| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Regional Bone Center (Drs. Nieves, Cosman, Shen, and Lindsay) and the Multiple Sclerosis Center (Dr. Herbert), Helen Hayes Hospital, West Haverstraw, NY; and the Departments of Medicine (Drs. Cosman and Lindsay), Neurology (Dr. Herbert), and Pathology (Dr. Shen), College of Physicians and Surgeons, Columbia University, New York, NY.
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/1) was in the insufficient range, and 12 patients (23%) had frank vitamin D deficiency (< 25 nmol/1). 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.
Address correspondence and reprint requests to Dr. Jeri Nieves, Helen Hayes Hospital, Route 9W, West Haverstraw, NY 10993.
Supported in part by Public Health Service grants AR39191 and DK46381.
Received January 27, 1994. Accepted in final form March 11, 1994.
This article has been cited by other articles:
|
|
 |
|
  G. Hiremath, D Cettomai, M Baynes, J. Ratchford, S Newsome, D Harrison, D Kerr, B. Greenberg, and P. Calabresi Vitamin D status and effect of low-dose cholecalciferol and high-dose ergocalciferol supplementation in multiple sclerosis Multiple Sclerosis, June 1, 2009; 15(6): 735 - 740. [Abstract] [PDF]
|
|
|
|
|
|
J. Kragt, B. van Amerongen, J Killestein, C. Dijkstra, B. Uitdehaag, C. Polman, and P Lips Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women Multiple Sclerosis, January 1, 2009; 15(1): 9 - 15. [Abstract] [PDF]
|
|
|
|
|
|
J Smolders, P Menheere, A Kessels, J Damoiseaux, and R Hupperts Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis Multiple Sclerosis, November 1, 2008; 14(9): 1220 - 1224. [Abstract] [PDF]
|
|
|
|
 |
|
 S.-M. Orton, A. P Morris, B. M Herrera, S. V Ramagopalan, M. R Lincoln, M. J Chao, R. Vieth, A D. Sadovnick, and G. C Ebers Evidence for genetic regulation of vitamin D status in twins with multiple sclerosis Am. J. Clinical Nutrition, August 1, 2008; 88(2): 441 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Dalgas, E. Stenager, and T. Ingemann-Hansen Review: Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training Multiple Sclerosis, January 1, 2008; 14(1): 35 - 53. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. Arnson, H. Amital, and Y. Shoenfeld Vitamin D and autoimmunity: new aetiological and therapeutic considerations Ann Rheum Dis, September 1, 2007; 66(9): 1137 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.S. Barnes, M.P. Bonham, P.J. Robson, J.J. Strain, A.S. Lowe-Strong, J. Eaton-Evans, F. Ginty, and J.M.W. Wallace Assessment of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D3 concentrations in male and female multiple sclerosis patients and control volunteers Multiple Sclerosis, June 1, 2007; 13(5): 670 - 672. [Abstract] [PDF]
|
|
|
|
|
|
J.A. Woolmore, M. Stone, E.M. Pye, J.M. Partridge, M. Boggild, C. Young, P.W. Jones, A.A. Fryer, C.P. Hawkins, and R.C. Strange Studies of associations between disability in multiple sclerosis, skin type, gender and ultraviolet radiation Multiple Sclerosis, April 1, 2007; 13(3): 369 - 375. [Abstract] [PDF]
|
|
|
|
|
|
B. Weinstock-Guttman, J. Hong, R. Santos, M. Tamano-Blanco, D. Badgett, K. Patrick, M. Baier, J. Feichter, E. Gallagher, N. Garg, et al. Interferon-{beta} modulates bone-associated cytokines and osteoclast precursor activity in multiple sclerosis patients Multiple Sclerosis, September 1, 2006; 12(5): 541 - 550. [Abstract] [PDF]
|
|
|
|
|
|
D. Shabas and M. Heffner Multiple sclerosis management for low-income minorities Multiple Sclerosis, December 1, 2005; 11(6): 635 - 640. [Abstract] [PDF]
|
|
|
|
 |
|
 C.H. Hawkes Are multiple sclerosis patients risk-takers? QJM, December 1, 2005; 98(12): 895 - 911. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D M Wingerchuk, J Lesaux, G P A Rice, M Kremenchutzky, and G C Ebers A pilot study of oral calcitriol (1,25-dihydroxyvitamin D3) for relapsing-remitting multiple sclerosis J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1294 - 1296. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Soilu-Hanninen, L Airas, I Mononen, A Heikkila, M Viljanen, and A Hanninen 25-Hydroxyvitamin D levels in serum at the onset of multiple sclerosis Multiple Sclerosis, June 1, 2005; 11(3): 266 - 271. [Abstract] [PDF]
