Abstract
There is mounting evidence that multiple sclerosis (MS) is associated with a significantly increased risk of osteoporosis and fractures. The development of osteoporosis in MS patients can be related to the cumulative effects of various factors.
Physical inactivity and reduced mechanical load on the bones is likely the major contributing factor for osteoporosis in MS. Additional possible factors leading to reduced bone mass are low vitamin D levels and medications such as glucocorticoids.
In addition, decreased muscle strength and coordination and balance disorders significantly increase the risk of falls. Some factors that may contribute to increased risk of osteoporosis and fractures have been understudied, including inflammation and gut microbiome, autonomic dysfunction, fatigue, and depression.
Therefore, bone mineral density and fracture risk assessment should be a part of the integral management of persons with MS.