Department of Medicine, School of Clinical Sciences at Monash Health, Monash Medical Centre, Monash University, Level 5/Block E, 246 Clayton Road, Clayton, VIC, 3168, Australia.
Institute for Nutrition and Health Innovation Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
Calcif Tissue Int. 2024 Mar;114(3):201-209. doi: 10.1007/s00223-023-01159-z. Epub 2023 Nov 28.
People with multiple sclerosis (MS) have a higher prevalence of osteoporosis, falls and fractures. Guidelines for MS populations targeting the management of osteoporosis, fracture and falls risk may help reduce the burden of musculoskeletal disease in this population. We aimed to systematically review current guidelines regarding osteoporosis prevention, screening, diagnosis and management in people with MS. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic review of scientific databases (MEDLINE, CINAHL, Embase and Scopus) was performed (n = 208). In addition, websites from MS organisations and societies were screened for clinical guidelines (n = 28). Following duplicate removal, screening and exclusions (n = 230), in total six guidelines were included in this review. Three of the identified guidelines were specific to managing osteoporosis in MS, while two linked vitamin D to bone health and one was focused on the effect of acute glucocorticoid use for MS exacerbations on bone health. All guidelines were found to contain inadequate recommendations for osteoporosis screening, management and treatment in people with MS given the evidence of higher prevalence of osteoporosis at an earlier age and compounding risk factors in this population. Early diagnosis and treatment of osteoporosis in people with MS is necessary as fractures lead to significant morbidity and mortality. Development of structured clinical guidelines directed at specific healthcare services will ensure screening, appropriate management, and care of bone health in people with MS.
多发性硬化症 (MS) 患者骨质疏松症、跌倒和骨折的患病率较高。针对 MS 人群管理骨质疏松症、骨折风险和跌倒风险的指南可能有助于减轻该人群的骨骼肌肉疾病负担。我们旨在系统地综述目前针对 MS 人群骨质疏松症预防、筛查、诊断和管理的指南。根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，对科学数据库 (MEDLINE、CINAHL、Embase 和 Scopus) 进行了系统的文献检索 (n=208)。此外，还对 MS 组织和学会的网站进行了临床指南的筛选 (n=28)。在重复去除、筛选和排除 (n=230) 之后，本综述共纳入了 6 项指南。其中 3 项确定的指南专门针对 MS 患者的骨质疏松症管理，2 项将维生素 D 与骨骼健康联系起来，1 项侧重于急性糖皮质激素治疗 MS 加重对骨骼健康的影响。鉴于 MS 患者骨质疏松症的患病率更高，发病年龄更早，且该人群的危险因素更为复杂，所有指南都被发现对 MS 患者的骨质疏松症筛查、管理和治疗的建议不够充分。MS 患者的骨质疏松症早期诊断和治疗是必要的，因为骨折会导致严重的发病率和死亡率。制定针对特定医疗服务的结构化临床指南将确保 MS 患者的筛查、适当管理和骨骼健康护理。
