Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun 55160, Turkey.
J Clin Neurosci. 2010 Oct;17(10):1260-4. doi: 10.1016/j.jocn.2010.01.044. Epub 2010 Jul 8.
Bone mineral density (BMD) is affected in young adults with multiple sclerosis (MS), which leads to disabling disease. We aimed to show changes that were independent of immobilization by measuring BMD and laboratory markers of bone metabolism in mobile MS patients. We compared a total of 52 premenopausal female patients with relapsing-remitting multiple sclerosis (RRMS) to 41 women of similar age who had no risk factors for osteoporosis. The lumbar and femur BMD were measured using the dual energy X-ray absorptiometry (DXA) method. The urine concentration of serum 25-hydroxycholecalciferol (25-OH vit D(3)), and pyridinoline and deoxypyridinoline were also measured. The concentration of serum osteocalcin was measured to determine the speed of bone metabolism. The mean age of patients (+/- standard deviation [SD]) was 36.1+/-7.4. The average Expanded Disability Status Scale (EDSS) score was 2.2+/-1.8. The concentration of 25-OH vit D(3) and osteocalcin was lower, whereas the concentration of parathyroid hormone (PTH), alkaline phosphatase (ALP), pyridinoline and deoxypyridinoline was higher in the patient group. In the patient group, lumbar 2-4 BMD, T score and Z score and femur neck and trochantor BMD, T score and Z score were significantly lower than in the control group. There was a significant negative relationship between: the disease period and L 2-4 BMD, T score and Z scores; and the femoral neck BMD, T score and Z scores. There was a significant relationship between the total Functional Independence Measure score and the femoral neck, femoral trochanter BMD, T score, and Z score. There was a significant negative relationship between the average EDSS, L 2-4 and all the DXA measurements obtained from the femur. There was a significant relationship between the 25-OH vit D(3) concentration and L 2-4 T score and Z score from the DXA measurements obtained from the femur. There were no significant relationships between osteocalcin, pyridinoline, deoxypyridinoline levels and the BMD measurements. Therefore, the duration of the disease and decrease in functional capacity are the main factors that affect BMD in MS. Apart from the decrease in functional capacity, 25-OH vit D(3) deficiency and secondary PTH increase contribute to the BDM changes observed in MS.
骨密度（BMD）在多发性硬化症（MS）的年轻患者中受到影响，这导致了致残性疾病。我们的目的是通过测量移动性 MS 患者的 BMD 和骨代谢实验室标志物，显示出与固定无关的变化。我们比较了总共 52 名患有复发缓解型多发性硬化症（RRMS）的绝经前女性患者和 41 名无骨质疏松危险因素的同龄女性。使用双能 X 射线吸收法（DXA）测量腰椎和股骨 BMD。还测量了血清 25-羟胆钙化醇（25-OH vit D（3））、吡啶啉和脱氧吡啶啉的尿浓度。测量血清骨钙素浓度以确定骨代谢速度。患者组的平均年龄（+/-标准差[SD]）为 36.1+/-7.4。平均扩展残疾状况量表（EDSS）评分为 2.2+/-1.8。25-OH vit D（3）和骨钙素浓度较低，而甲状旁腺激素（PTH）、碱性磷酸酶（ALP）、吡啶啉和脱氧吡啶啉浓度较高。在患者组中，腰椎 2-4 BMD、T 评分和 Z 评分以及股骨颈和转子间 BMD、T 评分和 Z 评分明显低于对照组。疾病期与腰椎 2-4 BMD、T 评分和 Z 评分呈显著负相关；与股骨颈 BMD、T 评分和 Z 评分呈显著负相关。总功能独立性测量评分与股骨颈、股骨转子间 BMD、T 评分和 Z 评分呈显著相关。平均 EDSS 与腰椎 2-4 和所有从股骨获得的 DXA 测量值呈显著负相关。25-OH vit D（3）浓度与从股骨获得的 DXA 测量值的腰椎 2-4 T 评分和 Z 评分呈显著正相关。骨钙素、吡啶啉和脱氧吡啶啉水平与 BMD 测量值之间无显著相关性。因此，疾病持续时间和功能能力下降是 MS 患者 BMD 变化的主要因素。除了功能能力下降外，25-OH vit D（3）缺乏和继发性 PTH 增加也导致了 MS 中观察到的 BDM 变化。
