Ayatollahi Azin, Mohajeri-Tehrani Mohammad Reza, Nafissi Shahriar
Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Neurol. 2013;12(1):19-22.
Multiple sclerosis (MS) is a demyelinating disease which can cause many disabilities for the patient. Recent data suggests that MS patients have higher risk for osteoporosis. This study was performed to investigate if the osteoporosis prevalence is higher in MS patients and to determine the possible factors affecting bone mineral density (BMD).
51 definite relapsing-remitting MS patients according to McDonald's criteria (45 females, 6 males aged between 20 and 50 years) participated in this study. The control group included 407 females aged from 20 to 49 years; they were healthy and had no history of the diseases affecting bone metabolism. Femoral and lumbar BMD were measured by Dual Energy X-ray Absorptiometry (DXA). The disability of MS patients was evaluated by Expanded Disability Status Scale (EDSS). The patient's quality of life was evaluated by the validated Persian version of multiple sclerosis impact scale (MSIS-29).
Patients' mean age was 36 ± 3.3 years and their mean disease duration was 8.7 ± 1.7 years. The mean EDSS score and the mean body mass index (BMI) of the patients were 3 ± 0.9 and 23.5 ± 2.3 kg/m(2), respectively. 29% of the patients had never been treated by ß-interferon and 6% of them had not received glucocorticoids (GCs) pulses since their MS had been diagnosed. 26% of the patients had a history of fracture.18% of our patients were osteoporotic and 43% of them were osteopenic. Femoral BMD was significantly lower among MS patients than age matched controls (P < 0.001), but lumbar BMD showed no difference. There was no correlation between administration of GCs pulses, interferon and BMD; however, we found a significant correlation between EDSS score, quality of life (QoL), disease duration and BMD of both site.
As a result of this study, bone loss inevitably occurs in MS patients. The major factor of BMD loss is immobility. Osteoporosis should be managed as part of MS patients' treatment protocols.
多发性硬化症（MS）是一种脱髓鞘疾病，可给患者带来多种残疾。最近的数据表明，MS患者患骨质疏松症的风险更高。本研究旨在调查MS患者中骨质疏松症的患病率是否更高，并确定影响骨密度（BMD）的可能因素。
根据麦克唐纳标准，51例确诊的复发缓解型MS患者（45名女性，6名男性，年龄在20至50岁之间）参与了本研究。对照组包括407名年龄在20至49岁之间的女性；她们身体健康，无影响骨代谢的疾病史。采用双能X线吸收法（DXA）测量股骨和腰椎的骨密度。通过扩展残疾状态量表（EDSS）评估MS患者的残疾情况。通过经验证的波斯语版多发性硬化症影响量表（MSIS-29）评估患者的生活质量。
患者的平均年龄为36±3.3岁，平均病程为8.7±1.7年。患者的平均EDSS评分和平均体重指数（BMI）分别为3±0.9和23.5±2.3kg/m²。29%的患者从未接受过β-干扰素治疗，6%的患者自确诊MS以来未接受过糖皮质激素（GCs）冲击治疗。26%的患者有骨折史。18%的患者患有骨质疏松症，43%的患者患有骨质减少症。MS患者的股骨骨密度显著低于年龄匹配的对照组（P<0.001），但腰椎骨密度无差异。GCs冲击治疗、干扰素与骨密度之间无相关性；然而，我们发现EDSS评分、生活质量（QoL）、病程与两个部位的骨密度之间存在显著相关性。
本研究结果表明，MS患者不可避免地会出现骨质流失。骨密度降低的主要因素是活动减少。骨质疏松症应作为MS患者治疗方案的一部分进行管理。
