bone health in patients with multiple sclerosis在多发性硬化症患者骨骼健康.pdfVIP

SAGE-Hindawi Access to Research Journal of Osteoporosis Volume 2011, Article ID 596294, 9 pages doi:10.4061/2011/596294 Review Article Bone Health in Patients with Multiple Sclerosis Vit Zikan Department of Internal Medicine 3, Faculty of Medicine 1, Charles University, 128 00 Prague, Czech Republic Correspondence should be addressed to Vit Zikan, vitzikan@ Received 12 October 2010; Accepted 2 February 2011 Academic Editor: Tomasz Miazgowski Copyright © 2011 Vit Zikan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Multiple sclerosis (MS) is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs) treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and resorption with depressed bone formation and a marked disruption of mechanosensory network of tightly connected osteocytes due to increase of osteocyte apoptosis. Patients with higher level of disability have also higher risk of falls that combined with a bone loss increases the frequency of bone fractures. There are currently no recommendations how to best prevent and treat osteoporosis in patients with MS. However, devastating effect of immobilization on the skeleton in patients with MS underscores the importance of adequate mechanical stimuli for maintaining the bone structure