Testing and treatment recommended
Three quarters of people who have had HSP for 10 years or more were found to have low bone mineral density (osteopenia or the more severe osteoporosis) according to a large study of people with HSP, Hereditary Ataxia or Multiple Sclerosis.
As there are often no symptoms of low bone mineral density prior to an adverse medical event such as a bone fracture, is a good idea for people who have had HSP for several years to ask their medical professionals about getting bone mineral density assessed.
Abstract
BACKGROUND: Although disability is considered the main cause of low bone mineral density (BMD) in multiple sclerosis (MS), other factors related to the disease process or treatment could also be involved. The aim of this study was to assess whether patients with MS are more likely to develop low BMD (osteopenia or osteoporosis) than patients with the non-inflammatory neurological diseases Hereditary Spastic Paraplegia (HSP) and Hereditary Ataxia (HA).
METHODS: We performed a case control study comparing BMD (spine, hip and total body) and biochemical measures of bone metabolism in 91 MS patients and 77 patients with HSP or HA, matched for age, gender and disability. Both patient groups had lived with the disease for at least 10 years.
RESULTS: In total 74.7% of the patients with MS and 75.3% of the patients with HSP or HA had osteopenia (-2.5 < T- score < -1.0) or osteoporosis (T- score ≤ -2.5) in one or more sites. Osteoporosis was more common in patients with MS than with HSP/HA (44.0 vs 20.8%, p =0.001). This difference was not significant after correction for confounders (p = 0.07), nor were any of the biochemical markers.
CONCLUSION: Most patients with disabling neurological diseases like MS and HSP/HA develop osteopenia or osteoporosis. MS patients had osteoporosis more frequently than HA/HSP patients, though the difference was not significant after adjusting for confounders. Osteoporosis and bone health should be considered in all patients with both inflammatory and degenerative chronic neurological diseases.
SOURCE: BMC Neurol. 2016 Dec 5;16(1):252. PMID: 27919248 PMCID: PMC5139093 DOI: 10.1186/s12883-016-0771-4
Bone mineral density in patients with multiple sclerosis, hereditary ataxia or hereditary spastic paraplegia after at least 10 years of disease – a case control study.
Simonsen CS1,2,3, Celius EG4,5, Brunborg C6, Tallaksen C4,7, Eriksen EF8,7, Holmøy T9,7, Moen SM4.
1 Department of Neurology, Drammen Hospital, Vestre Viken HF, Dronnigsgate 28, 3004, Drammen, Norway. [email protected].
2 Department of Neurology, Oslo University Hospital, Oslo, Norway. [email protected].
3 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. [email protected].
4 Department of Neurology, Oslo University Hospital, Oslo, Norway.
5 Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
6 Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
7 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
8 Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
9 Department of Neurology, Akershus University Hospitals, Oslo, Norway.
I am now aged 73 with SPG4 HSP and the HSP symptoms (like loss of Dorsiflexion and gait changes) began to appear in my late 20’s. I have been having Bone Mineral Densitometry tests every two years since 2011. (The frequency of testing is based on Medicare only fully funding tests that are 2 years apart). Initial results were towards the bottom end of normal with small declines in subsequent tests until the end of 2017 when I reached the stage of “osteopenia”. As a high risk “falls” patient, it is somewhat worrying to know that my bones are more brittle than normal!