Multiple sclerosis (MS) increases the risk of low bone density conditions such as osteopenia and osteoporosis. Those living with MS are also at an increased risk of fractures.

People with MS have an increased risk of low bone density conditions, osteopenia, and the more severe form, osteoporosis, which can lead to an increased risk of bone fractures.

Several factors, such as decreased mobility and less weight-bearing exercise, may contribute to this risk.

Learn more about the link between osteoporosis and MS, how common it is, the risk of fractures, how doctors diagnose it, and tips to protect bone health.

People living with MS have a greater risk for low bone mineral density, osteoporosis, and fractures than those without the condition.

Numerous factors are behind this association.

Bones may weaken over time if a person has decreased mobility due to being in a wheelchair or bed for longer periods.

Those with MS may also find weight-bearing activities challenging. This can have a negative effect on bone density.

Some medications people with MS may take to help with their symptoms or treat relapses could also affect bone health. Taking steroids over a prolonged period can affect bone density, as can antidepressants that a person may take for depression or nerve pain.

People living with MS have a high rate of falls. This, coupled with the increased risk of osteoporosis, puts people with MS at an increased risk of fractures.

Research studies have consistently found higher rates of osteoporosis among those with MS.

A 2022 review found that 17% of people with MS also have osteoporosis, and 43% have osteopenia — a decrease in bone density that can precede osteoporosis.

An older study suggests the incidence of osteoporosis among people with MS could be as high as 29%.

In a 2023 study investigating the presence of osteoporosis in people with MS, 30% of participants had osteoporosis compared with 9% in the control group.

The same study found that the people with MS who also had osteoporosis:

  • were an older age
  • had a longer duration of disease
  • had a lower body mass index (BMI)
  • had a lower abdominal circumference
  • were more likely to have a progressive form of MS

MS raises the risk of osteoporosis for everyone living with the condition, but some people may have additional risk factors.

The risk factors for osteoporosis for those with MS are similar to those in the general population.

Research from 2023 suggests that for those with MS, risk factors include:

  • age
  • sex, with females being more likely to be affected
  • postmenopausal status among females
  • smoking
  • low BMI

Those living with MS who have a greater degree of physical disability or a severe disease course are also more likely to have osteoporosis and low bone density.

People living with MS have a high rate of falls and fractures.

Research from 2019 notes that 60% of people living with MS experience a fall in a 12-month period. Half of people with MS experience a fall more than once during a 3-month period.

Studies have found that half of the falls experienced by those living with MS caused an injury, of which 40% were hip fractures.

People with MS have a higher risk of fractures to the hip compared with their peers without MS.

People with MS are 48% more likely to have a major osteoporotic fracture than their peers without MS.

People living with osteoporosis rarely experience symptoms, and some people may not know they even have it until they develop a fracture. In fact, healthcare professionals cannot detect osteoporosis and osteopenia with a physical exam. The only way to determine if a person has either condition is to get a diagnostic test.

A dual-energy X-ray absorptiometry (DXA) is a test that doctors commonly use to measure bone density. The test gives each person a result known as a T-score that is then compared against the bone density of a healthy young adult. T-score classifications are as follows:

  • T-score equal to or higher than 1.0: Normal
  • T-score between -1.0 and -2.5: Osteopenia, low bone density
  • T-score equal to or below -2.5: Osteoporosis

While MS is a known risk factor for developing osteopenia and osteoporosis, people can help reduce this risk and aim to keep bones strong.

Where applicable, lifestyle changes include:

  • limiting alcohol intake
  • quitting smoking
  • performing weight-bearing exercises
  • getting enough calcium and vitamin D either through diet or supplementation

Calcium and vitamin D are both important for bone health.

The daily recommended amount of calcium is as follows:

  • Adults age 25–65 years: 1,000 milligrams (mg)
  • Women over 51 years: 1,200 mg
  • All adults over 71 years: 1,200 mg daily

Vitamin D is necessary for the body to absorb calcium properly. Therefore, experts recommend people consume 400–800 IU of vitamin D through diet or a supplement. It may also be beneficial for a person to spend a brief period of time in the sun.

For some individuals, doctors may recommend medications to strengthen bone density. A class of drugs called bisphosphonates is a typical option to help increase bone density.

It is important that a person with MS consults their physician before beginning an exercise program or before taking any medications, including supplements.

People with MS are at an increased risk of osteoporosis and lower bone density than people without MS. Factors for this may include lack of weight-bearing activity, decreased mobility, and prolonged use of medications such as steroids.

People with MS have an increased risk of fractures. Lifestyle changes may be helpful to strengthen bones. A doctor may also recommend weight-bearing exercises and medications.