For people with multiple sclerosis (MS), falling is a natural part of living with the disease. Dizziness, loss of balance, weakness, and numbness can all make these patients more prone to taking a tumble. But a new study shows that there is more to fear than a bruise here and there—people with MS have a greater risk of hip fractures.
Scientists at the University of Kansas examined hospital admission records from 1988 to 2007. In this nationwide sampling, they isolated cases with a primary diagnosis of acute hip fracture. According to the study, “1,066,404 hip fracture admissions were identified and 0.25 percent [of patients] had MS."
Those with MS who broke their hips were on average younger than the typical patient with a similar fracture, and they were less likely to die from a complication of the condition. But the findings showed that the prevalence of hip fractures among MS patients was more than twice what the researchers had anticipated.
"This study is important because it confirms what we expected: MS puts you at risk for having falls that lead to hip fractures. Importantly, people with MS, even when they fall and break their hips, they do better than people without MS who fall and break their hips," said Dr. Daniel Kantor, the former president of the Florida Society of Neurology and the Medical Director of Neurologique. "This all reemphasizes the need to address your bone health with your medical team, and to make sure that you are taking preventive measures to have healthy bones and to avoid falls (even if it means using an assist device when needed)."
What Are Your Risk Factors?
In addition to more-frequent falls due to other MS symptoms, bone “thinness” is a main contributor to hip fractures. In a 2011 study published in Neurology, researchers at Oslo University Hospital in Norway discovered that low bone density occurs early in MS patients.
Vitamin D, which aids in the absorption of calcium, is necessary for creating and maintaining strong bones. Low vitamin D has been shown to be a risk factor for developing MS, and osteoporosis is common in patients with long-standing MS. The scientists theorized that if people with low vitamin D are at greater risk of developing MS, then weakening of the bones resulting from low vitamin D might be measured soon after the onset of MS.
To test this hypothesis, the researchers measured the bone mineral density (BMD) of patients in the early stages of MS who had no or minor disability. Indeed, they found that low bone mass begins early in MS. They concluded that optimizing bone health should begin soon after someone is diagnosed with the disease.
Besides low vitamin D levels, there are other factors that may compound the risk of bone loss in MS patients, including lack of physical exercise. Reduced mobility and fatigue are two hurdles that often prevent patients from engaging in bone-strengthening physical activity.
Certain drugs commonly used to treat MS may be a problem as well. Long-term steroid use is a known risk factor for osteoporosis in MS patients. Steroids interfere with calcium absorption and the body’s ability to make new bone.
Be Proactive to Prevent Fractures
For people with MS, preventing a hip fracture means following a two-part approach.
Part 1: Build Strong Bones
Make sure your bones can survive a tumble. Speak with your doctor about assessing your bone density and having a baseline test performed.
Your doctor may advise you to take vitamin D and calcium supplements to encourage bone growth. Depending on the health of your bones, prescription-strength treatments may be necessary.
According to the National Osteoporosis Foundation (NOF), eating a healthy diet of fatty fish (such as salmon and mackerel), dark green vegetables (such as collards and kale), and dairy products (which are rich in calcium) helps promote strong bones.
The NOF also recommends exercising regularly as part of a bone-building regimen. The organization warns against cigarette smoking and heavy drinking—habits that deplete calcium and weaken bones.
Part 2: Prevent Falls
Because every MS patient experiences the disease differently, the symptoms and medications that contribute to falls are unique to each person. Assess each fall as it occurs, and try to find the root of the problem. Were you dizzy or did you lose your balance? If so, perhaps it's time for a stability aid, like a cane, walker, or rollator.
Did you trip over your own feet? Tell your neurologist so he or she can check for gait problems or foot drop. Did you fall because you stumbled over obstacles in your path? Pick up the throw rugs, move the extension cords, and reduce clutter as best you can.
Take it slow and easy getting around, especially if your symptoms are worsened by a flare-up of MS. Make each movement a deliberate, conscious act, knowing where to place your foot each step of the way.
There is no cure for osteoporosis, so preventing it—and a related hip fracture—is even more important.