|
|
|
|
|
|
S. Schwarz and H. Leweling Multiple sclerosis and nutrition Multiple Sclerosis, February 1, 2005; 11(1): 24 - 32. [Abstract] [PDF]
|
|
|
|
|
|
A. Achiron, S. Edelstein, Y Ziev-Ner, U. Givon, Z. Rotstein, and Y. Barak Bone strength in multiple sclerosis: cortical midtibial speed-of-sound assessment Multiple Sclerosis, October 1, 2004; 10(5): 488 - 493. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Dovio, L. Perazzolo, G. Osella, M. Ventura, A. Termine, E. Milano, A. Bertolotto, and A. Angeli Immediate Fall of Bone Formation and Transient Increase of Bone Resorption in the Course of High-Dose, Short-Term Glucocorticoid Therapy in Young Patients with Multiple Sclerosis J. Clin. Endocrinol. Metab., October 1, 2004; 89(10): 4923 - 4928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Weinstock-Guttman, E. Gallagher, M. Baier, L. Green, J. Feichter, K. Patrick, C. Miller, K. Wrest, and M. Ramanathan Risk of bone loss in men with multiple sclerosis Multiple Sclerosis, April 1, 2004; 10(2): 170 - 175. [Abstract] [PDF]
|
|
|
|
|
|
R. D Simmons, A.-L. Ponsonby, I. A. van der Mei, and P. Sheridan What affects your MS? Responses to an anonymous, Internet-based epidemiological survey Multiple Sclerosis, April 1, 2004; 10(2): 202 - 211. [Abstract] [PDF]
|
|
|
|
 |
|
 K. L. Munger, S. M. Zhang, E. O'Reilly, M. A. Hernan, M. J. Olek, W. C. Willett, and A. Ascherio Vitamin D intake and incidence of multiple sclerosis Neurology, January 13, 2004; 62(1): 60 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Tuzun, A. AltWntas, I. Karacan, S. Tangurek, S. Saip, and A. Siva Bone status in multiple sclerosis: beyond corticosteroids Multiple Sclerosis, December 1, 2003; 9(6): 600 - 604. [Abstract] [PDF]
|
|
|
|
|
|
Y. Sato, N. Metoki, J. Iwamoto, and K. Satoh Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients Neurology, August 12, 2003; 61(3): 338 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I A F van der Mei, A-L Ponsonby, T Dwyer, L Blizzard, R Simmons, B V Taylor, H Butzkueven, and T Kilpatrick Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study BMJ, August 9, 2003; 327(7410): 316. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Sato, T. Asoh, I. Kondo, and K. Satoh Vitamin D Deficiency and Risk of Hip Fractures Among Disabled Elderly Stroke Patients Stroke, July 1, 2001; 32(7): 1673 - 1677. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M E LLOYD, T D SPECTOR, and R HOWARD Osteoporosis in neurological disorders J. Neurol. Neurosurg. Psychiatry, May 1, 2000; 68(5): 543 - 547. [Full Text]
|
|
|
|
 |
|
 M. T. Cantorna Vitamin D and Autoimmunity: Is Vitamin D Status an Environmental Factor Affecting Autoimmune Disease Prevalence? Experimental Biology and Medicine, March 1, 2000; 223(3): 230 - 233. [Abstract] [Full Text]
|
|
|
|
|
|
J. L. Steckley, D. A. Dyment, A. D. Sadovnick, N. Risch, C. Hayes, and G. C. Ebers Genetic analysis of vitamin D related genes in Canadian multiple sclerosis patients Neurology, February 8, 2000; 54(3): 729 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Sato, M. Kaji, K. Oizomi, and F. Cosman An alternative to vitamin D supplementation to prevent fractures in patients with MS Neurology, July 1, 1999; 53(2): 437 - 437. [Full Text]
|
|
|
|
|
|
Y. Sato, H. Maruoka, K. Oizumi, and M. Kikuyama Vitamin D Deficiency and Osteopenia in the Hemiplegic Limbs of Stroke Patients Stroke, December 1, 1996; 27(12): 2183 - 2187. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. R. Schwid, A. D. Goodman, J. E. Puzas, M. P. McDermott, and D. H. Mattson Sporadic Corticosteroid Pulses and Osteoporosis in Multiple Sclerosis Arch Neurol, August 1, 1996; 53(8): 753 - 757. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
