Page 123 - Read Online

Page 2 of 3 Sioka et al. Neuroimmunol Neuroinflammation 2018;5:18 I http://dx.doi.org/10.20517/2347-8659.2018.06

Several risk factors for low BMD in MS patients have been reported such as, disease duration, total steroid
dose, EDSS score (> 3), immobility and vitamin D deficiency . Vitamin D deficiency, especially during
[3-7]
relapses, suggests that it could regulate clinical disease activity and it may be a modifiable MS risk factor.
Vitamin D action is mediated through its specific receptor (VDR). Various polymorphisms of the VDR may
affect vitamin D function and may be linked to osteoporosis and MS .
[8,9]

Male MS patients exhibit reduced bone mass disproportionately to their age and ambulation . Furthermore,
[10]
reduced mobility and chronic low-dose glucocorticoid treatment in male MS patients is linked to increased
osteoporosis and muscle wasting . In premenopausal female patients, the length of the disease and their
[11]
relative immobility were linked to low BMD . In addition, menarche age ≥ 13 years and breast feeding may
[12]
be associated with reduced BMD . Another predisposing factor leading to reduced BMD in MS females
[12]
includes 25-OH-Vit D3 deficiency and secondary parathyroid hormone (PTH) elevation .
[13]
Overall, the study by Olsson et al. provides novel questions for the existence of bone loss in MS patients
[2]
and the participation of bone microarchitecture in this process. It is clear that further studies are needed
to elucidate the role of bone microarchitecture during bone loss, as evaluated with the TBS. Due to the
limitation of the study , several information could not be provided such as the association of TBS with the
[2]
fertility history or gynecological factors. Considering the physiological bone loss after a certain age and the
fact that 80% of the studying patients were females, it would have been interesting to see the role of TBS
according to gynecological factors in pre- and post-menopausal status.

In conclusion, the etiology of BMD loss in MS patients is yet to be answered and future studies of larger
number of patients would help further elucidate the etiology of bone loss and perhaps the participation of
bone microarchitecture during this process.

DECLARATIONS
Authors’ contributions
Conceived and wrote the manuscript: Sioka C
Reviewed and corrected the manuscript: Fotopoulos A

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Sioka C, Papakonstantinou S, Fotopoulos A, Alamanos Y, Georgiou A, Tsouli S, Pelidou SH, Kyritsis AP, Kalef-Ezra J. Bone mineral
density in ambulatory patients with multiple sclerosis. Neurol Sci 2011;32:819-24.