High-Dose Intravenous Steroid Treatment Seems to Have No Long-Term Negative Effect on Bone Mineral Density of Young and Newly Diagnosed Multiple Sclerosis Patients: A Pilot Study

Short-Term Risk Factors for Bone Loss in Multiple Sclerosis: A Prospective Study and Literature Review

BACKGROUND

Reduced bone mass and increased osteoporosis risk are common in people with multiple sclerosis (pwMS). The aim of the study was to identify risk factors for short-term bone loss in MS.

METHODS

This prospective study included 139 pwMS (ages 18-65). Baseline data included demographics, body-mass index, physical activity, smoking, menopause status, 25-hydroxy vitamin D levels, and history of glucocorticoid use. Bone mineral density (BMD) was measured at baseline and after 2 years using dual-energy X-ray absorptiometry (DXA) for the lumbar spine and hip. Disability worsening was assessed by the Expanded Disability Status Scale (EDSS). Additionally, a literature review was conducted on longitudinal data regarding BMD in MS.

RESULTS

Over the 2-year follow-up period, significant BMD loss was observed in the hip (baseline g/cm2: median 0.898; IQR 0.808-1.014; 2-year follow-up: 0.882; 0.784-1.01; p < 0.001), but not in the lumbar spine. Overall, 101 (73.1%) experienced hip BMD loss, with a median decrease of 3.5%. Patients with disability worsening had an approximately 7-times higher risk of bone loss compared to those without disability worsening (p = 0.013). PwMS with fractures during the follow-up period had significantly lower hip BMD (0.760, 0.546-0.890 vs. 0.909, 0.828-1.015; p = 0.024), a higher EDSS score (4.4, 2.8-5.8 vs. 2.0, 1.0-4.0 vs. p = 0.026), and were older (59, 46-62 vs. 47, 37-54; p = 0.030) compared to those without fractures.

CONCLUSION

Disability worsening was identified as a risk factor for BMD loss. These findings underscore the need for active monitoring of pwMS with disability worsening to prevent bone loss and, thus, to reduce fracture risk.

The Relationship Between Systemic Lupus Erythematosus and Osteoporosis Based on Different Ethnic Groups: a Two-Sample Mendelian Randomization Analysis

The previous observational studies could not overcome the effects of confounding variables and reverse causality. We aimed to determine whether there is a causal relationship between systemic lupus erythematosus and osteoporosis in East Asian and European populations, respectively, by two-sample Mendelian Randomization analysis. We obtained and downloaded data from publicly available genome-wide association study databases and analyses for East Asian and European populations, including systemic lupus erythematosus (SLE), osteoporosis (OP), multisite bone mineral density (BMD), and OP with fracture. After screening for instrumental single-nucleotide polymorphisms (SNPs) significantly correlated to SLE, the inverse-variance weighted (IVW) method was used for calculating the ratio and 95% confidence interval, besides utilizing MR-Egger, weighted median, and weighted mode to assess the robustness of the primary outcome. Moreover, multiple analyses, including MR-PRESSO, MR-Egger intercept, Cochran's Q test, as well as "leave-one-out" sensitivity, were used for evaluating horizontal pleiotropy, heterogeneity, and stability. Finally, we exchanged exposure and outcome and performed a reverse MR analysis. IVW (OR = 1.05, 95% CI = 1.01-1.09, P = 0.009) indicated a significant positive correlation between genetically predicted SLE and OP in East Asians. Furthermore, neither heterogeneity nor horizontal pleiotropy was observed. In Europe, there was no significant genetically predicted causal relation between SLE and OP. Bi-directional MR analysis showed no reverse causality between SLE and OP. In the East Asian population, genetically predicted SLE may have had a positive causal relationship with OP. In Europe, there is insufficient evidence for a potential causal relation between SLE and OP or BMD and fracture, and the correlations currently observed may be attributed to a variety of confounder variables.

Height Loss Is an Independent Predictor of Fracture Incidence in Postmenopausal Women: The Results from the Gliwice Osteoporosis Study (GO Study)

BACKGROUND

The aim of a longitudinal, retrospective study was to establish variables predicting fracture incidence over a decade.

METHODS

The study sample comprises a group of 457 postmenopausal women aged over 55 years, recruited from the database of an outpatient osteoporotic clinic. Several variables with potential influence on bone status, including the measurement of body height and hip bone densitometry, were collected. BMD at the femoral neck (FN BMD) was established using a Prodigy device (Lunar, GE, USA). Current body height was compared with the maximal historical body height in early adulthood, as reported by the patient.

RESULTS

Three hundred and ninety-four women did not have fractures during the follow up, and 63 subjects presented fractures. Subjects with fracture had lower FN BMD with a T-score of -1.86 ± 1.04 compared to -1.44 ± 0.89 in those without fractures (p < 0.001). Mean height loss (HL) was 3.47 ± 2.11 cm in fractured subjects and 2.50 ± 2.47 cm in unfractured ones, and differed significantly, p < 0.01. Fracture incidence was significantly related to age, rheumatoid arthritis, falls, and previous fractures. In the multivariable analysis using logistic regression, FN BMD, baseline fracture, and HL were identified as the significant predictors of fractures of follow up.

CONCLUSIONS

Osteoporotic fractures in postmenopausal women were predicted by FN BMD, prior fracture(s), and HL easily established during physical examination.