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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.
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