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Kim EY, Kim JE, Kim YE, Choi B, Sohn DH, Park SO, Chung YH, Kim Y, Robinson WH, Kim YG, Chang EJ. Dysfunction in parkin aggravates inflammatory bone erosion by reinforcing osteoclast activity. Cell Biosci 2023; 13:48. [PMID: 36882866 PMCID: PMC9993703 DOI: 10.1186/s13578-023-00973-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/25/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Parkin dysfunction associated with the progression of parkinsonism contributes to a progressive systemic skeletal disease characterized by low bone mineral density. However, the role of parkin in bone remodeling has not yet been elucidated in detail. RESULT We observed that decreased parkin in monocytes is linked to osteoclastic bone-resorbing activity. siRNA-mediated knockdown of parkin significantly enhanced the bone-resorbing activity of osteoclasts (OCs) on dentin without any changes in osteoblast differentiation. Moreover, Parkin-deficient mice exhibited an osteoporotic phenotype with a lower bone volume accompanied by increased OC-mediated bone-resorbing capacity displaying increased acetylation of α-tubulin compared to wild-type (WT) mice. Notably, compared to WT mice, the Parkin-deficient mice displayed increased susceptibility to inflammatory arthritis, reflected by a higher arthritis score and a marked bone loss after arthritis induction using K/BxN serum transfer, but not ovariectomy-induced bone loss. Intriguingly, parkin colocalized with microtubules and parkin-depleted-osteoclast precursor cells (Parkin-/- OCPs) displayed augmented ERK-dependent acetylation of α-tubulin due to failure of interaction with histone deacetylase 6 (HDAC6), which was promoted by IL-1β signaling. The ectopic expression of parkin in Parkin-/- OCPs limited the increase in dentin resorption induced by IL-1β, accompanied by the reduced acetylation of α-tubulin and diminished cathepsin K activity. CONCLUSION These results indicate that a deficiency in the function of parkin caused by a decrease in parkin expression in OCPs under the inflammatory condition may enhance inflammatory bone erosion by altering microtubule dynamics to maintain OC activity.
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Affiliation(s)
- Eun-Young Kim
- Department of Biochemistry and Molecular Biology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji-Eun Kim
- Department of Biochemistry and Molecular Biology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Young-Eun Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bongkun Choi
- Department of Biochemistry and Molecular Biology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong Hyun Sohn
- Department of Microbiology and Immunology, Pusan National University School of Medicine, Yangsan, 50612, Korea
| | - Si-On Park
- Department of Biochemistry and Molecular Biology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yeon-Ho Chung
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yongsub Kim
- Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.,Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - William H Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Eun-Ju Chang
- Department of Biochemistry and Molecular Biology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. .,Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Spindler P, Tkatschenko D, Alzoobi Y, Kuebler D, Kühn AA, Schneider GH, Prinz V, Vajkoczy P, Faust K. Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study. J Neurol Surg A Cent Eur Neurosurg 2022; 84:247-254. [PMID: 35100633 DOI: 10.1055/s-0041-1741535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND With increasing prevalence of Parkinson's disease (PD), instrumentation surgery of the thoracolumbar spine of PD patients grows in importance. Poor operative results with high rates of revision surgery have been reported. The goal of this study was to compare the biomechanical complications of thoracolumbar instrumentation surgery of patients with and without PD. METHODS In a retrospective case-control study, we compared 16 PD patients with a matched cohort of 104 control patients regarding the following postinstrumentation complications: (1) adjacent joint disease, (2) material failure, and (3) material loosening. Also, we compared the spinal bone density, which is the main prognostic criteria for failed instrumentation surgery, between the groups. RESULTS We found the rate of material revision to be significantly higher in PD patients (43.8 vs. 13.5%, p = 0.008, odds ratio (OR) = 5.0). Furthermore, the indications for revision surgery differed between the groups, with more hardware failures in the PD group and more adjacent segment degeneration in the control group. PD patients profited from modern operation techniques (percutaneous instrumentation and CT-navigated screw implantation). Hospitalization was significantly longer for PD patients (20.2 ± 15.1 vs. 14.1 ± 8.9 days, p = 0.03). CONCLUSION PD patients exhibit challenging biomechanical demands on instrumenting the spine. Besides osteoporosis, especially sagittal imbalance, gait disturbance, and altered muscle tone may be contributive. PD patients may particularly profit from navigated and less invasive surgical techniques.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Dimitri Tkatschenko
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Dorothee Kuebler
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
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The Effect of Parkinson's Disease on Patients Undergoing Lumbar Spine Surgery. PARKINSONS DISEASE 2018; 2018:8428403. [PMID: 30057738 PMCID: PMC6051025 DOI: 10.1155/2018/8428403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
Study Design Retrospective Database Analysis. Objective The purpose of this study was to assess characteristics and outcomes of patients with Parkinson's disease (PD) undergoing lumbar spine surgery for degenerative conditions. Methods The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on ICD-9-CM procedural codes for lumbar spine surgery and substratified to degenerative diagnoses. Incidence and baseline patient characteristics were determined. Multivariable analysis was performed to determine independent risk factors increasing incidence of lumbar fusion revision in PD patients. Results PD patients account for 0.9% of all degenerative lumbar procedures. At baseline, PD patients are older (70.7 versus 58.9, p < 0.0001) and more likely to be male (58.6% male, p < 160.0001). Mean length of stay (LOS) was increased in PD patients undergoing lumbar fusion (5.1 days versus 4.0 days, p < 0.0001) and lumbar fusion revision (6.2 days versus 4.8 days, p < 180.0001). Costs were 7.9% (p < 0.0001) higher for lumbar fusion and 25.2% (p < 0.0001) higher for lumbar fusion revision in PD patients. Multivariable analysis indicates that osteoporosis, fluid/electrolyte disorders, blood loss anemia, and insurance status are significant independent predictors of lumbar fusion revision in patients with PD. Conclusion PD patients undergoing lumbar surgery for degenerative conditions have increased LOS and costs when compared to patients without PD.
