The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients

Medication and bone health in multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications incur decreases in areal bone mineral density (aBMD) and higher fracture risk in this population.

OBJECTIVE

To investigate the effects of commonly used medications on aBMD and fracture risk among people with MS.

METHODS

MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from their inception until February 5, 2023. We included randomized controlled trials as well as cross-sectional, retrospective, and prospective studies investigating whether glucocorticoids, immunomodulators, antidepressants, anticonvulsants, anxiolytics, opioids, or antipsychotics influenced aBMD or fracture risk in people with MS. Data were pooled using random effects meta-analyses to determine hazard ratios (HRs) and 95% CIs.

RESULTS

We included 22 studies (n = 18,193). Six studies were included in the meta-analyses of glucocorticoid use and aBMD, whereas 2 studies were included in the medication use and fracture risk meta-analyses. No studies assessed the effect of antidepressants, anxiolytics, anticonvulsants, opioids, and antipsychotics on aBMD, and no studies assessed the effect of immunomodulators on fracture risk. Glucocorticoid use was significantly negatively associated with femoral neck aBMD (correlation = -0.21 [95% CI = -0.29 to -0.13]), but not with lumbar spine aBMD (correlation = -0.21 [95% CI = -0.50 to 0.12]). There were no differences in fracture risk between users of glucocorticoids (HR = 1.71 [95% CI = 0.04 to 76.47]), antidepressants (HR = 1.84 [95% CI = 0.09 to 38.49]), or anxiolytics (HR = 2.01 [95% CI = 0.06 to 64.22]), compared with nonusers.

CONCLUSIONS

The available evidence is insufficient to support a relationship between greater fracture risk for people with MS taking glucocorticoid, antidepressant, or anxiolytic medication, compared with nonusers, and it is unclear whether these medications are associated with bone loss in people with MS, beyond that in the general population. Additional high-quality studies with homogenous methodology exploring how medications influence aBMD and fracture risk in people with MS are required.

The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis

BACKGROUND

The prevalence of osteoporosis is reported differently. We designed this systematic review and meta-analysis to estimate pooled prevalence of osteoporosis and osteopenia in patients with MS.

METHODS

Independently, two researchers searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature (conference abstracts and references of the references) up to March 2021. We collected data regarding first author, country of origin, number of enrolled patients, number cases with osteoporosis/ osteopenia, mean age, F/M ratio, mean EDSS, and mean duration of the disease.

RESULTS

Literature search revealed 847 articles and 658 remained after deleting duplicates. Finally, 29 original articles and 6 conference papers remained for meta-analysis. A total of 13,906 patients were evaluated. The pooled prevalence of osteoporosis was 17% (95% CI: 14-20%) (I² = 90.4%, p < 0.001). The pooled prevalence of osteopenia was 43% (95% CI: 35-51%) (I² = 97.9%, p < 0.001).

CONCLUSION

Osteoporosis/osteopenia should be considered in patients with MS.

Signaling pathway STAT1 is strongly activated by IFN-β in the pathogenesis of osteoporosis

Background

Despite extensive research, the underlying pathological mechanisms of osteoporosis are not completely understood. Recent studies have indicated a distinct role for the IFN-β/STAT1 pathway in bone metabolism. An inhibitory effect of IFN-β on osteoclastogenesis has been detected and STAT1/2 has been shown to influence osteoblastic bone metabolism. So far, no data concerning the IFN-β/STAT1 pathways in osteoblasts and osteoclasts from osteoporotic and non-osteoporotic patients are available. The aim of the study was to analyze these pathways in both cell types.

Methods

Osteoblasts were isolated from the femoral heads of 12 osteoporotic and 11 non-osteoporotic patients and monocytes were differentiated into osteoclasts. After the differentiation period, cells were stimulated once with 20 and 100 ng/mL IFN-β for 4 days. Viability, activity, bone metabolism-related genes, and the proteins Fra1, SOCS1, STAT1, p-STAT1, and TRAF6 were analyzed.

