Osteoporosis and fracture risk: a practical guide for neurologists

Many people with neurological disorders are at high risk of osteoporosis and fragility fractures. Such fractures are a leading cause of disability and premature mortality. There are various underlying mechanisms, including reduced bone mineral density from biomechanical factors (eg, reduced muscle strength), inflammation and/or medications such as glucocorticoids, together with an increased risk of falls. Neurologists are well placed to initiate measures to protect bone health. In this review, we address the epidemiological associations between bone health, fracture risk and different neurological disorders and elucidate the potential underlying mechanisms. We set out overarching principles for managing bone health in the context of neurological disorders, together with guidance for specific diseases.