The main thing you need to know is that you are more at risk for Osteoporosis if you are a woman who also has MS. Osteoporosis is characterized by a lack of bone density which affects many women as they grow older. It seems that Multiple Sclerosis can accelerate this process of losing bone mass. An article in the International Journal of MS Care (Vol. 4, March 2002) reports that in one study less than half of the participants with MS had normal bone density. Women with MS are particularly susceptible to getting Osteoporosis due to things like using corticosteroid therapy and antiepileptic medications and the effect of limitations in mobility. Add to this, women with MS may have symptoms of impaired balance, lack of coordination, and leg muscle weakness, which can lead to falls and increased risk for fractures.
I have asked both Vicki Bridges, a writer here for MS Central who suffers from both MS and Osteoporosis and Pamela Flores, the Community Leader and writer for Health Central's Osteoporosis Connection to join us in discussing the link between Osteoporosis and MS and what we can do to possibly prevent it.
Pamela and Vicki, how long have you had Osteoporosis? When did it start and what were the warning signs?
Pamela: I've had osteoporosis for over 20 years. I was diagnosed in my early 30's from a bone biopsy which was done because I had several failed spinal surgeries. There really weren't any warning signs. I found out accidentally after having a spinal fracture and two subsequent failed fusions. I did go through early non-surgical menopause so I believe this loss of estrogen along with a family history of osteoporosis was the reason I contracted it so young.
Vicki: I have known about my osteoporosis for more than 10 years now. I have to believe I actually had it longer than that.
There were warning signs all over, yet I did not know. I was unaware that osteoporosis affected other people besides little old ladies.
One day, when Garry helped me transfer from my wheelchair to the car, we both heard a popping sound. I suddenly felt a pain in my leg, and we just looked at each other. Something was definitely wrong. My leg was fractured with the simple transferring from a wheelchair to a car. The fracture itself did not tell me I was a risk for osteoporosis. I was not old enough -- I had not yet gone through menopause.
Had I known then, or before then, about osteoporosis risks, I would have seen several warning signs. For example, regarding family history, my mother had osteoporosis. I have always been small framed, and I have European ancestry. There are two more warning signs.
I always walked a lot, and dancing was a favorite pastime. I often carried two young children, so the exercise and even the weight-bearing exercise was not a problem. I had been living in a wheelchair for two years before my bone snapped, so I was relatively inactive. There is another warning.
My diet was rich in calcium, phosphorus, and vitamin D because I always felt nutrition is important. However, I did drink soft drinks, colas -- still another warning.
I have MS, so I have taken steroids, and about 15 years earlier I had an ovarian cancer scare which resulted in an ovary being removed. Hmm. steroids and low estrogen levels sound like more warning signs.
I had plenty of warnings, but I am embarrassed to say I was not aware enough to recognize them.
What is it like to have Osteoporosis and how does it affect your everyday life?
Pamela: In my case, I need to be careful to prevent spontaneous fractures so this means avoiding exercises that twist or bend the spine or activities that involve lifting heavy objects. How I have to be constantly aware of good body mechanics and safe body movements. If I have to pick something up off the ground I have to squat down with my knees to reach it so I'm not bending from the waist. The cost of treatment is a major problem so that has quite an impact on my life. Many insurance companies don't pay for brand name drugs, and all the osteoporosis medications are relatively new so there is no generic, except for Fosamax, which I can't take.
Vicki: There few days when osteoporosis does not come to mind. Every time I move, every time I transfer from the chair to the bed, from the chair to the car, or back to the chair, I am aware that I may experience another fracture. I tend to be extra careful with every movement. I am also aware that pains in my joints may be caused by osteoporosis. My knees have extra pain, especially when they are moved. My caregiver and I have found ways to support my knees, and that makes it easier.
I am careful when I stretch which I do throughout the day as well as during my exercise routine. I take extra care not to upset my balance. When I look in the mirror I am aware of my posture. Osteoporosis is always in the back of my mind.
Vicki, how do you deal with having multiple health conditions such as MS and Osteoporosis? Does one condition make the other one worse?
There is a definite relationship between MS and osteoporosis. MSers develop osteoporosis sooner than the general population, it progresses faster and is likely to be more severe than that contracted by the average post-menopausal woman. Sooner, faster, more severe -- not very pleasant results.
