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In addition to the general determinants of bone health, two factors may contribute to reduced bone mineral density in multiple sclerosis: physical disability and corticosteroid therapy. The aim of this study was to examine the effect of physical disability and steroid exposure on bone health in weight\u2010bearing bones and spine and on the incidence of low\u2010trauma fractures in multiple sclerosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective analysis of prospectively collected data, associations between bone mineral density (at the femoral neck, total femur and the lumbar spine) and its change with disability or cumulative steroid dose were evaluated with random\u2010effect models adjusted for demographic and clinical determinants of bone health. The incidence of low\u2010trauma fractures during the study follow\u2010up was evaluated with <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ndersen\u2212<jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>ill models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 474 and 438 patients were included in cross\u2010sectional and longitudinal analyses (follow\u2010up 2347 patient\u2010years), respectively. The effect of severely impaired gait was more apparent in weight\u2010bearing bones (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a010<jats:sup>\u221215<\/jats:sup>) than in spine (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.007). The effect of cumulative steroid dose was relatively less pronounced but diffuse (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a010<jats:sup>\u22124<\/jats:sup>). Risk of low\u2010trauma fractures was associated with disability (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.02) but not with cumulative steroid exposure and was greater amongst patients with severely impaired gait (annual risk 3.5% vs. 3.0%). Synergistic effects were found only between cumulative steroid dose in patients ambulatory without support (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Bone health and the incidence of low\u2010trauma fractures in multiple sclerosis are more related to impaired gait than to extended corticosteroid therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12479","type":"journal-article","created":{"date-parts":[[2014,6,16]],"date-time":"2014-06-16T22:34:57Z","timestamp":1402958097000},"page":"624-632","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis"],"prefix":"10.1111","volume":"22","author":[{"given":"M.","family":"Tyblova","sequence":"first","affiliation":[{"name":"Department of Neurology Charles University in Prague First Faculty of Medicine and General University Hospital in Prague Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Kalincik","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Melbourne Melbourne Vic. 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Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Zikan","sequence":"additional","affiliation":[{"name":"Third Department of Medicine Charles University in Prague First Faculty of Medicine and General University Hospital in Prague Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Havrdova","sequence":"additional","affiliation":[{"name":"Department of Neurology Charles University in Prague First Faculty of Medicine and General University Hospital in Prague Prague Czech 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