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Torsney KM, Noyce AJ, Doherty KM, Bestwick JP, Dobson R, Lees AJ. Bone health in Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2014; 85:1159-66. [PMID: 24620034 PMCID: PMC4173751 DOI: 10.1136/jnnp-2013-307307] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/14/2014] [Accepted: 01/28/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) and osteoporosis are chronic diseases associated with increasing age. Single studies have reported associations between them and the major consequence, namely, increased risk of fractures. The aim of this systematic review and meta-analysis was to evaluate the relationship of PD with osteoporosis, bone mineral density (BMD) and fracture risk. METHODS A literature search was undertaken on 4 September 2012 using multiple indexing databases and relevant search terms. Articles were screened for suitability and data extracted where studies met inclusion criteria and were of sufficient quality. Data were combined using standard meta-analysis methods. RESULTS 23 studies were used in the final analysis. PD patients were at higher risk of osteoporosis (OR 2.61; 95% CI 1.69 to 4.03) compared with healthy controls. Male patients had a lower risk for osteoporosis and osteopenia than female patients (OR 0.45; 95% CI 0.29 to 0.68). PD patients had lower hip, lumbar spine and femoral neck BMD levels compared with healthy controls; mean difference, -0.08, 95% CI -0.13 to -0.02 for femoral neck; -0.09, 95% CI -0.15 to -0.03 for lumbar spine; and -0.05, 95% CI -0.07 to -0.03 for total hip. PD patients were also at increased risk of fractures (OR 2.28; 95% CI 1.83 to 2.83). CONCLUSIONS This systematic review and meta-analysis demonstrate that PD patients are at higher risk for both osteoporosis and osteopenia compared with healthy controls, and that female patients are at greater risk than male patients. Patients with PD also have lower BMD and are at increased risk of fractures.
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Affiliation(s)
| | - Alastair J Noyce
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Karen M Doherty
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ruth Dobson
- Blizard Institute, Centre for Neuroscience and Trauma, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
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Aoki Y, Nakajima A, Sakakibara R, Ohtori S, Takahashi K, Nakagawa K. Pathologic thoracic spine fracture in presence of Parkinson's disease and diffuse ankylosis: successful management of a challenging condition. BMC Musculoskelet Disord 2013; 14:61. [PMID: 23394219 PMCID: PMC3574840 DOI: 10.1186/1471-2474-14-61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 02/08/2013] [Indexed: 11/17/2022] Open
Abstract
Background Patients with Parkinson’s disease have higher risk of complications and revision surgery following spine surgery. Spinal fracture in an ankylosed spine is also difficult to treat. We recently treated a case of thoracic spine fracture in a patient with Parkinson’s disease complicating a severely ankylosed spine. There is no report describing surgical treatment of spine fracture in such a difficult condition, thus, we firstly report the case and discuss the reasons for a successful result. Case presentations A 68-year-old man with Parkinson’s disease had a pathologic thoracic spine fracture at T11. Four days after onset, he was referred to a local hospital because of gradually increasing back pain, but no spinal fracture was pointed out at that time. Because he developed lower extremity bilateral numbness and weakness, he was transported to our hospital, eight days after onset. When referred to our hospital, he exhibited severe back pain and paralysis of the lower extremities due to spinal cord involvement. Emergency surgery was performed. Decompression of T10-11 was performed followed by instrumented spinal fusion from T8 to L2. A dramatic neurological improvement was observed following surgery, and complete bony fusion was achieved. At the final two-year postoperative follow-up, the patient had no pathological symptoms related to spinal fracture and no instrument failure was observed. Conclusion This patient had Parkinson’s disease and a severely ankylosed spine, both of which may lead to unsatisfactory surgical results from spinal surgery. Generally, patients with Parkinson’s disease have an increased risk for adjacent segment disease and instrument failure. In this patient, fusion surgery did not change the number of fused segments because operated segments were already ankylosed. Because no stress force exists between adjacent vertebral bodies, a severely ankylosed spine may help prevent screw pullout. Thus, treatment of a spinal fracture in an ankylosed spinal segment is a less adverse condition for patients with Parkinson’s disease. Our experience led us to think that a combination of Parkinson’s disease with severely ankylosed spine does not necessarily suggest unsatisfactory outcomes after surgical treatment of spinal fracture.
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Affiliation(s)
- Yasuchika Aoki
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 654-1 Shimoshizu, Sakura, Chiba 285-8741, Japan.
