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).

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 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—an altogether unforgiving cycle.

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—since 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 doctor 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 with osteoporosis.

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.

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

• increasing age
• menopause
• smoking
• being too thin
• abusing alcohol
• a sedentary lifestyle
• a family history of 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. According to the National Osteoporosis Foundation, performing 30 minutes of daily weight-bearing exercises can not only prevent bone loss but can also help prevent falls. 

More rigorous weight-bearing exercises like climbing stairs may not be conducive for some with MS, and that's all right. There are other excellent weight-bearing exercises like power walking, dancing, lifting weights, or using resistance bands in your wheelchair. If you don't have weights or a resistance band, be creative and use canned foods or a bathrobe tie.

If you are very limited in your mobility, that's OK, too. Try standing as much as possible throughout the day to strengthen your bones. If you cannot stand alone, get a standing frame to assist you. Tai chi and wheelchair yoga can also help improve muscle strength, balance, and flexibility, which can further prevent falls and bone breaks.

If you are considering an exercise program, it's best to ask your doctor 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 happy and invigorated you feel after a workout.

In addition to exercising, it may be useful to ask your doctor for a dietician referral—someone who can help you create delicious, nutrient-rich meals that help your bones and overall health. Diets rich in fruits, vegetables, lean protein, calcium, and unsaturated fats are important for keeping your bones strong and robust.

If a dietician referral is too expensive, the National Osteoporosis Foundation offers calcium-rich recipes that you can try on your own. Having some fun in the kitchen may also be a good distraction from your MS symptoms.

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

Checking your vitamin D level is also a good idea. If your level is low, your doctor will likely recommend vitamin D tabs since getting adequate vitamin D from your diet can be difficult. But remember to not take any nutritional supplement without the guidance of your physician first—they may interact with your other medications or not be right for you based on your health history.

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 what aspects you can, keep your bones healthy through regular activity and a nutritious diet to minimize osteoporosis or related risk.