What's the Link Between Osteoporosis and Multiple Sclerosis?

Osteoporosis is a condition that weakens bones in the body, leading to an increased risk of bone breaks or fractures. For a number of reasons, osteoporosis is common in those with multiple sclerosis (MS).

Aerial view of doctors looking for signs of osteoporosis in x-ray
Katarzyna Bialasiewicz / iStock / Getty Images

The tricky part about osteoporosis is that it's a silent condition, meaning that a person does not have symptoms of bone weakening. For instance, there are no bony aches or pains, which are seen in other joint and bone diseases like osteoarthritis. In fact, the diagnosis of osteoporosis is usually only made after a person undergoes a screening test (a DEXA scan) or after they experience a fracture.

People with osteoporosis are especially vulnerable to fractures of the hip or wrist, which generally occur after a fall—a common consequence of declining mobility in people with MS.

Additionally, as bones fracture, they have the potential to heal poorly, especially if one receives a late osteoporosis diagnosis. This is more common for spinal fractures as they are not always painful. And these poorly healed fractures can further contribute to MS-related problems, making for an altogether unforgiving cycle.

Why Am I Susceptible to Osteoporosis If I Have MS?

MS itself is believed to play a role in increased risk for developing osteoporosis. Surprisingly, even young patients in the early stages of MS—who have fewer symptoms and walk well—have bone loss. Scientists are not quite sure why this is the case, but there are likely a number of reasons at play.

Another potential risk factor is having a low vitamin D level, which experts know increases a person's risk of developing MS. Likewise, we know that vitamin D is essential for maintaining bone strength, and a low level in the body can cause osteoporosis.

There are many reasons why a person may be vitamin D deficient. It could be a result of not getting enough sunlight (the skin makes vitamin D when exposed to UV rays from the sun). Or it could be due to a health condition, like celiac disease, where vitamins like vitamin D are not absorbed well into the body.

The good news is that if your healthcare provider discovers you have low vitamin D levels, taking a supplement can prevent you from getting osteoporosis or improve the strength and health of your bones if you have already been diagnosed.

Medications used to treat MS relapses and symptoms can also contribute to bone weakening; one major culprit is the steroid Solu-Medrol. Selective-serotonin reuptake inhibitors (SSRIs)—medications used to treat depression in MS—can also cause bone weakening and osteoporosis.

Are There Non-MS Related Factors That Increase Osteoporosis Risk?

There are several non-MS related factors that increase your chance of getting osteoporosis, including:

  • Increasing age
  • Menopause
  • Smoking
  • Being underweight
  • Abusing alcohol
  • Sedentary lifestyle
  • Family history of osteoporosis

What Can I Do to Prevent Osteoporosis?

Osteoporosis is preventable. If you have already been diagnosed with it, don't be discouraged. You can still improve the strength of your bones and prevent future fractures.

One way is through exercise. Performing 30 minutes of daily weight-bearing exercises cannot only prevent bone loss but help prevent falls.

More rigorous exercises like climbing stairs may not be suited for some with MS, but excellent weight-bearing exercises include:

  • Power-walking
  • Dancing
  • Lifting weights
  • Using resistance bands in your wheelchair

If you are very limited in your mobility, try these bone-strengthening techniques:

  • Stand as much as possible throughout the day; use a standing frame if you can't stand alone
  • Tai chi
  • Wheelchair yoga

If you are considering an exercise program, it's best to ask your healthcare provider for a physical therapy referral. A physical therapist can help you devise an exercise program that works for your personal limitations. More importantly, with your therapist, create a program that you enjoy—you may be surprised at how invigorated you feel after a workout.

In addition to exercising, it may be useful to rethink your diet. Some options to consider are:

  • Adding bone-strengthening foods like fruits, vegetables, lean protein, calcium and unsaturated fats to your diet 
  • Asking your healthcare provider for a dietitian referral
  • Trying calcium-rich recipes from the National Osteoporosis Foundation (having some fun in the kitchen may also be a good distraction from your MS symptoms)

Checking your vitamin D level is also a good idea. If your level is low, your healthcare provider will likely recommend vitamin D supplements; getting adequate vitamin D from your diet can be difficult. But remember to not take any nutritional supplement without getting your healthcare provider's OK first, as it may interact with your other medications or not be right for you based on your health history.

Finally, some healthcare providers recommend screening patients with MS for osteoporosis soon after diagnosis, regardless of age. Talk with your practitioner to see if this is appropriate for you.

A Word From Verywell

Having a broken bone—especially one that limits your independence and mobility—on top of living with MS is anything but ideal. So just as you have taken an active role in learning about your MS and controlling aspects of it that you can, keep your bones healthy through regular activity and a nutritious diet to minimize your risk of osteoporosis.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dobson R, Ramagopalan S, Giovannoni G. Bone health and multiple sclerosis. Mult Scler. 2012 Nov;18(11):1522-8. doi:10.1177/1352458512453362

  2. National Institutes of Health. Osteoporosis and Related Bone Diseases Resource Center. Osteoporosis overview.

  3. Dionyssiotis Y. Bone loss and fractures in multiple sclerosis: focus on epidemiologic and physiopathological featuresInt J Gen Med. 2011;4:505-509. doi:10.2147/IJGM.S22255

  4. Kampman MT, Eriksen EF, Holmøy T. Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications? Acta Neurol Scand Suppl. 2011;(191):44-9. doi: 10.1111/j.1600-0404.2011.01543.x

  5. U.S. National Library of Medicine. Vitamin D Deficiency. Medline Plus.

  6. National Osteoporosis Foundation. Calcium and vitamin D.

  7. National Institutes of Health. Osteoporosis and Related Bone Diseases Resource Center. Exercise for your bone health.

  8. National Osteoporosis Foundation. Exercise/Safe Movement.

  9. National Osteoporosis Foundation. Nutrients.

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.