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Kawaguchi Y, Nakano M, Seki S, Yasuda T, Hori T, Tanaka K, Kimura T. Surgical treatment of lumbar vertebral collapse in a patient with Parkinson's disease: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23 Suppl 2:S165-70. [PMID: 23412270 DOI: 10.1007/s00590-012-1145-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/28/2012] [Indexed: 12/13/2022]
Abstract
Parkinson's disease (PD) frequently develops postural abnormalities including extreme neck flexion and trunk flexion. Patients with PD sometimes have osteopenia and vertebral deformity due to the destruction of fragile bone can be also associated with the spinal deformity. Surgical treatment for these patients is very difficult. We encountered a patient with PD presenting severe trunk sagittal and frontal deformity. The patient had cauda equina syndrome due to progressive vertebral collapse of the lumbar spine. We performed anterior reconstruction surgery at first in order to achieve improved lordotic alignment of the lumbar spine. Then, we performed 2 posterior surgeries, resulting in total long fusion from T4 to S1. The clinical findings of this patient were presented, and the treatment options were discussed.
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Affiliation(s)
- Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan,
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Posterior spinal fusion from T2 to the sacrum for the management of major deformities in patients with Parkinson disease: a retrospective review with analysis of complications. ACTA ACUST UNITED AC 2012; 25:E53-60. [PMID: 22460399 DOI: 10.1097/bsd.0b013e3182496670] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD). OBJECTIVE To evaluate the effectiveness of the construct, the incidence and types of complications, and patient satisfaction. SUMMARY OF BACKGROUND DATA The association of degenerative, neuromuscular, and osteoporotic diseases in PD can lead to major complications after spine surgery. We treated PD patients with major spinal deformities by a posterior-only approach for spinal fusion from T2 to the sacrum. METHODS : This retrospective study reviews 12 consecutive patients with PD undergoing this surgery in a 2-year span at a single institution. Radiographs were taken with the EOS low-dose system (EOS Imaging, Paris, France) before and 3 months after surgery and at the last follow-up visit and were evaluated by a spine surgeon not involved in the surgery. Complications were analyzed. The functional outcome was assessed with the SRS-30 questionnaire. RESULTS The patients' mean age was 68±6.2 years, the mean duration of PD 10±4.9 years, and the mean follow-up 32.8±6.9 months. Six patients had first surgeries, and 6 revisions. Statistically significant improvement was observed in all patients in the frontal and the sagittal planes after surgery. The sagittal vertical axis improved from 15.2±9.3 cm preoperatively to 0.5±3.2 cm at the last follow-up. Six patients had revision, 3 times for instrumentation failure, twice for proximal junctional kyphosis at T1-T2, and once for an epidural hematoma. The SRS-30 questionnaire indicated strong patient satisfaction, with 11 patients who would have the same procedure again if they had the same condition. CONCLUSIONS This is the first reported series of PD patients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.
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Smith É, Carroll Á. Bone mineral density in adults disabled through acquired neurological conditions: a review. J Clin Densitom 2011; 14:85-94. [PMID: 21474350 DOI: 10.1016/j.jocd.2010.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 12/12/2010] [Accepted: 12/13/2010] [Indexed: 01/26/2023]
Abstract
This article is a review of the changes in bone mineral density (BMD), which occur in a number of acquired neurological conditions resulting in disability. For each of spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, and traumatic brain injury, the following aspects are discussed, where information is available: prevalence of low BMD according to World Health Organization diagnostic categories and recommended diagnostic method, prevalence based on other diagnostic tools, comparison of BMD with a control population, rate of decline of BMD following onset of the neurological condition, factors influencing decline; mechanism of bone loss, and fracture rates. The common risk factors of immobilization and vitamin D deficiency would appear to cross all disability groups, with the most rapid phase of bone loss occurring in the acute and subacute phases of each condition.
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Affiliation(s)
- Éimear Smith
- National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland.
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Sato Y, Iwamoto J, Honda Y. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson's disease. Parkinsonism Relat Disord 2010; 17:22-6. [PMID: 21050796 DOI: 10.1016/j.parkreldis.2010.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 10/08/2010] [Accepted: 10/13/2010] [Indexed: 12/18/2022]
Abstract
A high incidence of fractures, particularly of the hip, represents an important problem in patients with Parkinson's disease (PD), who are prone to falls and have osteoporosis. We previously showed that 25-hydroxyvitamin D (25-OHD) deficiency due to sunlight deprivation with compensatory hyperparathyroidism causes reduced bone mineral density (BMD) in elderly patients with PD. The present study was undertaken to address the possibility that sunlight exposure may maintain BMD and reduce the incidence of hip fracture in elderly patients with PD. In a prospective study, PD patients were assigned to regular sunlight exposure (n=162) or usual lifestyle (n=162), and followed for 2 years. BMD of the second metacarpal bone was measured using a computed X-ray densitometer. Incidence of hip fracture in the two patient groups during the 2 year follow-up period was assessed. At baseline, patients of both groups showed vitamin D deficiency due to sunlight deprivation with compensatory hyperparathyroidism. The exposed group patients were exposed to sunlight (3231 min/year). BMD increased by 3.8% in the sunlight-exposed group and decreased by 2.6% in the usual lifestyle group (p<.0001). Serum 25-OHD level increased from 27 nmol/L to 52 nmol/L in the sunlight-exposed group. Eleven patients sustained hip fracture in the normal lifestyle group, and 3 fractures occurred among the sunlight-exposed group (p=.03; odds ratio=2.4). Sunlight exposure can increase the BMD of vitamin D deficient bone by increasing 25-OHD concentration and leads to the prevention of hip fracture.
