People with MS have higher rates of osteopenia, osteoporosis, falls and fractures.1 In this article, we’ll look at why that is, how these conditions occur, and the impact they can have on quality of life. I will also share my recommendations and strategies around how to support stronger, healthier bones and live a full, healthy life.
Why People with MS are at Higher Risk
Corticosteroid is the most commonly prescribed treatment for MS-related conditions, including optic neuritis, clinically isolated syndrome (CIS), and acute worsening of symptoms. Prednisone, IV Solumedrol, and other corticosteroids can be very helpful in stopping the inflammation in your optic nerves, brain, or spinal cord—but they also cause an increase in osteoclastic activity, the process by which your body breaks down old bone, leaving space for new bone to form.
Under optimal conditions, osteoclastic activity is tightly regulated and balanced by osteoblastic activity—the process responsible for rebuilding strong, healthy bones. But, the presence of corticosteroids increases osteoclastic activity, causing the bone to break down faster than it can be rebuilt. This leads to a loss of calcium and other minerals from the bones.
As MS symptoms progress, people tend to become less and less physically active. You may walk less, climb fewer stairs, or stop carrying groceries. That means you’re putting less stress on your bones, and your body sends fewer signals to the cells responsible for building bone.
The result is that over time, your bones receive more signals to remove calcium and other minerals, and fewer signals to build new bones. Thinning bones, or osteopenia, will become apparent, and could eventually become osteoporosis.
How Osteopenia and Osteoporosis are Diagnosed
There are special tests you can get to measure the strength of your bones. The test that is typically used is called a dual-energy X-ray absorptiometry (DEXA) scan, a low-dose X-ray that measures bone density (you may also hear this referred to as a bone density scan). The DEXA scan will result in two different scores, a Z-score and a T-score.
The Z-score compares your bone density to the average values of a person of your same age and gender. A T-score compares the bone density to a young healthy person. A T-score between -1 and -2.5 is classified as osteopenia and would mean that you are at risk of developing osteoporosis, while a T-score of less than -2.5 is classified as osteoporosis.
Likely, you will need to speak with your primary care team to get a DEXA scan completed. Depending on your specific situation, your neurologist may be open to ordering one for you.
A Note on Fractures
Bones that are weakened by osteopenia or osteoporosis are more likely to fracture, and for people with MS, that could lead to major, long-term setbacks in your mobility and function. That’s why it’s so important to do everything you can to support the health and strength of your bones. This is what we’ll talk about next.
What You Can Do to Prevent Osteopenia and Osteoporosis
While there are a variety of FDA-approved medications to increase bone mineral density, there is less evidence that those drugs reduce the risk of fractures. This section outlines the lifestyle changes, diet, and targeted supplements that can help improve bone density.
Exercises That Make a Difference
One of the most important things you can do for your bones is to put them to work. Putting more gravity stress on the bones stimulates the osteoblasts to help develop new bone—and that means exercising.
The recommendation is to do exercise that combines strength training and impact exercise.2 Strength training can include bodyweight exercises, resistance bands, dumbbells or barbells, and/or weight machines. Impact training usually involves some form of jumping—jumping rope, vertical jumps, hopping forward and backward or side to side. Personally, I strength train three times a week, and include a lot of push-ups and planks to strengthen my core, wrists, and forearms. Start with where you are and what feels good, and gradually add more resistance and impact training as you go. It might also help to work with a personal trainer or fitness coach to help you find the kinds of exercises that are safe and most effective for your body.
A whole-body vibration (WBV) device can also be a great addition to your regimen. WBVs add a gentle and controlled gravity stress to your bones, and can help you feel and perform better. These tools have been used by athletes to recover from injury more quickly and are now being studied for how well they can help increase bone mineral density. Two recent meta-analyses (statistical analyses that combine the results of multiple studies) found that oscillating WBV devices led to improving bone mineral density in the spine and femur in postmenopausal women3,4 The WBV is an excellent tool to begin gently increasing the gravitational force to your skeleton and improving your bone density.
Balance training is another essential for reducing fall and fracture risk.5,6 Yoga, Pilates, and Tai Chi are all great options, or you can ask your medical team about physical therapy to help reduce your fall risk.5,6
Hormone Replacement
Low sex hormones make bone mineral loss more rapid. Talk to your primary care team about checking your hormone levels and how or if hormone replacement could fit into your wellness plan. In my practice, I recommend bio-identical hormone replacement for men and women with low estrogen and testosterone levels.