MS often leads to a sedentary lifestyle which comes with minimal physical activity, lack of weight bearing exercise, and even use of steroids. All of this increases the risk of osteoporosis. Add to that fact that someone with MS has a high risk of falling, and we learn how osteoporosis leads to fractures. I have written about this before.
Osteoporosis is not generally listed as an MS symptom, but perhaps it should be. I listed it in a sharepost called MS Plus. It could have easily been included as a secondary or musculoskeletal symptom. Many of the symptoms of MS and osteoporosis are similar, and they work against each other. A joint pain hurts whether it is the result of an MS spasm or osteoporosis.
Is there any way to prevent Osteoporosis?
Pamela: Yes you can prevent osteoporosis if you start with proactive measures early. Weight bearing exercise, calcium, and vitamin D are all very important to prevent further bone loss if you have normal bone density or osteopenia. If you can get your vitamins through diet I believe that is the best way to do it since you can avoid problems like malabsorption.
What role does diet play in preventing or treating Osteoporosis?
Pamela: In my case diet is very important because I try to get the majority of my calcium that way. I include things like a cup of yogurt, milk, low-fat cheese and veggies high in calcium to increase my calcium intake. Calcium from foods rarely cause absorption or high calcium levels, so if you can get enough calcium through your diet that's great and if not then just supplement with a calcium tablet.
What are the possible treatments for Osteoporosis?
Pamela: Oral Bisphosphonates, like Fosamax, Actonel, and Boniva are possible treatments for osteoporosis. We also have IV Bisphosphonates, like Reclast--given once yearly for osteoporosis, and biannually for osteopenia. Boniva comes in an injected form which is given quarterly. These IV medications come with side effects, but are generally recommended for those who've had gastrointestinal problems with the oral forms. Since the infusion bypasses the stomach it doesn't cause the esophagus and stomach problems seen by some with the oral medications. The IV form can also be used for those who have trouble remembering to take their meds and those who want a more convenient administration.
Forteo, a man made form of parathyroid hormone is recommended for those at high risk for fracture, and is given daily for two years in an injection. This medication is very expensive, at $1,000.00 a month retail, and some insurance companies won't authorize this unless you've tried a Bisphosphonate first and it failed to increase your scores or you couldn't tolerate it.
Evista, is a estrogen agonist/antagonist that treats osteoporosis and may reduce the incidence of invasive breast cancer in postmenopausal women.
Miacalcin is a nasal spray made of salmon calcitonin. Generally Miacalcin is used as a second line of defense since the other treatments work faster. However, if you can't tolerate Bisphosphonates, SERMs (Evista), or are not a candidate for Forteo, Miacalcin can be used to slow bone loss.
Pamela and Vicki, do you have any last thoughts on Osteoporosis to impart to our readers on MS Central?
Pamela: Osteoporosis is preventable and treatable. I think many of us don't know this and worry that once you have it there's nothing you can do other than try to prevent it from getting worse. When I had my first DXA my numbers were in the low -3's and with Forteo treatment for 2 years my scores went to normal, in the spine, and osteopenia in my hip, so you can reverse these numbers if you work hard, find the right treatment and have a bit of luck.
Vicki: I had heard of Osteoporosis for years, but I didn't think much about it. Now I know better. I would like people, especially those with MS, to take osteoporosis seriously.
I thought I was living a healthy lifestyle, but I did not know. Anyone with MS should know they are already at risk for developing osteoporosis, and they should become proactive working with their doctor to maintain their bone health. Osteoporosis is not just for little old ladies. It may be hidden, but it can be found and treated.
Weak and brittle bones are ready to fracture with the slightest misstep. MS provides the awkward gait or inactivity that allows bone health to deteriorate. This cannot be ignored. The truth is that osteoporosis sneaks up on energetic, active people. Begin eating a calcium-rich diet and taking supplemental calcium at an early age.
Thank you both, Pamela and Vicki, for contributing so much of your time to share both your stories and your information to our MS Central readers. And if anyone in our audience would like more information and/or support for Osteoporosis please check out Osteoporosis Central here on Health Central.
Published On: August 24, 2009