People with MS have a higher rate of osteoporosis, and increased prevalence of falls and fractures. Great, another challenge on our road to good health.
What is osteoporosis?
Osteoporosis is the imbalance in the rate of osteoclast mediated bone resorption (the process by which the bones are broken down and absorbed by the body) and osteoblast mediated bone formation, leading to a loss of bone mineral density, bone strength and an increase in fractures.
Reduced physical activity
Mechanical stress, including load bearing exercise, stimulates osteoblast activity (cells that build bones) and suppresses osteoclast activity (cells that break down bones). Reduced physical activity due to MS-related disabilities may contribute to decreased mechanical stress on bones, leading to bone loss and higher rates of osteoporosis.
Medications
Glucocorticoids which can be used for the management of acute relapses in MS, increase bone turnover, and are a subsequent risk for osteoporosis and osteopenia.
Vitamin D
Vitamin D deficiency, a risk factor for the development of MS, may also play a role in increased rates of osteoporosis. Vitamin D plays a crucial role in bone health by regulating the intestinal absorption of calcium and phosphorus, and promoting osteoblasts (those bone builders).
The autonomic nervous system (ANS)
Dysfunction in the autonomic nervous system (ANS) is increasingly recognised in MS, and it may contribute to reduced bone mineral density and an increased risk of osteoporosis. The ANS modulates bone metabolism through its sympathetic and parasympathetic branches. Dysfunction in either branch can impact bone health, with an overactive sympathetic nervous system leading to excessive bone breakdown and an underactive parasympathetic nervous system hindering bone formation.
While the exact mechanisms are still under investigation, several factors contribute to ANS dysfunction in MS:
- Inflammation – The chronic inflammatory process characteristic of MS can directly damage autonomic nerve pathways, leading to functional impairment.
- Demyelination – Damage to the protective myelin sheath surrounding nerve fibres disrupts signal transmission within the ANS.
- Brain lesions – Lesions in specific brain regions responsible for autonomic control can disrupt communication and feedback loops within the nervous system.
Women’s health, oestrogen, menopause, and MS
In women with MS, the decline in oestrogen during perimenopause and menopause further heightens the risk of osteoporosis. Oestrogen plays a crucial role in bone health by stimulating bone formation, inhibiting bone breakdown, and regulating calcium absorption. The shift during perimenopause and menopause disrupts this delicate balance, leading to increased bone breakdown and slower formation. Postmenopausal women with MS are at an elevated risk of osteoporosis, compounded by other factors such as low calcium intake, family history, and reduced exercise. This interplay of hormonal changes, MS, and osteoporosis underscores the need for tailored interventions and heightened awareness in women’s health care.
Nutritional therapy
While osteoporosis, osteopenia, and MS bring unique challenges, nutritional therapy offers a valuable tool to support bone health and overall well-being in individuals facing these conditions. By working with me, a registered nutritional therapist, you will receive a personalised plan that addresses your specific needs and risk factors.
If you would like support on your health journey, take a look at the range of nutritional therapy programmes which I offer. Please contact me for a free discovery call for more information. I look forward to working with you soon.