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Affiliation(s)
- Yoshihiro Sato
- Department of Neurology, Mitate Hospital, 3237 Yugeta, Tagawa 826-0041, Japan.
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Nakashima H, Yukawa Y, Ito K, Horie Y, Machino M, Kato F. Combined posteroanterior surgery for osteoporotic delayed vertebral fracture and neural deficit in patients with Parkinson's disease. Orthopedics 2009; 32:orthopedics.43776. [PMID: 19824600 DOI: 10.3928/01477447-20090818-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteoporotic thoracolumbar compression fracture occasionally occurs in patients with Parkinson's disease and can lead to neural compromise due to delayed vertebral body collapse, requiring surgical treatment. Surgical treatment and postoperative care are difficult because of poor bone quality, involuntary exercise, and postural imbalance. Due to such difficulties in treatment, few reports exist about surgery for osteoporotic thoracolumbar compression fracture in patients with Parkinson's disease. Anterior decompression and posteroanterior reconstructive stabilization were performed for 3 patients with Parkinson's disease and osteoporotic vertebral body collapse. To prevent instrument-related complications, it is important to achieve initial rigid stability. Regarding the stabilization of the posterior elements, laminar hooks were used. Two pedicle screws and 1 hook were placed at 1 level above and 1 level below the injured vertebra. As for the stabilization of the anterior part, a titanium cage was used. All patients resumed their activities of daily living postoperatively. Two of 3 patients experienced sinking of the rib cage after commencement of ambulation with a hard brace postoperatively. After these patients wore a body cast for 2 months, they were able to resume activities of daily living under careful treatment. In all patients, junctional kyphosis improved postoperatively and progressed postoperatively. None experienced recurrent neural deterioration or backache related to the fracture through >3 years of postoperative follow-up. Combined posteroanterior reconstruction surgery was useful for osteoporotic thoracolumbar compression fracture with Parkinson's disease. However, maintenance of postoperative alignment was difficult to achieve. Careful postoperative management was important for good clinical results.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Aichi 455-0018, Japan
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Kamanli A, Ardicoglu O, Ozgocmen S, Yoldas TK. Bone mineral density in patients with Parkinson's Disease. Aging Clin Exp Res 2008; 20:277-9. [PMID: 18594197 DOI: 10.1007/bf03324774] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS This study assesses bone mineral density (BMD) in the lumbar spine, proximal femur and hand, and examines the relationship between BMD and disease duration, Hoehn and Yahr staging in Turkish elderly patients with Parkinson's disease (PD). DESIGN Twenty-four PD patients and 31 age- and sex-matched controls took part in the study. The BMD in the lumbar spine (L2-L4), femoral neck, Ward's triangle, trochanter and bilateral hands were evaluated by dual X-ray absorptiometry (DXA). RESULTS There was no significant difference in right hand BMD (rHBMD), L2-L4 spinal BMD, and right proximal femur BMD between patients and controls. However, in female patients hand BMD and right femoral neck BMD were significantly lower than in female controls (p<0.05). Male patients had no significant difference in BMD measurements in any sites compared with controls. Patients' Hoehn and Yahr index and disease duration were negatively correlated with BMD in all sites except L2-L4. CONCLUSIONS We emphasize the increased risk for osteoporosis in elderly female patients with PD, which is more prominent in proximal femur and hand measurements. Elderly female patients should be carefully examined and screened for osteoporosis to prevent bone loss and associated disability.
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Affiliation(s)
- Ayhan Kamanli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Firat University, 23119 Elazig, Turkey.
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Fernández MC, Parisi MS, Díaz SP, Mastaglia SR, Deferrari JM, Seijo M, Bagur A, Micheli F, Oliveri B. A pilot study on the impact of body composition on bone and mineral metabolism in Parkinson's disease. Parkinsonism Relat Disord 2007; 13:355-8. [PMID: 17292656 DOI: 10.1016/j.parkreldis.2006.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 11/30/2006] [Accepted: 12/06/2006] [Indexed: 11/29/2022]
Abstract
The impact of body composition on bone and mineral metabolism in Parkinson's disease (PD) was evaluated. Body fat mass, lean mass, bone mineral content, and bone mineral density (BMD) were measured by DXA in 22 PD patients and 104 controls. Female patients exhibited reduced body mass index, fat mass, and BMD compared to controls (p<0.05). Significant positive correlation was found between 25 OHD levels and BMC. Diminished bone mass in women with PD was found to be associated with alterations in body composition and low 25 OHD levels.