Eating Right: Nutrition for Your Bones
I do not recommend taking calcium supplements. Over the past several decades as the rates of osteopenia and osteoporosis have increased, the FDA has increased the recommended daily amount of calcium we should be consuming—yet the rates of osteopenia and osteoporosis have increased. Taking calcium supplements also significantly increases the risk of heart attack and stroke.7
Remember, our ancestors did not drink milk after weaning (sometime between ages 3 and 5) for millions of years. Our paleolithic ancestors’ bones had much more calcium content than modern humans’ bones. I don’t think we need milk. I do think we need much better nutrition than what most people are eating.
Having a vitamin D level in the top half of the reference range increases the absorption of calcium from the gut. We need protein, collagen, and vitamin C to make the collagen to build bone.8 We also need the fat-soluble vitamins A and K, and B vitamins to support the osteoblastic (bone building) process.8
Vitamins rarely act alone, and they need their associated mineral cofactors to properly function. The minerals that are needed to make bone include calcium, magnesium, manganese, copper, boron, iron, zinc.8 Yet over 60% of Americans have diets that in insufficient in key bone nutrients: magnesium, trace minerals, and vitamins K, A, and C.9,10
In your diet, I recommend reducing or eliminating added sugars and flour-based products. Additions are easier than subtractions, so focus on adding more green leafy vegetables and other non-starchy vegetables to your diet. Try to eat at least 0.7 grams of protein/kilogram body weight—or at least 1.2 grams/kilogram if you’re over 60. Bone broth is an excellent source of collagen, minerals, and glutamine, all of which are terrific for your bones.
Targeted Supplements for Healthy Bones
There are three key supplements that help build stronger bones. They are helpful to anyone who has osteopenia or osteoporosis.
Vitamin K2 facilitates moving calcium out of blood vessel walls and off the heart valves and into the teeth and bones.
In addition to vitamins and minerals, MitoMulti Complete has several antioxidants that support mitochondrial function. These include carnitine, lipoic acid, n acetylcysteine, coenzyme Q, green tea, resveratrol, huperzine A, broccoli seed extract, and milk thistle extract. Healthy mitochondria support more effective bone-building by the osteoblasts.
More than 60% of Americans have diets that are insufficient in magnesium is a key mineral for building stronger bones. Magnesium threonate is well absorbed and will not lead to diarrhea, making it superior to other forms of magnesium. Magnesium is also a key nutrient for mitochondria.
Next Steps to Protect Your Bones and Prevent Osteoporosis
- Begin strength and impact training for better bone mineral density.
- Add balance training to reduce fall risk.
- Improve your nutrition, by eating more protein and non-starchy vegetables.
- Take targeted supplements so that you have the necessary vitamins, minerals, and antioxidants on hand for your osteoblasts to use to build better bones.
I am 69 years old, and each time I check my DEXA scan, I see my bone mineral density improving. Healthy, strong bones are possible and within reach for people with MS, and that is what I want for you too.
Citations
Grech L, Laurence K, Ebeling PR, Sim M, Zengin A. Management of Osteoporosis, Fracture and Falls in People with Multiple Sclerosis: Systematic Review of Guidelines. Calcif Tissue Int. 2024;114(3):201-209.
Bea JW, Blew RM, Howe C, Hetherington-Rauth M, Going SB. Resistance Training Effects on Metabolic Function Among Youth: A Systematic Review. Pediatr Exerc Sci. 2017;29(3):297-315.
de Oliveira RDJ, de Oliveira RG, de Oliveira LC, Santos-Filho SD, Sa-Caputo DC, Bernardo-Filho M. Effectiveness of whole-body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int. 2023;34(1):29-52.
Li Q, Liang L, Gao C, Zong B. Therapeutic effects of whole-body vibration on postmenopausal women with osteoporosis: a systematic review and meta-analysis. Braz J Med Biol Res. 2024;57:e13996.
Sibley KM, Thomas SM, Veroniki AA, et al. Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis. Exp Gerontol. 2021;143:111151.
Wiedenmann T, Held S, Rappelt L, Grauduszus M, Spickermann S, Donath L. Exercise based reduction of falls in community dwelling older adults: a network meta-analysis. Eur Rev Aging Phys Act. 2023;20(1):1.
Reid IR. Cardiovascular effects of calcium supplements. Nutrients. 2013;5(7):2522-2529.
Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. 2006;46(8):621-628.
Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341-354.
Reider CA, Chung RY, Devarshi PP, Grant RW, Hazels Mitmesser S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients. 2020;12(6).
