Highlights
- •Patients with neuromyelitis optica had a higher risk of fractures.
- •Falling was the only significant risk factor for fracture in neuromyelitis optica.
- •Low bone mineral density was observed in neuromyelitis optica; prominent in youngs.
- •Low bone mineral density was associated with steroid use in neuromyelitis optica.
- •Prophylactic calcium supplement might be helpful in terms of bone mineral density.
Abstract
Background
The bone health in neuromyelitis optica spectrum disorder with aquaporin-4 immunoglobulin
G antibodies (NMOSD-AQP4) have not been fully evaluated. To evaluate the prevalence
of fractures and bone loss in patients with NMOSD-AQP4 compared to healthy controls
and patients with multiple sclerosis (MS) and to identify the risk factors associated
with fractures and low bone mineral density (BMD) in patients with NMOSD-AQP4.
Methods
Seventy-one patients with NMOSD-AQP4 were included. The two control groups consisted
of 213 age-, sex-, menopause-, and body mass index (BMI)-matched healthy participants
from the Korean National Health and Nutrition Examination Survey (healthy controls)
and 41 patients with multiple sclerosis (disease controls). We collected demographic
and clinical data related to bone health including BMD and FRAX score.
Results
Patients with NMOSD-AQP4 had a higher prevalence of fractures than the healthy control
group (OR = 5.40, CI = 2.004–14.524, p = 0.001), with falling, but not steroid use, being associated with an increased risk
of fractures after diagnosis with NMOSD-AQP4 (OR = 24.902, CI = 3.086–200.947, p = 0.003). They also had significantly lower BMD than controls (femur neck, p = 0.044; total hip, p < 0.001), which was more prominent in young participants. The BMD in the NMOSD-AQP4
group was associated with cumulative dose of oral steroids, age, sex, BMI, and partly
with the prophylactic calcium supplements. Though the patients with NMOSD-AQP4 did
not differ significantly from patients with MS in terms of fracture rate and BMD,
they had higher risk of fractures as measured by the Fracture Risk Assessment Tool
(for major osteoporotic fractures, (p = 0.001; for hip fractures, p = 0.018).
Conclusion
Patients with NMOSD-AQP4 had a significantly higher risk of fractures that could mostly
be attributed to falling. Additionally, low BMD was observed in these patients; it
was more prominent among young patients, associated with steroid use, and may partially
prevented by the use of prophylactic calcium supplements.
Keywords
Abbreviations:
BMD (bone mineral density), BMI (body mass index), CI (confidence interval), CS (corticosteroids), CTX (carboxy-terminal collagen crosslinks), DEXA (dual energy X-ray absorptiometry), EDSS (Kurtzke Expanded Disability Status Scale), IRB (Institutional Review Board), IVMP (intravenous pulses of methylprednisolone), KNHANES (Korean National Health and Nutrition Examination Survey), MS (multiple sclerosis), NMOSD-AQP4 (neuromyelitis optica spectrum disorder with aquaporin 4 IgG), OR (odds ratio), RA (rheumatoid arthritis), sBMD (standardized bone mineral density), VIF (variance inflation factor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 28, 2020
Accepted:
March 29,
2020
Received in revised form:
March 20,
2020
Received:
August 27,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