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Affiliation(s)
- María C Fernández
- Department of Internal Medicine, Sección Osteopatías Médicas, Hospital de Clínicas, Universidad de Buenos Aires, Córdoba 2351, 8 piso, (1120) Buenos Aires, Argentina
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Abstract
Parkinson's disease (PD), a common disease of the elderly, is a movement disorder characterized by tremor, akinesia, and loss of postural reflexes, leading to immobility and frequent falls. It results from selective loss (death) of dopaminergic neurons in the substantia nigra region of the brain, largely developed prior to clinical diagnosis, and continuous after diagnosis, despite use of current therapeutic modalities. In PD in the United States the cause and mechanism of continued neuron cell death in the substantia nigra is currently unknown. We hypothesize, based upon several lines of evidence, that documented chronically inadequate vitamin D intake in the United States, particularly in the northern states and particularly in the elderly, is a significant factor in the pathogenesis of PD. This hypothesis implies that dietary aid for prevention and therapy for PD is possible.
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Affiliation(s)
- Harold L Newmark
- Susan Lehman Cullman Laboratory for Cancer Research, Department of Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.
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Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Abnormal bone and calcium metabolism in immobilized Parkinson's disease patients. Mov Disord 2006; 20:1598-603. [PMID: 16114020 DOI: 10.1002/mds.20658] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To elucidate the influence of immobilization-induced hypercalcemia on bone metabolism in Parkinson's disease (PD), we measured serum biochemical indexes and bone mineral density (BMD) in the second metacarpals of 142 elderly PD patients and 99 age-matched healthy controls. Serum concentrations of 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-[OH](2)D), ionized calcium, intact parathyroid hormone (PTH), and intact bone Gla protein (BGP) were measured. Urinary deoxypyridinoline (D-Pyr) was also measured. Increased serum calcium levels (mean, 1.27 mmol/L) were observed in PD patients, and the levels correlated negatively with the Unified Parkinson's Disease Rating Scale III (UPDRS III), indicating the presence of immobilization-induced bone resorption with resultant hypercalcemia. Decreased serum concentrations of 1,25-[OH](2)D (mean, 88.7 pmol/L) and 25-OHD (mean, 29.7 nmol/L) were noted. Serum PTH was decreased (mean, 25.2 ng/L). Serum BGP was decreased while urinary D-Pyr concentration elevated. A negative correlation was observed between 1,25-[OH](2)D levels and serum calcium or UPDRS III (P < 0.0001). In disabled PD patients, immobilization-induced hypercalcemia may inhibit secretion of PTH, which in turn suppresses 1,25-[OH](2)D production. 25-OHD insufficiency may also contribute to decreased 1,25-[OH](2)D. These abnormalities may be corrected by the suppression of bone resorption with bisphoshonate, and supplementations of calcium and vitamin D should be avoided in these patients.
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Affiliation(s)
- Yoshihiro Sato
- Department of Neurology, Mitate Hospital, Tagawa, Japan.
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Abstract
There are few studies of osteoporosis in Parkinson's disease (PD). We assessed the prevalence of osteoporosis in a PD clinic cohort. All subjects with a confirmed diagnosis of PD attending a clinic were invited to participate. All consenting subjects had bone density measured by dual energy X-ray absorptiometry scanning. Further data, including demography, disease duration, and disease severity, were collected. One hundred five subjects participated; median age was 75 (54-92) years. Fifty-one (49%) patients were men. Of the men: median T score, -1.3 (range, -4.7 to 3.8); median Z score, 0.0 (-3.2 to 4.7); diagnostic categories: osteoporosis, 20%; osteopenia, 41%; normal, 39%. Of the women: median T score -2.7 (-4.7 to 1.4); median Z score, -0.25 (-2.6 to 4.2); diagnostic categories: osteoporosis, 63%; osteopenia, 28%; and normal, 9%. Whole sample: osteoporosis, 42%; osteopenia, 34%; and normal, 24%. There were associations between age, depression, disease duration, and osteoporosis but not with disease severity. Female gender was an independent predictor of osteoporosis. The prevalence of osteoporosis/osteopenia is considerable in PD patients but does not exceed that of other people of similar age. Osteoporosis/osteopenia was present in almost all women of this age group with PD.
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Affiliation(s)
- Brian Wood
- Northumbria Healthcare NHS Trust, Wansbeck General Hospital, Ashington, Northumberland, UK.
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Melton LJ, Leibson CL, Achenbach SJ, Bower JH, Maraganore DM, Oberg AL, Rocca WA. Fracture risk after the diagnosis of Parkinson's disease: Influence of concomitant dementia. Mov Disord 2006; 21:1361-7. [PMID: 16703587 DOI: 10.1002/mds.20946] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In an inception cohort of 196 Olmsted County, Minnesota, residents with Parkinson's disease (PD) first recognized in 1976 to 1995, we tested whether the increased risk of bone fractures is associated with concomitant dementia. Using the data resources of the Rochester Epidemiology Project, information about PD, dementia, other clinical risk factors for fracture and fracture events was obtained from review of complete inpatient and outpatient medical records spanning each subject's residence in the community. Compared to an equal number of age- and sex-matched non-PD referent subjects from the community, PD patients were at a 2.2-fold increased risk of fractures generally and a 3.2-fold greater risk of hip fractures specifically. Adjusting for age, the independent predictors of overall fracture risk in the PD subjects included female sex (hazard ratio [HR] 1.6; 95% confidence interval [CI], 1.1-2.3), dementia (HR, 1.6; 95% CI, 1.1-2.4) and chronic depression, which was associated with a reduced risk (HR, 0.4; 95% CI, 0.2-0.8). Hip fractures were predicted by dementia (HR, 2.2; 95% CI, 1.2-4.1). The increased fracture risk in patients with PD is not entirely explained by concomitant dementia, and additional study is needed to determine the relative contributions to fracture risk of falls versus bone loss in these patients.
