Bone health in neuromyelitis optica: Bone mineral density and fractures

Young Nam Kwon, Sun Young Im, Yong Shik Park, So Hyun Ahn, Jaeyoung Seo, Sang Beom Kim, Sung Sang Yoon, Patrick Waters, Hyung Jin Choi, Sung Hye Kong, Jung Joon Sung, Sung Min Kim, Kyung Seok Park

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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.

Original languageEnglish
Article number102080
JournalMultiple Sclerosis and Related Disorders
StatePublished - Jul 2020


  • Bone mineral density
  • Corticosteroids
  • Fall
  • Fracture
  • Neuromyelitis optica

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    Kwon, Y. N., Im, S. Y., Park, Y. S., Ahn, S. H., Seo, J., Kim, S. B., Yoon, S. S., Waters, P., Choi, H. J., Kong, S. H., Sung, J. J., Kim, S. M., & Park, K. S. (2020). Bone health in neuromyelitis optica: Bone mineral density and fractures. Multiple Sclerosis and Related Disorders, 42, [102080].