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Review
. 2025 May;32(5):e70176.
doi: 10.1111/ene.70176.

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

Anne Zinganell  1 , Harald Hegen  1 , Janette Walde  2 , Robert Barket  1 , Klaus Berek  1 , Michael Auer  1 , Martin Schmidauer  1 , Gabriel Bsteh  3   4 , Alexander Stephan Kroiss  5   6 , Andrea Griesmacher  7 , Birgit Waldner  1   8 , Alexander Tschoner  9 , Thomas Berger  3   4 , Florian Deisenhammer  1 , Franziska Di Pauli  1
Affiliations
Review

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

Anne Zinganell et al. Eur J Neurol. 2025 May.

Abstract

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.

Keywords: bone fracture; bone mineral density; disability; multiple sclerosis; osteoporosis.

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Conflict of interest statement

A.Z. has participated in meetings sponsored by, received speaking honoraria or travel funding from Biogen, Merck, Novartis, Sanofi‐Genzyme, Janssen, Bristol Myers Squibb, and Teva. H.H. has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer, Biogen, Bristol Myers Squibb, Horizon, Janssen, Merck, Novartis, Sanofi‐Genzyme, Siemens, Teva, and received honoraria for acting as a consultant for A‐med, Biogen, Bristol Myers Squibb, Novartis, Roche, Sanofi‐Genzyme, and Teva. J.W. has nothing to disclose. R.B. has participated in meetings sponsored by or received travel grants from Novartis, Janssen‐Cilag, Merck, and Sanofi‐Genzyme. Received honoraria from Janssen‐Cilag and Biogen. K.B. has participated in meetings sponsored by and received travel funding or speaker honoraria from Roche, Teva, Merck, Biogen, Sanofi, and Novartis. He is an associate editor of Frontiers in Immunology/Neurology, Section Multiple Sclerosis and Neuroimmunology. M.A. received speaker honoraria, honoraria for consulting and/or travel grants from Biogen, Novartis, Merck, Sanofi, Horizon Therapeutics/Amgen, and Zentiva. M.S. has participated in meetings sponsored by or received travel grants from Novartis, Sanofi‐Genzyme, and Amgen. G.B. has participated in meetings sponsored by, received speaker honoraria or travel funding from Biogen, Celgene/BMS, Janssen, Lilly, Medwhizz, Merck, Novartis, Roche, Sanofi‐Genzyme, and Teva, and received honoraria for consulting Adivo Associates, Biogen, Celgene/BMS, Janssen, Merck, Novartis, Roche, Sanofi‐Genzyme, and Teva. He has received unrestricted research grants from Celgene/BMS and Novartis. He serves on the Executive Committee of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). A.S.K. has nothing to disclose. A.G. has nothing to disclose. B.W. has nothing to disclose. A.T. has nothing to disclose. T.B. has participated in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for MS: Amgen, Allergan, Bayer, Biogen, Bionorica, BMS, Genesis, GSK, GW/Jazz Pharma, Horizon, Janssen, MedDay, Merck, Neuraxpharma, Novartis, Octapharma, Roche, Sandoz, Sanofi, Teva, TG Therapeutics, and UCB. His institution has received financial support in the past 12 months by unrestricted research grants (Biogen, Bayer, BMS, Merck, Novartis, Roche, Sanofi, Teva) and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Merck, Novartis, Octapharma, Roche, Sanofi, and Teva. F.D. has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Alexion, Almirall, A‐Med, Amgen/Horizon, Biogen, BMS, Sanofi, Janssen, Laurea Group, Medwhizz, Merck, Novartis Pharma, Neuraxpharm, Roche, Sandoz, and Teva. He is section editor of the MSARD Journal (Multiple Sclerosis and Related Disorders) and review editor of Frontiers in Neurology. F.D.P. has participated in meetings sponsored by, received honoraria (lectures, advisory boards, consultations), or travel funding from Amgen, Bayer, Biogen, Celgene, BMS, Horizon, Merck, Novartis, Sanofi‐Genzyme, Teva, and Roche.

Figures

FIGURE 1
FIGURE 1
Inclusion flow chart. DXA, dual‐energy X‐ray absorptiometry.
FIGURE 2
FIGURE 2
Percentage of total hip bone loss in people with multiple sclerosis without or with disability worsening.
See this image and copyright information in PMC

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