PATIENTS WITH AN ACUTE MULTIPLE SCLEROSIS RELAPSE: A HIGH RISK GROUP FOR OSTEOPENIA AND OSTEOPOROSIS
J Neurol Neurosurg Psychiatry 2013;84:e2 doi:10.1136/jnnp-2013-306573.194
Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23–24 October 2013
Olwen Murphy⇓, Michael S Zandi, Nitzan Lindenberg, Elaine Murphy, Jeremy Chataway
National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London.
Objective To evaluate the bone health of a cohort of patients with an acute Multiple Sclerosis (MS) relapse and to develop an algorithm for the management of bone health in this patient group.
Methods We recruited 53 consecutive patients from our acute relapse clinic. Bone health was assessed with Dual Energy X-ray Absorptiometry (DEXA) scanning and vitamin D levels. Statistical analyses including regression were used to define predictive variables. A review of the literature led to a proposed management protocol.
Results Pre-relapse the baseline EDSS was ≤6.5 in all subjects, and ≤4.0 in the majority. The majority of patients received corticosteroids. Half of all subjects who attended for DEXA scanning had low bone mineral density (BMD) as defined by a T-score or Z-score less than −1.0. Two were osteoporotic (T-score less than −2.5).
One third of subjects were Vitamin D deficient (25–OH–Vitamin D less than 25nmol/L).
There were no significant predictive variables for reduced BMD, including previous corticosteroid usage.
Conclusion There was a high frequency of both low BMD and Vitamin D deficiency in this cohort of relatively young and largely ambulatory patients with an acute relapse. Current tools, such as the WHO FRAX algorithm, are inadequate in assessing bone status and fracture risk in this patient group, predominantly as they are focused on older age groups. We present a simple clinical management algorithm.
- 50% had low bone mineral density
- 30% had < 10ng/ml of vitamin D
- Overview MS and vitamin D
- Multiple Sclerosis: number needed to treat with vitamin D may be as low as 1.3 – Meta-analysis Oct 2013
- Full-on Multiple Sclerosis was 3.3X more likely in patients with the lowest vitamin D levels – July 2013
- Appears that Vitamin D can induce remission in recent Multiple Sclerosis
- Risk of going from pre-MS to MS reduced 68 percent with 7100 IU vitamin D – RCT Dec 2012