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Sioka et al. Neuroimmunol Neuroinflammation 2018;5:18 Neuroimmunology
DOI: 10.20517/2347-8659.2018.06 and Neuroinflammation

Editorial Open Access

Bone mineral density in patients with multiple
sclerosis

Chrissa Sioka , Andreas Fotopoulos 1
1,2
1 Department of Nuclear Medicine, University Hospital of Ioannina School of Medicine, Ioannina 45500, Greece.
2 Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina 45500, Greece.

Correspondence to: Dr. Chrissa Sioka, Department of Nuclear Medicine, University Hospital of Ioannina, No. 1 Stavrou Niarchou
St., Ioannina 45500, Greece. E-mail: csioka@yahoo.com
How to cite this article: Sioka C, Fotopoulos A. Bone mineral density in patients with multiple sclerosis. Neuroimmunol
Neuroinflammation 2018;5:18. http://dx.doi.org/10.20517/2347-8659.2018.06
Received: 27 Feb 2018 First Decision: 13 Apr 2018 Revised: 18 Apr 2018 Accepted: 18 Apr 2018 Published: 22 May 2018

Science Editor: Athanassios P. Kyritsis Copy Editor: Guang-Zhe Zhu Production Editor: Cai-Hong Wang

Patients with multiple sclerosis (MS) have higher incidence of low bone mineral density (BMD) compared
to normal subjects . In their recent paper, Olsson et al. studied trabecular bone score (TBS) employing
[2]
[1]
dual-energy X-ray absorptiometry (DXA) in lumbar spine (L2-L4), providing measurement of the bone
microarchitecture. Their study was performed in 260 MS patients (202 being females) and compared with
the results of 6310 healthy individuals taken from the TBS software database. Patients’ mean age was 43
± 10 years (20-71) and control’s group age was from 45 to 85 years old. The authors found that trabecular
bone score was not altered in MS from the control population. They concluded that although BMD may be
affected in MS patients, the bone microarchitecture seems to remain intact. However, an association was
found with lower TBS and higher age, gender, expanded disability status scale (EDSS) ≥ 6, disease duration,
smoking and menopause.

The TBS is an assessment of bone quality correlated with bone microarchitecture and consists of an
indicator for the risk of osteoporosis. It is actually a reflection of the structural condition of the bone
microarchitecture.

This study had some limitations as reported by the authors. Due to the type of the study (retrospective/
cross-sectional), causality could not be determined and there was lack of medical information such as bone
fractures, menarche age and lactation. Finally, the control group was not selected by the authors but was
taken by the TBS software, where data is provided for individuals over 45 years old up to 85 years old that is
problematic in comparison to a MS young to middle age peak demographic.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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