MS and Our Bones

Of late, I’ve been acutely aware of my bone health. After a recent fall, I’m in consultation with a team of surgeons and pain specialists as we plan for what will likely be an eventful revision of my current, 17-year-old, hip prosthesis.

The reason I initially got the hip replaced was because of multiple sclerosis (MS). Well … sort of. But there’s enough of a connection that I think it’s important to put bone health on the radar of those living with — and being treated for — MS.

Steroids and Avascular Necrosis

I acquired something called avascular necrosis (sometimes called osteonecrosis, or “bone death” because of a lack of adequate blood supply) as a result of multiple infusions of corticosteroids to treat acute flares early in my course of MS.

It’s one of those potential side effects we read about but, let’s face it, when in the throes of an exacerbation, we’re more concerned about immediate symptom abatement than what might happen 10 or 15 years down the road.

My experience highlights that bone death is something about which people with MS who have received a good few doses of high-dose steroids to treat attacks should be aware.

Other Medications and Bone Health

But corticosteroids aren’t the only medications used in treating MS and its symptoms that can (and do) relate to poor bone health.

Osteoporosis is a progressive condition that weakens bones, causing them to become thinner and more brittle. This can make them more prone to breaking. Along with a number of other factors (such as age, gender, weight, diet, smoking, family history), some medications can raise the risk of osteoporosis.

Research shows that antidepressants, which are prescribed to people with MS for both depression and nerve pain, are also linked to osteoporosis.

It is worth noting that research also suggests that one disease-modifying therapy (DMT) — fingolimod (Gilenya) — may have some protective mechanisms against osteoporosis in women.

Preliminary research in mice also suggests that dalfampridine (Ampyra), a drug used by some people with MS to improve walking, has potential to help bone fractures heal faster and improve bone mass and strength.

Weight-Bearing Exercise

Many of us will be aware that weight-bearing exercises can slow bone loss and even increase bone density.

That’s good to know, but it’s also true that more than a few people living with MS have difficulty with such exercises. Not that there aren’t workarounds and modified exercises that can benefit bone health, but perhaps not to the level that those without MS can achieve.

Treating and Preventing Osteoporosis

There are a number of treatments of osteoporosis, but an ounce of prevention is worth a pound of cure, goes the saying.

A diet rich in calcium (think dark, leafy green vegetables, dried fruits and nuts, tinned sardines, and dairy) can help, but if you are deficient in vitamin D (and many of us with MS are), your body may have difficulty absorbing said calcium. Make sure you are eating foods that contain vitamin D (oily fish, eggs, fortified dairy products, and fortified plant-based dairy alternatives) and spend a safe amount of time in the sun!

Increase your physical activity and add in weight-bearing exercise as practicable. Stop smoking if you smoke, and limit your alcohol consumption (most official recommendations advise men to have no more than two drinks per day and women to have no more than one per day).

Not Just an Old Person’s Problem

Bone health might be something we think of as an old person’s problem, or one that only women will have to face. Not so, at all. I was in my very early forties when I experienced the onset of my bone condition. Because of MS and how we treat it and its symptoms, it’s an “every person” consideration.

Wishing you and your family the best of health.

Cheers,

Trevis