UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Neurology

Faculty Mentor

Carolina Ionete, Judith K. Ockene

Publication Date


Document Type



Clinical Epidemiology | Community Health and Preventive Medicine | Epidemiology | Musculoskeletal Diseases | Nervous System Diseases | Neurology | Preventive Medicine | Women's Health


Background: Osteoporosis is the most common bone disease in the United States, and it is particularly common among women with multiple sclerosis (MS). However, despite this association, the temporal relationship between these two conditions has not been previously studied. Data from the Women’s Health Initiative provides a unique opportunity to examine the risk of developing osteoporosis over time in individuals diagnosed with MS.

Objective: The purpose of this study is to refine the relationship between MS and osteoporosis, clarifying the impact of environmental and pharmacologic factors on each condition, as well as addressing treatment and preventative efforts for a patient population at a greater potential risk for osteoporosis.

Methods: The study sample, derived from the Women’s Health Initiative, included 449 women who reported an MS diagnosis at baseline and 161,359 women without MS who comprised a control group. Baseline measures of self-reported osteoporosis, age, smoking status, steroid and anti-inflammatory use, and supplementary as well as dietary calcium and vitamin D were compared. MS patients reporting osteoporosis at baseline were removed, resulting in 355 women with MS to monitor for time to incident osteoporosis. Survival analyses were performed on follow-up data gathered annually between 1993 and 2005 to factor out significant associations of additional factors. Proportions of participants on osteoporosis-related medications as well as latency to use were compared between the multiple sclerosis and control cohorts.

Results: At baseline, women with MS are nearly three times as likely to report osteoporosis (p

Conclusions: A higher prevalence of osteoporosis at baseline suggests MS may significantly increase the risk of osteoporosis in premenopausal women. In contrast, environmental and pharmacologic variables appear to have a more significant role in the post-menopausal population. While osteoporosis was treated similarly between both groups, the point for intervention or prevention of osteoporosis in MS patients may be earlier in the disease course.


Multiple Sclerosis, Risk factors, Osteoporosis, Women's Health Initiative

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Copyright is held by the author(s), with all rights reserved.

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Journal/Book/Conference Title

2014 Senior Scholars Program Poster Presentation Day


Poster presented on Senior Scholars Program Poster Presentation Day at the University of Massachusetts Medical School, Worcester, MA, on April 30, 2014. Medical student Christopher Perrone participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.