Long-term effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis
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Published on: December 7, 2011
M Zorzon1, R Zivadinov, L Locatelli
1Department of Clinical Medicine and Neurology, University of Trieste, Cattinara Hospital, Trieste, Italy. m.zorzon@fmc.units.it
Abstract:
To determine the effects of high dose methylprednisolone (HDMP) pulses on bone mineral density (BMD) in patients with multiple sclerosis (MS), we studied 25 MS patients who received regular pulses of HDMP as well as pulses of HDMP for relapses, 18 MS patients who received HDMP at the same dose schedule only for relapses, and 61 healthy controls. We measured BMDs at lumbar spine and femoral neck and we assessed biochemical markers of bone metabolism and turnover. The average lifetime dosage of MP was 75.4 (SD 11.9) g in the pulsed HDMP group and 28.6 (SD 18.3) g in the HDMP for relapses group (P < 0.0001). Two MS patients (4.7%) and four controls (6.6%) had osteoporosis (P = NS), whereas 25 patients with MS (58.1%) and 21 controls (34.4%) had osteopenia (P = 0.016). BMDs measured at lumbar spine and femoral neck and biochemical indices of bone metabolism did not differ in MS patients and controls. BMD measures were not associated with lifetime methylprednisolone dosage. In partial correlation analysis, controlling for age, gender and menopausal status there was a significant inverse correlation between BMD at femoral neck and Expanded Disability Status Scale (EDSS) score (r = -0.31, P = 0.05). In conclusion, treatment with repeated HDMP pulses was not associated with osteoporosis in patients with MS who participated in a trial of methylprednisolone. However, osteopenia was observed more frequently in MS patients than healthy controls. Our data are reassuring, as them suggest that repeated pulses of methylprednisolone do not result in substantially increased risk of osteoporosis in MS patients. Moreover, osteopenia was found only in patients treated for relapses, who had a significantly higher EDSS score than patients in the HDMP group, suggesting that decreased mobility may contribute to bone loss more than corticosteroid use. BMD should be monitored in patients with MS, regardless of the use of methylprednisolone.
Insights
High-dose methylprednisolone (HDMP) pulses did not increase osteoporosis risk in multiple sclerosis (MS) patients. However, MS patients showed more osteopenia, possibly linked to decreased mobility rather than corticosteroid use.
Area of Science:
- Neurology
- Endocrinology
- Bone Metabolism
Background:
- Multiple sclerosis (MS) is a chronic neurological disease.
- Corticosteroid therapy, including high-dose methylprednisolone (HDMP) pulses, is common in MS management.
- The impact of HDMP on bone mineral density (BMD) in MS patients requires clarification.
Purpose of the Study:
- To investigate the effects of HDMP pulses on BMD in MS patients.
- To compare BMD and bone metabolism markers between MS patients and healthy controls.
- To assess the relationship between cumulative HDMP dosage, disease severity (EDSS), and BMD.
Main Methods:
- Cross-sectional study comparing 25 MS patients on regular HDMP, 18 MS patients on HDMP for relapses, and 61 healthy controls.
- Measurement of BMD at the lumbar spine and femoral neck.
- Assessment of biochemical markers of bone metabolism and turnover.
Main Results:
- No significant difference in osteoporosis prevalence between MS patients and controls.
- Higher prevalence of osteopenia in MS patients (58.1%) compared to controls (34.4%).
- BMD and bone metabolism markers did not differ between MS patients and controls; BMD was not associated with lifetime HDMP dosage. A significant inverse correlation was found between femoral neck BMD and EDSS score.
Conclusions:
- Repeated HDMP pulses are not associated with an increased risk of osteoporosis in MS patients.
- Osteopenia is more frequent in MS patients, potentially linked to reduced mobility (higher EDSS) rather than corticosteroid treatment.
- Bone mineral density monitoring is recommended for all MS patients, irrespective of HDMP use.
