Factors associated with receiving bone mineral density screening among people with multiple sclerosis

Accidental falls and fall-related injuries are common among people with multiple sclerosis (MS). Fractures are the most common injury, pointing to the need to understand current practices related to bone health management in this population. We sought to identify factors associated with bone mineral density (BMD) screening, using dual-energy X-ray absorptiometry, among people with MS.

Using population-based databases from Manitoba, Canada, we identified all people with MS. Through linkage to the Manitoba Bone Mineral Density Database we subsequently determined which of these individuals underwent BMD screening following their MS diagnosis. We used Cox proportional hazards regression analysis to identify factors associated with time to BMD screening after MS diagnosis.

Of the 5729 eligible persons with MS, most were females (n = 4032, 70.4%) and were living in an urban centre (n = 3601, 62.9%). Ten percent (n = 584) had suffered a recent fracture and nearly one-third used anticonvulsants. BMD screening occurred in 783 (13.7%). Factors associated with BMD screening were female sex (hazard ratio [HR] 5.34; 95%CI: 4.10-6.95), prolonged glucocorticoid therapy (HR 3.73; 95%CI: 2.64-5.25), breast cancer (HR 3.54; 95%CI: 2.37-5.30), recent fracture (HR 3.44; 95%CI: 2.39-4.90), continuity of care (HR 1.69; 95%CI: 1.17-2.44), greater disability (HR 1.49; 95%CI: 1.19-1.86), older age (HR/decade 1.34; 95%CI: 1.22-1.34), anticonvulsant use (HR 1.32; 95%CI: 1.06-1.63) and urban (versus rural) residence (HR 1.17; 95%CI: 1.00-1.36).

Factors known to be associated with low BMD were associated with BMD screening in people with MS, but overall BMD screening rates are relatively low, suggesting that a clinically meaningful proportion of individuals with MS who have low bone mass may be missed.