Sporadic corticosteroid pulses and osteoporosis in multiple sclerosis

S. R. Schwid, A. D. Goodman, J. E. Puzas, M. P. McDermott and D. H. Mattson
Department of Neurology, University of Rochester Medical Center, Ny, USA.

BACKGROUND: Bone mineral density is reduced in patients with multiple sclerosis (MS), but the reduction has not been shown to correlate with steroid use retrospectively. OBJECTIVE: To prospectively measure bone density following a single corticosteroid pulse using dual energy x-ray absorptiometry. PATIENTS AND METHODS: Thirty acutely relapsing patients with MS were given 1000 mg of methylprednisolone intravenously daily for 3 days followed by an oral prednisone taper for 2 weeks. The bone density was determined at the lumbar spine and femoral neck prior to treatment. Seventeen patients were reevaluated 2,4, and 6 months following treatment. RESULTS: Prior to treatment, bone density in patients with MS was already reduced at the femoral neck compared with an age-matched reference population, but the degree of this reduction did not correlate with prior steroid exposure. Lumbar density, in contrast, was normal. Following the steroid pulse, lumbar bone density increased, becoming 1.7% greater than baseline 6 months later (P = .02). Femoral bone density did not change on average, but the patients who required a cane or walker for ambulation had a 1.6% decrease in femoral bone density, while those with better ambulation had a 2.9% increase (P = .04). CONCLUSIONS: Bone density is decreased in MS. A single corticosteroid pulse did not reduce bone density in fully ambulatory patients with MS and multiple pulses did not have a cumulative effect on bone density in retrospective analysis. The change in femoral density in poorly ambulatory patients may have been related to inactivity rather than the steroid pulse.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Multiple sclerosis management for low-income minorities
Shabas and Heffner
Mult Scler 2005;11:635-640.
ABSTRACT  

Bone strength in multiple sclerosis: cortical midtibial speed-of-sound assessment
Achiron et al.
Mult Scler 2004;10:488-493.
ABSTRACT  

Immediate Fall of Bone Formation and Transient Increase of Bone Resorption in the Course of High-Dose, Short-Term Glucocorticoid Therapy in Young Patients with Multiple Sclerosis
Dovio et al.
J. Clin. Endocrinol. Metab. 2004;89:4923-4928.
ABSTRACT | FULL TEXT  

Risk of bone loss in men with multiple sclerosis
Weinstock-Guttman et al.
Mult Scler 2004;10:170-175.
ABSTRACT  

Bone status in multiple sclerosis: beyond corticosteroids
Tuzun et al.
Mult Scler 2003;9:600-604.
ABSTRACT  

High-Dose Methylprednisolone Therapy in Multiple Sclerosis Induces Apoptosis in Peripheral Blood Leukocytes
Leussink et al.
Arch Neurol 2001;58:91-97.
ABSTRACT | FULL TEXT  

Osteoporosis in neurological disorders
LLOYD et al.
J. Neurol. Neurosurg. Psychiatry 2000;68:543-547.
FULL TEXT  

Recent developments in drug therapy for multiple sclerosis
Smith and Darlington
Mult Scler 1999;5:110-120.
ABSTRACT