People with multiple sclerosis (MS) can also have other health conditions, known as comorbidities. One common comorbidity is osteoporosis — a condition where bones weaken from losing mass (also called low bone density or low bone mineral density). Weak bones are more fragile and more likely to break. The increased risk for osteoporosis — as well as falls related to MS — can put you at a greater risk of fractures (broken bones). This can also make it harder for caregivers.

Here is what people with MS and their caregivers need to know about the risk of osteoporosis associated with MS, how to maintain bone health, and how to heal from broken bones.

Bone-Health Issues Related to MS

A few factors can cause poor bone health among people with multiple sclerosis. Some are related directly to MS, while others are linked to MS treatments.

Increased Risk of Fractures

People with MS are more likely to trip and fall than those without MS. In many cases, this is because MS can cause symptoms that affect mobility, including:

• Muscle spasms and tightness (spasticity)
• Problems with balance and walking (gait)
• Vision problems
• Muscle weakness

A few factors can cause poor bone health among people with multiple sclerosis. Some are related directly to MS, while others are linked to MS treatments.

These symptoms together can cause falls that may lead to broken bones, regardless of overall bone health.

MS-Induced Osteoporosis

MS itself seems to be a risk factor for osteoporosis, at least in some people. One in five people with MS also have osteoporosis.

This may happen because people with MS often move less than others. Pain and neurological problems can make it hard to do weight-bearing activities. Weight-bearing movement is any movement in which your bones support your body, like walking or climbing stairs. This movement is necessary to keep your bones strong. When bones are not put under some stress from normal movement, they can get weaker.

However, people with MS who don’t have mobility problems can still experience bone loss. This may be because MS causes inflammation, which can interfere with the body’s natural process of renewing bones. Another reason could be low vitamin D levels, which can also cause osteoporosis. Some people with MS may be sensitive to heat and may avoid the sun. Since sunlight is one of the main ways your body absorbs vitamin D, not getting enough sun can lead to a vitamin D deficiency.

Steroid-Induced Osteoporosis

Many people with MS take corticosteroids, medications used to manage symptom flare-ups. These steroids can increase the risk of developing osteoporosis, especially when taken in high doses over long periods of time.

Several MyMSTeam members have shared their experiences with this. One wrote, “I am suffering today from the effects of the prednisone: very thin skin, bruising all over, and osteoporosis.” Another shared, “My bones are so soft now that if I bump them, I fracture them. Thus, my broken ribs, wrist, and hip. My doctor says it’s normal with so many years of steroid use.”

Steroids affect how the body uses vitamin D and calcium, both of which are needed to build and maintain bones. People who experience bone-density loss due to steroid medications will typically lose the most bone density in the first six months. After that, bone loss usually slows down.

Note that bone loss from steroid use may not be a reason to avoid these medications. Talk to your health care provider about the pros and cons of taking steroids to decide what is best for you.

What Is It Like To Have Osteoporosis and MS?

Many members of MyMSTeam have described dealing with osteoporosis along with MS. For many, it means adding other medical treatments to their already busy medical routine. “I was informed I have osteoporosis, which means another pill in the pile,” one member wrote.

Caregivers can provide support to people with MS who also have osteoporosis by helping to monitor their bone health, prevent falls, and reduce the risk of broken bones.

For some, osteoporosis has caused broken bones and other health problems. One member shared, “I was diagnosed in my 40s with a fracture of the lumbar spine. It now has progressed to osteoporosis. At 79, it’s a hard fight to stand up straight. I use my walker more than usual to straighten up.”

One member shared, “I now have osteoporosis. I fractured two vertebrae in my back last month, and two weeks ago, I fell into a snowbank and fractured two ribs on the upper right side. My bones are so brittle.”

Another wrote, “I have osteoporosis and had bilateral hip replacements. I’ll have a knee replacement soon also.”

Clearly, osteoporosis can make life with MS even more challenging, both for people with the conditions and their caregivers. It can add extra medications, treatments, and the risk of broken bones. Therefore, it’s important to know how to manage the condition along with multiple sclerosis.

How To Heal if You Break a Bone

If you break a bone, it’s important to see your health care provider right away. They may give you a splint or cast or you may need surgery, depending on the type of fracture.

In addition to medical treatment, there are a few things you can do at home to help with the healing process. Your medical team will help you create a plan that works with your neurological treatments for MS and will help your bone health.

Eat Well

Many doctors recommend eating well — especially eating enough protein — when you are waiting for a bone to heal. Nutritious snacks and meals can help your body heal and may specifically support bone healing.

Rest

You will need to rest the broken bone and the area around it. Avoid putting strain on it to prevent reinjury, and give your body plenty of time to heal properly. Be sure to ask your doctor how long you will need to rest the affected bone. Even if your pain goes away before that period is up, it’s important to continue resting. New bone formation can be fragile, and resting gives it time to get stronger again.

Avoid Smoking

Don’t smoke while you are healing from a broken bone. Smoking can reduce the blood flow to your bones. Bones need a good blood supply to provide new bone formations with all the minerals they need to become strong again and heal.

How To Improve or Maintain Healthy Bones With MS

The best way to protect your bones is to avoid breaking them in the first place. Here are some ways to help prevent injury and ensure bone strength and health. Before trying any new treatments for bone health, talk to your neurology team. They can help you find safe ways to protect your bones and improve your outlook with MS.

Osteoporosis can make life with MS even more challenging. It can add extra medications, treatments, and the risk of broken bones.

Take Supplements

Taking vitamin D and calcium supplements can help maintain your bone strength. Work with your doctor to figure out the amount of calcium and vitamin D supplementation that’s right for you. Your doctor may also want to do regular blood tests to see how well your body is absorbing these minerals.

Exercise

Certain types of exercise may help maintain bone strength and prevent even more weakening. If you have trouble exercising because of MS, talk to a physical therapist. They can create an exercise plan that is specific to you and your needs.

Take Medications

There are a number of medications that have been approved to help prevent further bone loss due to osteoporosis. Some of these can be taken as pills, some are injections, and some are IV infusions. You and your doctor can work together to find the best medication or combination of medications for you.

How Caregivers Can Provide Support

Caregivers can provide support to people with MS who also have osteoporosis by helping to monitor their bone health, prevent falls, and reduce the risk of broken bones.

Mobility Support and Fall Prevention

If you’re a caregiver for someone with MS and osteoporosis, there are steps you can take to help them prevent falls that could lead to broken bones. Start by removing any obstacles, like furniture or power cords, that they could trip over. You can also make changes in the home, such as adding handrails in the shower or near the toilet. Caregivers can also help with balance and strength exercises to help prevent falls.

Bone Health Monitoring

Caregivers can be advocates for people with MS by encouraging regular bone health monitoring. They can also help by giving health care providers important information about a person’s daily routine, symptoms, and risks of falling.

Nutrition and Medication Assistance

Caregivers can assist people with MS by ensuring they get enough nutrients for better bone health, like calcium and vitamin D. They can also make sure that their medications are taken on time and as prescribed.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 217,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you dealing with MS and osteoporosis? What are some ways you make sure your bones stay strong and healthy? Share your thoughts in the comments below or by posting on your Activities page.