Healthy bones

26 June 2023

People with MS have a greater risk of developing a bone thinning condition called osteoporosis. This is an invisible condition, even to the person who has it. You may not notice anything is wrong, right up to the point when you break a bone in a minor accident.

In osteoporosis, the internal structure of your bones becomes weaker. For women, this is more common after menopause, when hormone changes can slow down the rate at which your bones repair themselves. If your bones are weak, a fall could cause a bone break. Osteoporosis does not normally cause bone pain.

Some common symptoms of MS can make you more likely to fall, including fatigue, visual problems, mobility and balance problems, or problems with your concentration.

Some drugs used in MS such as steroids, anti-epileptic pain drugs and certain antidepressant drugs can affect your bones and increase the risk of osteoporosis. You should not stop any medications until you have spoken to a health professional.

If you're concerned about your bone health, talk about your concerns and risk factors with your GP, MS nurse or neurologist. Let them know if there is any family history of hip fracture or osteoporosis too. You may be offered a referral to a bone specialist who can carry out further tests and give advice on any treatments that may be necessary.

You can read more about osteoporosis and how it is diagnosed and treated in our A-Z page on osteoporosis.

Here are some tips for keeping your bones healthy and strong.

Take regular exercise

Regular, moderate weight-bearing or resistance exercise helps keep your bones strong. Exercise that focuses on balance and coordination will improve your core stability and reduce the risk of falls.

If you can, it’s good to get a variety of exercise. Walking or wheeling, dancing, gardening and housework are all good ways of exercising. Joining a local keep-fit class can make it more fun and help with motivation.

If you have problems with mobility, a physiotherapist can give advice on suitable exercises and equipment that can help you exercise in the best way for your bones.

Eat a healthy diet with sufficient calcium

Eating a balanced diet and maintaining a healthy weight is good for your general health but eating calcium-rich foods in particular will help maintain your bone density.

Calcium is essential to keeping bones and teeth strong as well ensuring your muscles and nerves work well.

The daily recommended amount of calcium is 700 mg for adults. Most people should be able to get this from their diet. Good sources of calcium include:

  • low-fat milk, cheese, yoghurt and other dairy foods
  • green leafy vegetables, such as broccoli, cabbage and kale
  • soya beans
  • tofu
  • soya drinks with added calcium
  • nuts and seeds
  • bread and anything made with fortified flour
  • fish where you eat the bones, such as sardines and pilchards or canned salmon
  • tap water (particularly in hard water areas)

Get lots of sunshine and vitamin D

Vitamin D is vital to help the body absorb calcium. We get most of our vitamin D from sunlight on our skin. Most people can get enough vitamin D by exposing their face and arms to sunlight for just 5-15 minutes daily during the summer months. There's no need to risk sunburn though!

You'll find small amounts of vitamin D in foods such as oily fish like salmon and sardines, as well as eggs, fortified fat spreads and breakfast cereals, powdered milk and cod liver oil.

To maintain bone health, the Department of Health recommends a daily 400 IU (10 micrograms) vitamin D supplement for everyone over 1 year old through the British winter.

If you tend to stay indoors, or stay covered up outside, or if you have dark skin, you may not make enough vitamin D in your skin just from sunlight. You should consider taking a vitamin D supplement throughout the year.

People with MS may already be taking vitamin D supplements on the advice of their MS team. This will cover your bone health needs.

If you smoke, stop

Smoking increases your risk of developing osteoporosis by disrupting the processes that form healthy bone in your body. People with MS who are at risk of osteoporosis are encouraged to cut down or stop smoking completely.

Your GP can give you information on local stop-smoking services.

Cut down your alcohol intake

A high alcohol intake can interfere with the hormones in your body and impair your ability to absorb calcium from your food. This reduces your body’s ability to produce healthy bone and can increase your osteoporosis risk. Heavy alcohol use can also increase the risk of falls.

Moderate or occasional alcohol intake is unlikely to be harmful to your bones, so long as you have a nutritious diet and get enough exercise.

Avoid falls

You can reduce the risk of falling by checking your home and work environment for trip hazards. Look out for trailing wires, rugs that tend to slide, or slippery surfaces, and try to keep your routes tidy.

There may be some places in your home where a hand rail can be fitted to help you navigate comfortably. Try to ensure rooms are well lit so that you can easily see any obstacles.

This article was developed from a piece originally authored by MS Nurses Pauline Shaw and Debbie Quinn.

Find out more

On this page