Multiple sclerosis affects all aspects of the patient’s lives and can significantly reduce their quality of life. The complications that result from multiple sclerosis are multi-systemic. Multiple Sclerosis Complications include: Intractable tremors. Depression Muscle spasms. Heat sensitivity Chronic pain. Sexual dysfunction Bladder dysfunction. Fatigue Urinary Tract Infections.Cognitive deficits Constipation/ Fecal incontinence Here, we will briefly discuss the pharmacological and non-pharmacological management of each of them. Intractable tremors: are a common symptom in MS patients. They can be managed by use of devices like weights on the hands, deep brain stimulation, or surgery of the Thalamus in the brain. Pharmacotherapy includes the use of anticonvulsants like Clonazepam. Other drugs that have been used are Mysoline, Ondansetron, and Propranolol. Muscle spasms: may also be present and are treated by encouraging the patients to participate in exercise and stretching regularly. Other treatments such as physiotherapy and occupational therapy have been shown to be of benefit. Drugs used to reduce spasticity include Diazepam (Valium), Baclofen, Dantrolene, and Tizanidine. These are skeletal muscle relaxing agents. Pain: is another primary symptom MS patients will experience over a prolonged period. It is managed using anticonvulsants, tricyclic antidepressants, and anti-arrhythmic agents. These include agents like gabapentin, phenytoin and carbamazepine 100 -1000 milligrams per day.

With new cutting-edge technology such as gene-chip technology and new MRI-based advancements, the boundaries of multiple sclerosis as we know them today are being stretched to the limit. Numerous research activities directed at understanding its etiopathogenesis, halting its progression, restoring lost function, and development of a cure are underway with new strides being made every day. Major clinical trials are underway testing novel ways of treating multiple sclerosis with several drugs in advanced phases. Laquinimod is an experimental immunomodulatory that alters T-cell populations to promote regulatory T-cell activity instead of the attack-focused Th1 response and also seems to play a role in the synthesis of neuroprotective molecules. Developed by Active Biotech and Teva, it is being investigated as an option for management of some forms of multiple sclerosis. Teriflunomide, the active metabolite of leflunomide, is another immunomodulator under investigation for the treatment of multiple sclerosis. The proposed mechanism of action of teriflunomide is the blockade of pyrimidine synthesis that exerts a cytostatic effect on proliferating lymphocytes. Other drugs under investigation for the treatment of multiple sclerosis include BG-12 (dimethyl fumarate), daclizumab (Zena pax), Alemtuzumab (Campath/Lemtrada), Rituximab (Rituxan), Ocrelizumab and Ibudilast. New studies have shed more light on the role of lifestyle factors in influencing the development of multiple sclerosis.

Patients with osteoporosis have weak, brittle bones that are at risk of breaking easily. Osteoporosis literally means “porous bones” and is the result of several modifiable factors, such as diet and exercise and non-modifiable factors such as age, sex, and race. Bones, like other tissue in the body, are self-renewing—up to a point. In a healthy person, old bone tissue is used up and worn out, but the old bone tissue is replaced with new bone tissue. Advanced age and other factors can harm this cycle of rebuilding. As people age, their bones are not rejuvenated as vigorously. The result is a thinning of the bone which becomes more vulnerable to injury. A patient with severe osteoporosis may break a bone by doing a very light activity such as simply bending over or even coughing. A broken hip bone is one of the most common and devastating outcomes of this condition. Prevalence of Osteoporosis According to the International Osteoporosis Foundation, approximately 200 million people across the world suffer from osteoporosis. Osteoporosis is more common than heart attack, stroke, or cancer. In the United States, 44 million people have osteoporosis or low bone density. Anywhere from 24-50% of women and 7.5% men over age 50 have osteoporosis.

Before talking about what causes osteoporosis, let’s look at the functions of bones. Bones serve as a large reservoir of calcium and to support the skeletal system. Bones are constantly regenerating as a way to get rid of old bone tissue and strengthen the bones with new bone tissue. It is estimated that the skeleton is completely replaced approximately over 4 years. Bone building, known as “remodeling” is the process of resorption and formation. Resorption : In resorption old bone is eaten up by the body (osteoclasts) and calcium, phosphorus, and collagen type 1 are in released into circulation. Osteoblasts are created when the parathyroid hormone stimulates the Osteoblasts, who in turn signal the monocytes and macrophages to differentiate into osteoclasts. Resorption takes days to weeks. Bone formation : is when osteoblats lay down new bone tissue called osteoid, which is made up of of type 1 collagen and other proteins. In order for the new bone tissue to grow strong, the osteoblasts deposit calcium and phosphorus (this step depends on the amount of calcium and phosphorus available, which is why it is important that we get enough calcium in our diet.) Bone formation takes months. Osteoporosis Causes Osteoporosis occurs when more bone is being broken down than built up. This can occur due to estrogen deficiency, steroid use, etc. There are two types of osteoporosis; primary and secondary.

Unmodifiable Risk Factors for Osteoporosis: Things you can’t do anything about Over age 50 Caucasian or Asian race Dementia Female gender/ postmenopausal women Women are at a much greater risk for osteoporosis than men.  The loss of sex hormones in the body is the most common cause of osteoporosis. Women experience a decline in estrogen, the female sex hormone, when they undergo menopause. This means that women who have undergone menopause are much more likely to develop osteoporosis. Family history of Osteoporosis Broken bones or height loss Decline in testosterone Men can and do occasionally develop osteoporosis for the same reason: A decline in testosterone, the male sex hormone, results in bone loss. As they age, men lose testosterone more gradually than women, and that protects many men from developing osteoporosis. However, the treatment for prostate cancer depletes testosterone, making patients with prostrate cancer at higher risk for bone loss. Chronic health conditions that effect bone formation/resorption People with small frames Are at greater risk for this condition because they have less bone tissue to begin with. Modifiable Risk Factors for Osteoporosis : Things you can change to lower your risk Low Calcium intake and Vitamin D Calcium deficiency has been implicated in the development of osteoporosis.