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Affiliation(s)
- L Joseph Melton
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Fink HA, Kuskowski MA, Orwoll ES, Cauley JA, Ensrud KE. Association between Parkinson's disease and low bone density and falls in older men: the osteoporotic fractures in men study. J Am Geriatr Soc 2005; 53:1559-64. [PMID: 16137287 DOI: 10.1111/j.1532-5415.2005.53464.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the association between Parkinson's disease (PD) and bone mineral density (BMD) and risk of falls. DESIGN Cross-sectional and prospective cohort study. SETTING Six U.S. clinical centers. PARTICIPANTS Five thousand nine hundred ninety-five community-dwelling, ambulatory men aged 65 and older. MEASUREMENTS History of physician-diagnosed PD was ascertained from participant self-report. BMD was measured at the hip and spine using dual energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). Incident falls were ascertained for 1 year using mailed queries. RESULTS Fifty-two participants (0.9%) reported a history of PD. In multivariate models, PD was associated with significantly lower BMD at the spine (-4.9%, P=.04) and total hip (-5.3%, P=.007) using DEXA and at the spine (-6.7%, P=.05) and total hip (-8.2%, P=.03) using QCT. PD was associated with a nearly three times greater age-adjusted risk of multiple future falls (odds ratio (OR)=2.91, 95% confidence interval (CI)=1.55-5.46). Further adjustment for history of multiple falls in the year before baseline attenuated this risk, but it remained significant (OR=2.30, 95% CI=1.15-4.59). CONCLUSION In this cohort of older men, PD was associated with lower BMD at the hip and spine, measured using areal and volumetric BMD, as well as increased falls. Clinicians should consider screening older men with PD for osteoporosis.
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Affiliation(s)
- Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
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Babat LB, McLain RF, Bingaman W, Kalfas I, Young P, Rufo-Smith C. Spinal surgery in patients with Parkinson's disease: construct failure and progressive deformity. Spine (Phila Pa 1976) 2004; 29:2006-12. [PMID: 15371701 DOI: 10.1097/01.brs.0000138306.02425.21] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series review of patients with Parkinson's disease undergoing elective spine surgery at a single tertiary referral center. OBJECTIVES To assess the rate of complications of spine surgery in the population with Parkinson's disease and characterize the causes of failure and special needs of this unique population. SUMMARY OF BACKGROUND DATA Patients with Parkinson's disease experience a combination of poor bone quality and a severe neuromuscular disorder. There is little information in the literature about outcomes of spine surgery in this population. Preliminary review suggests that these patients have a high rate of instrument-related complications that has not been reported previously. METHODS A computerized search using diagnostic and procedural codes identified 14 patients with Parkinson's disease who underwent spine surgery from January 1993 through December 2000. Their charts and radiographs were reviewed, and those not examined within twelve months were invited for follow-up review. The remaining patients were being followed on a regular basis by their spine surgeon, the Movement Disorders Clinic, or both and were seen and examined during their routine follow-up observation. INDICATIONS AND EXTENT OF INDEX SURGERY VARIED: Complications, revisions, and radiographic evidence of loosening were assessed. Causes of failure were sought with respect to surgical and clinical factors. All patients underwent surgical care by a fellowship-trained spine surgeon. RESULTS The mean follow-up period from index procedure was 66.8 months; the median follow-up period was 38 months. Of 14 patients, 12 (86%) required additional surgery, undergoing a total of 31 reoperations. Eleven patients (79%) underwent 22 additional procedures at the same or adjacent level for instability, including four patients (29%) who had hardware failure or pullout, necessitating 10 reoperations. The one other patient who required additional surgery had a successful index procedure but underwent another operation to address instability at a remote spinal segment. Of five patients whose index procedure involved only one spinal level, three (60%) required additional procedures, all at that level. Two patients (14%) developed wound infections during the course of treatment but not as the cause of initial treatment failure. The primary mechanisms of failure were relentless kyphosis or segmental instability at the operated-on or adjacent levels. CONCLUSION Patients with Parkinson's disease undergoing spine surgery in a single tertiary referral center had a very high reoperation rate associated with technical complications. Patients should be appropriately counseled regarding the increased risk of operative complications and closely followed for incipient failure.
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Affiliation(s)
- L Brett Babat
- Premier Orthopaedics and Sports Medicine, Skyline Medical Center, Nashville, Tennessee, USA.
