Osteoporosis and Multiple Sclerosis

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The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.

The panelists are:

• Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
• Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
• Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School

Switching from one disease-modifying therapy to another is preferred over trying to use two separate disease-modifying therapies at once, said Lublin. “There are anecdotes where things have been combined, but we don’t have good data to guide us.” More promising combinations are with anti-inflammatories taken with drugs that could reverse neurologic damage.

The way to measure improvement for repair using an MRI is not clear yet. “We have some advanced metrics that may help looking at brain volume and recovery of brain volume, looking at measures of tracks and tractography, like diffusion sensor imaging and magnetization transfer ratios, which also can assess underlying tissue damage. They have a ways to go, and I’m hopeful that with higher field strength magnets, we’ll be able to do even better,” said Lublin.

For patients with severe disease with a significant amount of neurological damage, they still might benefit from disease-modifying therapy, because there could be even more to lose, said Coyle. “If you’ve lost leg function but your hands are critical, you want to prevent losing hand function. That’s a valuable thing to that person.”