Bone mineral density in patients with multiple sclerosis. A descriptive study from a unique center from the east of Spain

Flores-Fernández, E.; Valera-Ribera, C.; Vázquez-Gómez, I.; Orenes Vera, A. V.; Martínez-Ferrer, À Landete L.; Valls-Pascual, E.; Ybáñez-García, D.; Alegre-Sancho, J. J.

Background: Several studies have suggested that multiple sclerosis (MS) patients have low bone mineral density (LBMD) compared to healthy adults of same age. This fact, combined with the functional impairment of the disease, increases the risk of fractures. However, information about the prevalence and the risk factors of LBMD in Spanish patients with MS is still quite limited1-3. Objectives: To evaluate the prevalence of LBMD and low vitamin D in patients with MS from a unique center from the east of Spain, describing the clinical features of these patients. Methods: Type of study: observational, cross-sectional, descriptive. Patients with MS from a local cohort have been consecutively recruited for this study since Apr-2020. A cross-sectional visit which included a clinical interview, analytic test (blood and urine) and a dual-energy X-ray absorptiometry (DXA) was performed. We defined LBMD as T score ≤-1SD in postmenopausal women and men over 50 years and a Z score ≤-2SD in premenopausal women and men under 50 years. Low levels of vitamin D were defined as < 20ng/mL. A descriptive and associative analysis of these data was carried out using the SPSS software. Results: From a cohort of 288 MS patients, due to the COVID-19 pandemia, we have only been able to assess 60 patients, and only 48 out of them have undergone all the tests required. These were 30 women and 18 men, with a mean age of 49 (SD 11,6) years. The main type of MS was relapsing-remiting (77,1%) and 25% of them were not taking any maintenance treatment. Some of the classical factors related to a LBMD are shown in table a1. A 43,8% of the patients had a LBMD and 40,5% had low levels of vitamin D. Despite these results, as far as 89% of patients had never received any specific treatment, not even calcium and/or vitamin D supplementation. Furthermore, 13 patients (27,1%) must have received specific treatment, according to latest guidelines4, and only 4 of them (8,5%) were being adequately treated. Conclusion: These preliminary results show that almost half of the MS patients have LBMD and a low vitamin D, most of them without taking any specific treatment. Taking this in mind, it is necessary to integrate the early diagnosis of LBMDin MS patients, working together with neurologists, to prevent the appearance of fractures and protect the quality of life of these patients. An analysis of our whole cohort of MS patients will help us in correctly assessing the magnitude of this problem.