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Sato Y, Kaji M, Tsuru T, Oizumi K. Risk factors for hip fracture among elderly patients with Parkinson's disease. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0531-5131(03)00110-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Non-motor symptoms may considerably reduce parkinsonian quality of life, particularly in advanced stages of the disease. Autonomic features, such as seborrhoea, hyperhidrosis, orthostatic hypotension, excessive salivation, bladder dysfunction and GI disturbances, and neuropsychiatric symptoms, such as depression, sleep disorders, psychosis and dementia, appear in the course of Parkinson's disease. Pharmacotherapy of these non-motor symptoms complicates long-term antiparkinsonian combination drug therapy due to possible drug interactions, side effects and changes in metabolism. Moreover, antiparkinsonian compounds themselves contribute to the onset of these non-motor symptoms to a considerable extent. This complicates differentiation between the disease process itself and drug-related effects, thus influencing therapeutic options, which are often limited because of comorbidity and polypharmacy. Therefore, standardised recommendations are questionable, since drug tolerability and response differ between patients. Nevertheless, this review tries to provide a survey of possible therapeutic options for the treatment of the symptoms of Parkinson's disease other the dopamine-sensitive motor features.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.
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Sato Y, Kaji M, Tsuru T, Satoh K, Kondo I. Vitamin K deficiency and osteopenia in vitamin D-deficient elderly women with Parkinson's disease. Arch Phys Med Rehabil 2002; 83:86-91. [PMID: 11782837 DOI: 10.1053/apmr.2002.27376] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the influence of vitamin K on bone mineral density (BMD) in vitamin-D-deficient women with Parkinson's disease (PD). DESIGN Cross-sectional study. SETTING Neurology department at a university medical center in Japan. PARTICIPANTS Sixty-two women with PD (mean age, 70.7yr) and 62 age-matched controls. Patients were divided into 2 groups according to their functional capabilities: group A (independent: stages I-II of Hoehn and Yahr stages of Parkinson's disease, n = 26); and group B (dependent: Hoehn and Yahr stages 3-5; n = 36). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Sera were analyzed to relate vitamin K concentrations to bone-related biochemical indices. BMD was measured by computed radiograph densitometry. RESULTS Group B had significantly lower metacarpal BMD (P <.0001) lower serum concentrations of vitamin K1 (P <.01) and 25-hydroxyvitamin D (25-OHD; P <.0001) than group A. Serum undercarboxylated osteocalcin levels were higher in group B than in group A (P <.0001). The serum concentration of vitamin K1 correlated positively with that of 25-OHD (r =.735, P <.0001), and negatively with undercarboxylated osteocalcin (r = -.751, P <.0001) and Hoehn and Yahr stages (r =.787, P <.0001). Multiple regression analysis identified Hoehn and Yahr stages, vitamin K1, 25-OHD, and undercarboxylated osteocalcin as independent determinants of BMD (P <.0364.0003). CONCLUSION In functionally dependent women with PD, nutritional vitamin K1 deficiency is believed to reduce production of fully carboxylated osteocalcin, causing reduced BMD.
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Affiliation(s)
- Yoshihiro Sato
- Department of Neurology, Kurume University Medical Center, Kurume, Japan.
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Sato Y, Kaji M, Tsuru T, Oizumi K. Risk factors for hip fracture among elderly patients with Parkinson's disease. J Neurol Sci 2001; 182:89-93. [PMID: 11137512 DOI: 10.1016/s0022-510x(00)00458-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incidence of hip fracture among patients with Parkinson's disease (PD) is high, especially in elderly women. To determine effects of various factors on hip fracture risk, we prospectively studied fractures in a cohort of 115 elderly patients of both genders with PD (46 men, 69 women; mean age, 71.9 years) for 1 year. At baseline, we recorded body mass index (BMI), Hoehn and Yahr stage, and postmenopausal interval, and also measured bone mineral density (BMD) and serum concentrations of ionized calcium, intact parathyroid hormone (PTH), pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP; a bone resorption marker), and 25-hydroxyvitamin (25-OHD). During the year hip fractures occurred in 18 patients (2 male and 16 female). We compared baseline variables between patients with and without hip fracture. PD patients with decreased BMI, lower BMD, and low concentrations of serum ionized calcium, and 25-OHD (mean 4.0 ng/ml) with compensatory hyperparathyroidsim had increased risk of hip fracture. Female PD patients with long postmenopausal intervals also had increased hip fracture risk. BMI, illness duration, postmenopausal intervals, Hoehn and Yahr stage, 25-OHD, PTH, calcium, and ICTP were determinants of BMD in patients with fracture. Elderly PD patients with low BMI, low BMD, and serum 25-OHD concentrations < or =5 ng/ml with secondary hyperparathyroidism have increased risk of hip fracture, as do female PD patients with long postmenopausal intervals.
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Affiliation(s)
- Y Sato
- Department of Neurology, Kurume University Medical Center, 155-1 Kokubu-machi, 839-0863, Kurume, Japan.
