Multiple sclerosis (MS) is very difficult to live with, and it's a never-ending challenge for the doctors to manage. MS tends to remit and relapse, come and go. A medication that seems to be a break-through may not be working as well at it seems because the underlying disease is temporarily going into remission. A medication that seems not to be working may actually be doing its job, but the effects are not as noticeable because the disease is relapsing.
This effect is also true for natural and nutritional interventions for the disease. And since MS is treated with immunomodulators, corticosteroids, immunosuppressants, sphingosine 1-phosphate receptor modulators, dopamine agonists, muscle relaxants, alpha2-adrenergic agonists, benzodiazepines, stimulants, hydantoin anticonvulsants, other anticonvulsants, selective serotonin/norepinephine receptor inhibitors, nonsteroidal anti-inflammatory drugs, urinary antispasmodics, both laxatives and medications to control diarrhea, central anticholinesterases, and potassium channel blockers, for a less than comprehensive list, keeping up with side effects is practically a full-time job.
Just about everyone who has MS will take one or more drugs that have the side effect of causing brittle bones. Rather than try to keep up with the side effects of MS meds on bone health in terms of individual medications, it's safe to assume fractures can be in your future and you should go ahead and take some simple steps for prevention. Here are just two things to keep in mind.
1. Avoid falls if you have MS and osteoporosis
The side effects of MS drugs can cause weakness in the bones of the spine, hip, and wrist. Many spine fractures are due to compression. They occur slowly. They are not due to a fall or an impact. They are not as easy to prevent. However, in people who have MS, bone mineral density in the spine (something the endocrinologist measures) is a good predictor of the risk of fractures in other bones.
Hip fractures, on the other hand, more often than not are due to a fall, and the kind of fall that is the most problematic is a fall to one side (not falling forward or backward). These are falls that occur when getting into a car or when gripping for a side rail and missing it. People break their hips when they are stepping sideways to get out of a tub. Preventing these kinds of falls prevents one of the major risks of osteoporosis.
Wrist fractures in people who have MS are most often happen after putting out the hands to break a fall forward. Using a walker prevents many of these falls. It also helps to wear shoes with non-slip soles.
A reality of osteoporosis is sometimes falls cause fractures, but other times fractures cause falls. If they bone has already failed, a fall may be inevitable. It's possible to have a fracture and not know it. But simple safety measures help prevent two of the three most common kinds of osteoporotic fractures.
2. Take calcium and vitamin D, along with magnesium and vitamin K2
Most people who have MS are deficient in vitamin D. This vitamin helps the digestive tract absorb calcium. It also keeps the parathyroid glands from producing a hormone that "steals": calcium from bone. If you don't get sun, you definitely need vitamin D supplements. As little as 1000 IU per day makes a difference. (Don't take more than 10,000 IU per day. Excessive vitamin D can have a reverse effect on bone health.)
Magnesium helps bone-building cells use calcium. You need about half as much magnesium as calcium every day. Unless you are a big fan of leafy green vegetables, taking up to 600 mg of magnesium per day is helpful. Don't take more; excessive magnesium can have a laxative effect.
And the obscure vitamin K2 helps calcium go where it is needed, into bone, rather than into cholesterol deposits in the linings of your arteries. A beneficial dose is 45 mg per day. Product labels may identify K2 as M-4 or M-7 or menaquinone.