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Management of Osteoporosis, Fracture and Falls in People with Multiple Sclerosis: Systematic Review of Guidelines

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Abstract

People with multiple sclerosis (MS) have a higher prevalence of osteoporosis, falls and fractures. Guidelines for MS populations targeting the management of osteoporosis, fracture and falls risk may help reduce the burden of musculoskeletal disease in this population. We aimed to systematically review current guidelines regarding osteoporosis prevention, screening, diagnosis and management in people with MS. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic review of scientific databases (MEDLINE, CINAHL, Embase and Scopus) was performed (n = 208). In addition, websites from MS organisations and societies were screened for clinical guidelines (n = 28). Following duplicate removal, screening and exclusions (n = 230), in total six guidelines were included in this review. Three of the identified guidelines were specific to managing osteoporosis in MS, while two linked vitamin D to bone health and one was focused on the effect of acute glucocorticoid use for MS exacerbations on bone health. All guidelines were found to contain inadequate recommendations for osteoporosis screening, management and treatment in people with MS given the evidence of higher prevalence of osteoporosis at an earlier age and compounding risk factors in this population. Early diagnosis and treatment of osteoporosis in people with MS is necessary as fractures lead to significant morbidity and mortality. Development of structured clinical guidelines directed at specific healthcare services will ensure screening, appropriate management, and care of bone health in people with MS.

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Acknowledgements

Marc Sim is supported by a Royal Perth Hospital Career Advancement Fellowship (CAF 130/2020), an Emerging Leader Fellowship from the Western Australian Future Health and Innovation Fund. Lisa Grech has received partial salary support through a Multiple Sclerosis Australia Fellowship (20-206; 2021-2023).

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No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Medicine, School of Clinical Sciences at Monash Health, Monash Medical Centre, Monash University, Level 5/Block E, 246 Clayton Road, Clayton, VIC, 3168, Australia

    Lisa Grech, Kiran Laurence, Peter R. Ebeling & Ayse Zengin

  2. Institute for Nutrition and Health Innovation Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Marc Sim

  3. Medical School, Royal Perth Hospital Unit, The University Western Australia, Perth, WA, Australia

    Marc Sim

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  1. Lisa Grech
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Contributions

Study concept and design: LG, KL and AZ; data collection: LG, AZ, KL and MS; interpretation of data: LG, KL, MS, PRE and AZ; preparation of manuscript: LG, KL, MS, PRE and AZ; and final approval of manuscript LG, KL, MS, PRE and AZ.

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Correspondence to Ayse Zengin.

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Lisa Grech, Kiran Laurence, Peter R. Ebeling, Marc Sim and Ayse Zengin declare that they have no conflict of interest.

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Grech, L., Laurence, K., Ebeling, P.R. et al. Management of Osteoporosis, Fracture and Falls in People with Multiple Sclerosis: Systematic Review of Guidelines. Calcif Tissue Int 114, 201–209 (2024). https://doi.org/10.1007/s00223-023-01159-z

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