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Abstract
OBJECTIVE To review how mineral stores and endocrine factors affect bone mass in poststroke patients immobilized by hemiparesis. DATA SOURCES Computer databases and published indexes. STUDY SELECTION Case-control studies of hemiparetic poststroke patients examined regarding bone metabolism. DATA EXTRACTION References were obtained from MEDLINE; all data concerning the objective were used. DATA SYNTHESIS Bone loss occurs in affected extremities after stroke. Immobilization from hemiplegia causes hypercalcemia. Insufficiency or deficiency of 25-hydroxyvitamin D (25-OHD) is very common in stroke patients and may be caused by poor dietary intake, decreased sunlight exposure, or both. Compensatory hyperparathyroidism may not occur because hypercalcemia inhibits the parathyroid glands even when 25-OHD is in the insufficient range. However, hyperparathyroidism does occur when 25-OHD is in the deficient range, in which case the parathyroid response to hypovitaminosis D overrides effects of hypercalcemia. Increased bone resorption was observed during the first year after stroke, declining to normal during the second year. During the first year, determinants of bone mineral density (BMD) in hands affected by hemiplegia were age, severity of hemiplegia, duration of paralysis, serum calcium concentration, and 25-OHD concentration. In the second year, BMD determinants on the hemiplegic side were severity of hemiplegia and 25-OHD concentration, whereas 25-OHD concentration was the only BMD determinant on the intact side. Administering 1alpha-hydroxyvitamin D3, vitamin K2, or ipriflavone ameliorated osteopenia on both sides and decreased the frequency of hip fracture on the hemiplegic side. CONCLUSIONS Bone remodeling and determinants of bone mass for the affected and unaffected sides after stroke differ between the first and subsequent years.
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Affiliation(s)
- Y Sato
- Department of Neurology, Kurume University Medical Center, Japan
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Sato Y, Manabe S, Kuno H, Oizumi K. Amelioration of osteopenia and hypovitaminosis D by 1alpha-hydroxyvitamin D3 in elderly patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 1999; 66:64-8. [PMID: 9886454 PMCID: PMC1736147 DOI: 10.1136/jnnp.66.1.64] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES A high prevalence of hip and other fractures in elderly patients with Parkinson's disease has been linked to reduced bone mass arising from a defect of renal synthesis of 1, 25-dihydroxyvitamin D (1, 25-[OH]2D). Treatment with 1alpha-hydroxyvitamin D3 (1alpha(OH)D3; an active form of vitamin D) was evaluated for maintaining bone mass and reducing the incidence of hip and other nonvertebral fractures in patients with Parkinson's disease. METHODS In a double blind, randomised trial, 86 elderly patients with Parkinson's disease (mean Hoehn and Yahr stage, 3; mean age 70.6 years) were randomised to receive either 1 microg 1alpha(OH)D3 daily (treatment group, n=43) or a placebo (n=43) for 18 months. Bone mineral densities in the second metacarpals were determined by computed radiographic densitometry. Serum bone turnover indices were measured serially, and incidence of nonvertebral fractures was recorded. RESULTS Bone mineral densities decreased 1.2% in the treatment group compared with 6.7% in the placebo group during 18 months (p<0.0001). At baseline in both groups, the serum concentration of 1, 25-[OH]2D was reduced. Parathyroid hormone was abnormally increased in 15 patients (17%) and correlated negatively with serum 25-hydroxyvitamin D, indicating compensatory hyperparathyroidism. Eight patients sustained fractures (six at the hip and two at other sites) in the placebo group, and one hip fracture occurred among treated patients (odds ratio 9.8; p=0.0028). CONCLUSION By increasing serum 1, 25-[OH]2D concentrations, treatment with 1alpha(OH)D3 can reduce the risk of hip and other non-vertebral fractures in osteoporotic elderly patients with Parkinson's disease by slowing the loss of bone mineral densities.
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Affiliation(s)
- Y Sato
- Department of Neurology, Futase Social Insurance Hospital, Iizuka, Japan.
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Revilla M, Jiménez-Jiménez F, Villa L, Hernández E, Ortı́-Pareja M, Gasalla T, Rico H. Body composition in Parkinson’s disease: a study with dual-energy X-ray absorptiometry. Parkinsonism Relat Disord 1998; 4:137-42. [DOI: 10.1016/s1353-8020(98)00033-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/1998] [Revised: 09/28/1998] [Accepted: 09/30/1998] [Indexed: 10/18/2022]
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Revilla M, de la Sierra G, Aguado F, Varela L, Jiménez-Jiménez FJ, Rico H. Bone mass in Parkinson's disease: a study with three methods. Calcif Tissue Int 1996; 58:311-5. [PMID: 8661963 DOI: 10.1007/bf02509377] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent reports suggest the presence of osteopenia in a high percentage of patients with Parkinson's disease (PD). These data contrast with previous reports of our group, perhaps due to the different methods used. We studied bone mass in 52 PD patients (28 males, 24 females) and in 80 age- and sex-matched controls (40 males, 40 females) who had no other disease that could affect bone mass. We measured the totally body bone mineral content (TBBMC) and the ultrasound bone velocity (UBV) of transmission in phalanx, and performed metacarpal radiogrammetry with computerized radiography (CCT). We also measured serum levels of total alkaline phosphatase and tartrate-resistant acid phosphatase, which were significantly increased in PD patients compared with controls (P < 0.0001). TBBMC was significantly lower in males (P < 0.05) and females (P < 0.05) with PD with respect to their controls. CCT did not differ significantly between the study groups. UBV was significantly lower in males with PD (P < 0.005), but similar in female PD and controls. These data suggest that the changes reported in bone mass in PD patients can depend on the sex and the study methods. We only found severe osteopenia in one male (3.6%) and five females (20.8%) with PD according to z-score. Only in women was no relationship found between TBBMC and severity of PD.
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Affiliation(s)
- M Revilla
- Department of Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, E-28801 Spain
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