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From the Clinical Research/Regional Bone Centers (Drs. Cosman, Nieves, Formica, Shen, and Lindsay, and L. Komar and G. Ferrer), Helen Hayes Hospital, West Haverstraw; Departments of Medicine (Drs. Cosman, Formica, and Lindsay), Epidemiology (Dr. Nieves), and Pathology (Dr. Shen), Columbia University, New York; and Multiple Sclerosis Center (Dr. Herbert), Helen Hayes Hospital, West Haverstraw, NY.
Address correspondence and reprint requests to Dr. Felicia Cosman, Clinical Research Center, Helen Hayes Hospital, West Haverstraw, NY 10993.
Objectives: We have previously shown that MS patients have significantly reduced bone mass and a high prevalence of abnormal vitamin D status. The object of this study was to characterize the frequency of adulthood fractures in MS patients, prospectively determine rates of bone loss in MS, and determine whether vitamin D status is a predictor of bone loss.
Methods: MS patients (36 women, 18 men) were compared with age- and gender-matched healthy controls (35 women, 14 men). Bone mass was performed by dual x-ray absorptiometry at baseline and at 12-month intervals over 2 years.
Results: Fractures in the absence of major trauma had occurred in 2% of controls and 22% of MS patients (p < 0.002). Over the 2 years of prospective follow-up, both women and men with MS lost substantially more bone in the femoral neck than did controls (3% and 6% per year in pre- and postmenopausal women with MS versus 0.5% and 0.8% per year in controls; 7.3% per year in men with MS versus 1.6% per year in controls). Bone loss in the spine was also greater in women with MS than in controls (1.6 to 3.5% per year loss in MS patients versus no change in controls). Duration of steroid treatment beyond 5 months and ambulatory status were both predictors of bone loss. Bone loss in the spine occurred faster in MS patients with low (<20 ng/mL) 25-hydroxyvitamin D levels (1.9% per year, p < 0.04), whereas in those with normal 25-hydroxyvitamin D levels, bone loss was insignificant. At the femoral neck, bone loss was substantial in all patients, but was somewhat faster in the group with low levels of 25-hydroxyvitamin D (5.6% per year, p < 0.0001) compared with the group with high levels of 25-hydroxyvitamin D (4.3% per year, p = 0.03).
Conclusions: MS patients have more frequent fractures and lose bone mass more rapidly than do their healthy age- and gender-matched peers, in part related to insufficient vitamin D. Vitamin D repletion in MS patients who are deficient might reduce, to some extent, the rate of bone loss and decrease osteoporosis-related fractures.
Supported in part by grants from NIH (DK46381 and AR39191) and National MS Society (RG 2994-A-1).
Received February 2, 1998. Accepted in final form June 19, 1998.
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