Multiple Sclerosis
"High prevalence of vitamin D deficiency and reduced bone mass
in multiple sclerosis"
Nieves J; Cosman F; Herbert J; Shen V; Lindsay R, Neurology 1994 Sep;44(9):1687-92
ABSTRACT: BACKGROUND: Female patients with multiple sclerosis
(MS) are at risk for osteoporosis because of gender, immobility, and corticosteroid
use. METHODS: Bone mineral density (BMD) was measured by dual x-ray absorptiometry
in 80 female MS patients admitted to a tertiary care hospital. All patients
completed a questionnaire that included measurements of dietary intake
and sunlight exposure. Biochemical indices of bone metabolism and turnover
were measured in a random sample of 52 patients. RESULTS: BMD of the lumbar
spine and femoral neck was 1 to 2 SDs lower in MS women compared with
a healthy reference population. BMD was lower in patients with more severe
MS. The mean 25(OH)D level of the sample population (43 nmol/l) was in
the insufficient range, and 12 patients (23%) had frank vitamin D deficiency
(< 25 nmol/l). BMD and age-related BMD (z scores) at all skeletal sites
measured were lowest when 25(OH)D levels were deficient. Parathyroid hormone
(PTH) was frankly elevated in 13% of patients. PTH levels were negatively
correlated with 25(OH)D levels and with BMD. Dietary intake of vitamin
D was below the recommended level in 80% of patients, and 40% reported
no weekly sunlight exposure. After controlling for age, cumulative steroid
use was not a determinant of BMD. CONCLUSIONS: BMD was significantly reduced
in female MS patients, which might increase fracture risk two- to threefold.
Vitamin D deficiency with secondary hyperparathyroidism is prevalent and
is probably a significant cause of low BMD in this population. Vitamin
D deficiency in the female MS patient might be safely and inexpensively
corrected by the routine use of vitamin D supplements.
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