathways. Thorough fracture risk assessment and timely intervention—ranging from physical rehabilitation and vitamin D optimisation to pharmacological antiresorptive therapy—are therefore critical components of comprehensive MS care.

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Bone Health in Multiple Sclerosis publication trend

The graph below shows the total number of articles in bone health in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Bone mineral density (BMD): A measure of mineral content in bone, reflecting strength and fracture resistance, typically assessed by dual-energy X-ray absorptiometry.

Osteopenia: A condition in which BMD is below normal levels but not low enough to be classified as osteoporosis, indicating early bone loss.

Osteoporosis: A skeletal disorder characterised by markedly reduced BMD and microarchitectural deterioration, leading to increased fracture risk.

Expanded Disability Status Scale (EDSS): A method of quantifying disability in MS, scoring neurological function and mobility on a scale from 0 (normal) to 10 (death due to MS).

Glucocorticoids: A class of steroid hormones used in MS to control inflammation and relapses, which can influence bone remodelling when used long term.

References

1. High-Dose Intravenous Steroid Treatment Seems to Have No Long-Term Negative Effect on Bone Mineral Density of Young and Newly Diagnosed Multiple Sclerosis Patients: A Pilot Study. Biomedicines (2023).
2. Correlation of Circulating Omentin-1 with Bone Mineral Density in Multiple Sclerosis: The Crosstalk between Bone and Adipose Tissue. PLOS ONE (2011).
3. Screening for osteoporosis in people with MS: A new risk score. Multiple Sclerosis and Related Disorders (2023).
4. Falls, fracture and frailty risk in multiple sclerosis: a Mendelian Randomization study to identify shared genetics. Journal of Bone and Mineral Metabolism (2024).