Results

Viability, activity, and gene expressions were not affected by stimulating the osteoblasts. However, in osteoporotic osteoclasts, which display a significantly higher basal osteoclastic activity, the stimulation with IFN-β lead to significant inhibition. Further, an increased STAT1 activation was detected in both cell types with no significant differences between the groups. Regarding the phosphorylation of STAT1, no significant influence was detected in osteoblasts but the IFN-β stimulation led to a significant increase of p-STAT1 in osteoclasts of both groups.

Conclusions

IFN-β is a principal mediator in the pathogenesis of osteoporosis by inhibiting osteoclasts and inducing and activating STAT1. Our results also confirm this in cells from osteoporotic and non-osteoporotic patients. Strong inhibitory effects on the osteoclastogenesis of osteoporotic osteoclasts were detectable. Nevertheless, osteoblast activity was not negatively affected by IFN-β stimulation. These results may contribute to a better understanding of the underlying pathological signaling pathways of osteoporosis.

Electronic supplementary material

The online version of this article (doi:10.1186/s40001-014-0074-4) contains supplementary material, which is available to authorized users.

Investigation of the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis

The aim of this study was to investigate the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis (MS) and to compare results with data from healthy controls. A total of 60 subjects, including 30 patients with MS, newly diagnosed and untreated (18 females, 12 males, at 18-40 years of age) and 30 healthy controls (20 female, 10 male) were enrolled in this study. Bone mineral density (BMD) of the lumbar spine and left femoral neck region were measured by dual-energy X-ray absorptiometry (DEXA). Serum levels of 25-hydroxyvitamin D (25OHD) were measured by chemiluminescence microparticle immunoassay (CMIA) on the Architect-i2000(®) (Abbott) system. 25OHD levels of MS patients were significantly lower than in controls. 25OHD levels were 27.2 ± 14.1 ng/ml in MS patients and 42.6 ± 8.8 ng/ml in controls (p = 0.001). Twenty-six (86.6 %) of our patients had a reduced BMD in lumbar spine or femoral neck region; of these 24 patients (80 %) had osteopenia and 2 patients (6.6 %) had osteoporosis. Interestingly, there was no significant correlation between 25OHD and BMD in lumbar spine and femoral neck region (r = 0.454, p = 0,074; r = 0.636, p = 0.082). Interestingly, a significant reduction of bone density in female MS patients was observed. In our study, 25OHD deficiency and lower BMD appeared in newly diagnosed multiple sclerosis. This is compatible with shared etiologic or pathogenic factors in MS and osteopenia/osteoporosis, and calls for an active approach to optimize bone health in early stages of MS.

Bone health and multiple sclerosis

People with multiple sclerosis (MS) have many reasons to have low bone mineral density and an increased fracture risk. Osteoporosis is a major cause of morbidity and mortality, and is more common in people with MS than the general population. A number of studies have examined the relationship between multiple sclerosis and reduced bone mineral density. In this topical review we seek to address the risk of low bone mineral density, osteoporosis and fractures associated with MS, and make practical suggestions as to how this pertinent issue may be approached in clinical practice.

Immunomodulators for multiple sclerosis may ameliorate spinal bone loss

BACKGROUND

The effect of immunomodulator therapy (IMT) for multiple sclerosis (MS) on bone turnover is unknown.

AIM

The aim of this study was to assess bone turnover in MS patients on IMT.

METHODS

MS patients (n = 29) on maintenance IMT had repeat measurement of bone mineral density (BMD) after a 4.0 ± 0.4 years; bone turnover markers (BTM) were measured at the time of repeat BMD.

RESULTS

BMD was unchanged at the spine but declined at the hip. BTMs, both resorption and formation, were reduced compared to normative range that may indicate an anti-resorptive action of IMT. Significant negative correlations were noted between BTMs and changes in BMD at spine but not hip.

CONCLUSION

These observations suggest that IMT may have a beneficial effect on spinal bone by an antiresorptive action. A prospective study of the effect of IMT on BMD and bone turnover is warranted.

Bone health in multiple sclerosis

People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.