Introduction
Osteoporosis is a bone disease causing thinning of the bones. Osteoporosis increases the risk of fractures (broken bones) of the hip, wrist and spine. Osteopenia refers to mild bone loss that is not severe enough to be called osteoporosis; it increases your risk of osteoporosis. According to the National Osteoporosis Foundation (www.nof.org), 10 million individuals in the United States are estimated to have osteoporosis and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. Osteoporosis is regarded as more common in multiple sclerosis (MS) than in the general population (Smeltzer, Zimmerman, Capriotti, & Fernandes, 2002; Tuzun, Altintas, Karacan, & Tangurek, 2003; Weinstock-Guttman, et al. 2004). In the Fall 2007 questionnaire we asked NARCOMS participants about osteoporosis. In this article we report responses submitted by NARCOMS participants.

The Questions
In the Fall 2007 update questionnaire we asked participants if they had broken a wrist, hip or vertebra (spine) after the age of 13 years (Marrie, Cutter, Tyry, & Vollmer, 2009). We asked whether a doctor had ever told them that they had osteoporosis or osteopenia. We asked participants about use of medications for osteoporosis (bisphosphonates, calcitonin), multivitamins with vitamin D, and calcium or vitamin D supplements. Finally, we asked how much physical activity participants were getting.

Study Participants
In Fall 2007, 9346 NARCOMS participants living in the United States completed questionnaires (Marrie et al., 2009). For this analysis we considered participants with an age of symptom onset between 16 and 60 years. Seventy-six percent of participants were women. Ninety-four percent of participants were white, while the remainder of participants reported another race. Their average age was 53.6 years, and their average disease duration was 23.0 years.

Frequency of Osteoporosis and Fractures
Fifteen percent of participants said that they had osteoporosis. Seventeen percent of participants said that they had osteopenia. Altogether 2,501 (27.2%) participants reported osteoporosis or osteopenia. Women were more than three times as likely to report osteoporosis or osteopenia as men (Figure 1). Older participants were more likely to report osteoporosis than younger participants. For example, a participant between the ages of 55 and 72 was seven times more likely to have osteoporosis as a participant aged 44 years or younger. More disabled participants were more likely to have osteoporosis than less disabled participants.

Sixteen percent of participants reported that they had broken a bone after age 13 years (n = 1,482). This included:

• Wrist fractures  522
• Spine fractures  165
• Hip fractures   100
• More than one fracture 685

Counseling
We asked participants if they have been counseled by a doctor or other health care professional about the following osteoporosis-related topics:

• Osteoporosis and how to prevent it
• Intake of calcium or dairy products
• Exercise to strengthen bones
• Falls
• Whether you might need a bone density test
• Family history of osteoporosis

As seen in Figure 1, 73% of female responders and 45% of male responders indicated that a doctor or other health care professional has talked to them about one or more of these topics. 

Physical Activity
The Fall 2007 survey included several questions related to level of physical activity.  We asked participants to measure their level of physical activity during different phases of their life.  As Figure 2 shows, responders show a shift from moderate to light activity after age 39.

Treatments
Overall, half of NARCOMS participants (n = 4,329) were using calcium supplements. Two-thirds of participants (n = 5,341) were taking vitamin D supplements or a multivitamin with vitamin D.  Some participants were taking medications to treat osteoporosis. This included 1,337 people taking a bisphosphonate (such as fosamax), and 61 were taking calcitonin. Women were more likely than men to use all of these products.
Participants with osteoporosis and fractures were more likely to take calcium, vitamin D, or osteoporosis medications (Figure 3).

Summary
Osteoporosis and osteopenia are common in patients with MS. Patients with MS also have a significant risk of fractures. Many patients with osteoporosis and osteopenia are not taking supplemental calcium and vitamin D which could help to improve bone health.

References
Marrie, R. A., G. Cutter, T. Tyry & T. Vollmer (2009). A cross-sectional study of bone health in multiple sclerosis. Neurology, 73(17), 1394-1398.
Smeltzer, S. C., V. Zimmerman, T. Capriotti & T. Fernandes (2002). Osteoporosis risk factors and bone mineral density in women with MS. International Journal of MS Care, 4(1), 17-23.
Tuzun, S., A. Altintas, I. Karacan, S. Tangurek, S. Saip & A. Siva (2003). Bone status in multiple sclerosis: Beyond corticosteroids. Multiple Sclerosis, 9, 600-604.
Weinstock-Guttman, B., E. Gallagher, M. Baier, L. Green, J. Feichter, K. Patrick, et al. (2004). Risk of bone loss in men with multiple sclerosis. Multiple Sclerosis, 10, 170-175.

Figure 1. Percentage of NARCOMS participants that said that their doctor has talked to them about osteoporosis, calcium, strengthening bones, falls, bone density testing or family history of osteoporosis

Figure 2. Level of physical activity reported by NARCOMS participants

Figure 3. Percentage of NARCOMS participants using calcium, vitamin D, or osteoporosis medications

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