Boning up on skeletal health

Have you ever discussed your bone strength with your doctor?

The majority of our bone mass is laid down by our early 20s.  After this time, the body will replace old bone, but the overall mass of the skeleton will never increase. In fact, it will gradually decrease with age¹ – and for some more quickly than others, if the results of a recent study² are anything to go by.

Canadian researchers measured the bone mineral density of 783 people with Multiple Sclerosis (MS), and compared it with that of people without the condition. The results revealed that the MS group had significantly lower bone density than the control group, as well as a higher rate of osteoporosis (weak bones that are more prone to fracture). Gulp.

Vitamin D and bone health

So what is it about MS that can affect bone strength in this way? Well, for starters, though very different, the two conditions  share similar risk factors. Like smoking, for example; not only does puffing away make you one and a half times more likely to develop MS³, it’s also associated with an increased risk of brittle bones, and bone fracture⁴.

And then there’s the vitamin D link. We know that low levels of the so-called sunshine vitamin are associated with an increased risk of developing MS⁵. We also know that vitamin D plays a vital role in calcium absorption, a mineral that’s crucial to bone strength and development. So it doesn’t take a genius to work out that low vitamin D levels could also increase your risk of osteoporosis, too. Talk about a double whammy.

MS, disability and osteoporosis

There’s also the fact that MS can affect muscle strength and mobility, not to mention energy levels, which can leave us less active. Since exercise is vital to bone strength (the pressure it puts on the bones, stimulates bone producing cells called osteoblasts^6,7), being less active could mean the musculoskeletal system isn’t getting the workout it needs⁸. The Canadian study we mentioned earlier for example, found disability to increase risk of osteoporosis².

If that wasn’t enough, certain medications commonly prescribed for MS can also cause possible bone issues. Long-term use of steroids for example, can interfere with calcium absorption and bone regeneration^{9, 10}, while some forms of anti-spasmodic drugs and even anti-depressants can also affect bone health. Of course all of these drugs can be invaluable for managing symptoms, so it’s a case of weighing up the pros and cons with your doctor.

Reducing your risk of osteoporosis

Whatever the link between MS and osteoporosis, there’s plenty you can do to reduce your own personal risk. A healthy balanced diet that provides plenty of the bone-building mineral calcium is a good place to start. Think dairy products such as milk (fun fact: there is more calcium in skimmed milk than full fat¹¹), yoghurt and cheese, as well as green vegetables such as kale, spinach, bok choy and broccoli. Salmon and sardines are also good sources.

Topping up your vitamin D levels also makes sense. Exposure to sunshine is the best source, as the skin makes the vitamin in response to UV radiation. Spending plenty of time outdoors will naturally boost your levels (experts recommend exposing skin for around 20 minutes a day without sunscreen, but not so you burn), while dietary sources include oily fish such as salmon and mackerel, as well as egg yolk and liver. If you’re someone who struggles to get outdoors, or you rarely bare your skin, a supplement can also be beneficial. Something to discuss with your doctor.

Weight-bearing exercise is also vital, whether it’s a daily stroll in the park, or a seriously sweaty circuits class – whatever your fitness level allows. Even if you’re in a wheelchair there are ways to build muscle and bone mass, so speak to your physiotherapist about devising an exercise plan.

Ultimately, investing in your bones makes good sense for the future whether you have MS or not. Sensible shoes might be an inevitable part of getting older, but brittle bones and fractures really don’t have to be.

Now that we have your skeleton sorted, it may be time to think about that pension…

References:

1. Peak Bone Mass In Women. National Institutes of Health Osteoporosis And Related Bone Disease. Resources. https://www.niams.nih.gov/health_info/bone/osteoporosis/bone_mass.asp
2. Factors Associated with Osteoporosis in People with MS Undergoing Bone Density Screening. Presented at the 2017 Consortium of Multiple Sclerosis Centers Annual Meeting, May 24-27 in New Orleans, America. Etienne J Bisson, Marcia Finlayson, Okechukwu Ekuma, Ruth Ann Marrie. https://cmsc.confex.com/cmsc/2017/webprogram/Paper5023.html
3. Smoking: effects on multiple sclerosis susceptibility and disease progression Dean M. Wingerchuk Ther Adv Neurol Disord Jan 2012; 5 (1):13-22. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251901/
4. Smoking And Bone Health. National Institutes of Health Resources. Available at: https://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/bone_smoking.asp
5. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study, Lauren E. Mokry, Stephanie Ross, Omar S. Ahmad, Vincenzo Forgetta, George, Davey Smith, Aaron Leong, Celi MT. Greenwood, George Thanassoulis, J. Brent Richards. PLOS Medicine 13(3): e1001981. https://doi.org/10.1371/journal.pmed.1001866
6. Website ‘Peak fitness’ How Exercise Helps Strengthen Your Bones and Avoid Osteoporosis, Safely and Naturally. Available at: http://fitness.mercola.com/sites/fitness/archive/2014/04/25/exercise-bone-health.aspx
7. Website ‘National osteoporosis foundation’ Osteoporosis Exercise For Strong Bones. National Osteoporosis Foundation. Available at: https://www.nof.org/patients/fracturesfall-prevention/exercisesafe-movement/osteoporosis-exercise-for-strong-bones/
8. Osteoporosis and Multiple Sclerosis: Risk Factors, Pathophysiology, and Therapeutic Interventions Gupta, S., Ahsan, I., Mahfooz, N. et al. CNS Drugs (2014) 28: 731. https://link.springer.com/article/10.1007/s40263-014-0173-3
9. Multiple Sclerosis and Osteoporosis: What's the Connection? Jeri Burtchell, Healthline, 02 August 2014 http://www.healthline.com/health-news/multiple-sclerosis-osteoporosis-connection-080214
10. Certain antidepressants may erode bone, reports the Harvard Mental Health Letter Harvard Health Publications. http://www.health.harvard.edu/press_releases/certain-anti-depressants-may-erode-bone
11. Website ‘Daily mail’. Which Milk Has More More Calcium? Daily Mail Newspaper http://www.dailymail.co.uk/femail/article-197372/Which-milk-calcium.html