- In addition to poor balance and abnormal postural righting reflexes poor vision increases your risk of having a fall. If you have visual problems you may need to been seen by an eye clinic to see if anything can be done to improve vision.
- Drinking alcohol exacerbates MS-related inco-ordination and exaggerate the effects of sedatives. A large number of MSers drink excessively. Please try and not drink alcohol, or at least reduce your consumption. If you have an alcohol dependency problem ask for help.
The other factor is bone health. MSers are more likely to have thin bones due to a number of potential factors; for example physical inactivity, low vitamin D levels, repeated course of steroids, the use of concomitant medication that reduces vD levels and/or thin bones further, smoking, excessive alcohol intake, etc. We routinely request bone density scans or DEXA scans in MSers at risk of falls and treat them if we find them to be osteopenic. Yes, there are many effective therapies available for osteopenia and osteoporosis. We also make sure all our MSers take vitamin D supplements with the aim of keeping them vD replete. The driver behind our routine vD supplementation programme in established MS is bone health rather than disease modification. I am personally not convinced of the evidence that vD modifies the course of MS.
I suppose the elephant in the room is if we prevented MSers becoming disabled in the first place, they wouldn't have balance and visual problems, nor would they have thin bones and hence won't fall and fracture bones. This brings us back to the argument for early and effective DMTs to prevent, or delay the onset of disability. I know I sound like a stuck record, but using DMTs as a preventive measure is very important.
Falls and fractures has not passed us by as a crude but important outcome measure. We are currently looking into whether or not DMTs prevent falls and fractures. This could be another metric to prove, or disprove, whether or not DMTs are effective in the long-term. If we can show that early and effective use of DMTs reduces falls and fractures in the future it would be another argument to support adoption of early effective treatment in MS."
Su et al. The association between multiple sclerosis and fracture risk. Int J Clin Exp Med. 2014 Nov 15;7(11):4327-31. eCollection 2014.
Background: Several studies were performed to assess the association between multiple sclerosis (MS) and fracture risk. However, the results were inconsistent and inconclusive.
Aim: In the present study, the possible association was investigated by a meta-analysis.
Methods: Eligible articles were identified for the period up to August 2014. Pooled risk ratios (RR) with 95% confidence intervals (CI) were appropriately derived from random-effects models. Nine studies with more than 9,000,000 subjects were eligible.
Results: We found that MS was significant associated with fracture risk in overall population (OR = 1.58, 95% CI 1.36-1.84, P < 0.01). In terms of subgroup analyses by fracture sites, the associations were significant in femur (RR = 4.57, 95% CI 3.01-6.69, P < 0.01), hip (RR = 3.01, 95% CI 2.72-3.41, P < 0.01), tibia (RR = 2.72, 95% CI 2.22-3.32, P < 0.01), humerus (RR = 1.78, 95% CI 1.12-2.40, P = 0.02), pelvis (RR = 1.34, 95% CI 1.12-1.67, P < 0.01), and vertebrae (RR = 1.30, 95% CI 1.13-1.69, P < 0.01).
Conclusion: This meta-analysis suggested that MS may be associated with fracture development.