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Lima DP, Chagas-Neto FAD, Gomes de Luna JR, Martins YDO, de Almeida SB, Feitosa CX, Gradvohl LB, Rosa ID, Lopes FKDM, Aragão LFF, Viana-Júnior AB, Augusto KL, Roriz-Filho JDS, d’Alva CB, Montenegro-Júnior RM, Braga-Neto P. Osteoporosis in Parkinson's disease and the role of lean body mass: a cross-sectional study in a Brazilian tertiary center. Front Endocrinol (Lausanne) 2024; 15:1326212. [PMID: 38711983 PMCID: PMC11070524 DOI: 10.3389/fendo.2024.1326212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures. Objective This study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD. Methods We performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person's 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations. Results We evaluated 107 patients in total, of whom 45 (42%) were women. The group's mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria. Conclusion Our findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD.
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Affiliation(s)
- Danielle Pessoa Lima
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Francisco Abaeté das Chagas-Neto
- Diagnostic Imaging Department, Division of Radioloy and Sports Medicine of Hospital Geral do Fortaleza, Fortaleza, Ceará, Brazil
- Diagnostic Imaging Department, TS Health Center, Fortaleza, Ceará, Brazil
| | - João Rafael Gomes de Luna
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Yasmin de Oliveira Martins
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Samuel Brito de Almeida
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Camila Ximenes Feitosa
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Leticia Brasil Gradvohl
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Isabele Dantas Rosa
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Fábia Karine de Moura Lopes
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Luciana Felipe Férrer Aragão
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
- Division of Endocrinology and Metabolism, Department of Clinical Medicine, Fortaleza, Ceará, Brazil
| | - Antonio Brazil Viana-Júnior
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Kristopherson Lustosa Augusto
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- Medical School of Faculty of Universidade Federal do Ceará, Department of Clinical Medicine, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Jarbas de Sá Roriz-Filho
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Catarina Brasil d’Alva
- Division of Endocrinology and Metabolism, Department of Clinical Medicine, Fortaleza, Ceará, Brazil
| | - Renan Magalhães Montenegro-Júnior
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
- Division of Endocrinology and Metabolism, Department of Clinical Medicine, Fortaleza, Ceará, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Clinical Medicine Department, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
- Health Sciences Center, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
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Liguori S, Moretti A, Paoletta M, Gargiulo F, Barra G, Gimigliano F, Iolascon G. Bone involvement in the early stages of Parkinson's disease: a case-control study. J Int Med Res 2024; 52:3000605241237880. [PMID: 38518193 PMCID: PMC10960339 DOI: 10.1177/03000605241237880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/21/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To evaluate the qualitative and quantitative alterations of bone tissue in patients with early-stage Parkinson's disease (PD) and to measure the associations between bone mineral density (BMD), trabecular bone score (TBS) and physical performance. METHODS This case-control study enrolled patients with early-stage PD and age-matched controls. BMDs for the left femoral neck (L-FN) and lumbar spine (LS) were measured. Bone microarchitecture for the LS was determined using TBS. Muscle performance was assessed using the short physical performance battery (SPPB). Patients and controls were stratified in two groups based on the SPPB score: a poor performance group (SPPB score ≤8) and high performance group (SPPB > 8). RESULTS This study included 26 patients: 13 in the PD group and 13 age-matched controls. The mean ± SD BMD results in the PD group were: L1-L4 BMD = 0.935 ± 0.183 g/cm2; L-FN BMD = 0.825 ± 0.037 g/cm2; with bone microarchitecture degraded in four patients and partially degraded in three patients. TBS was significantly different in the patients with PD stratified according to SPPB. Among the controls, there was a significant difference in body mass index between the two SPPB groups. CONCLUSION TBS might identify bone involvement earlier than BMD in the initial stages of PD.
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Affiliation(s)
- Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Fiorinda Gargiulo
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giuseppe Barra
- Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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Daghi M, Lakhdar A, Otmani HE. Parkinson's disease research in Morocco: a review. Neurodegener Dis Manag 2023; 13:129-139. [PMID: 36803100 DOI: 10.2217/nmt-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Aim: To quantify and provide an overview on the scientific productivity made by Moroccan academics in the research on Parkinson's disease (PD) and parkinsonism. Materials & methods: Scientific articles, in either English or French, were gathered from published literature in three recognized databases: PubMed, ScienceDirect and Scopus. Results: We identified 95 published papers from which 39 articles have been extracted after removing inadequate publications and duplications between databases. All articles were published between 2006 and 2021. The selected articles were subdivided into five categories. Conclusion: The Moroccan academia is presently facing a low productivity issues and a lack of research laboratories focusing on PD research. We anticipate that providing more budgetary funds will significantly improve the productivity of PD research.
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Affiliation(s)
- Mohamed Daghi
- Research Laboratory of Nervous System Diseases, Neurosensory Disorders & Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, 20250, Morocco
| | - Abdelhakim Lakhdar
- Research Laboratory of Nervous System Diseases, Neurosensory Disorders & Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, 20250, Morocco.,Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca, 20360, Morocco
| | - Hicham El Otmani
- Laboratory of Medical Genetics & Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, 20250, Morocco.,Department of Neurology, Ibn Rochd University Hospital, Casablanca, 20360, Morocco
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Koo HY, Cho EB, Kong SH, Han K, Lee KN, Yoo JE, Min JH, Chun S, Shin DW. Fracture risk in Parkinson's disease according to its severity and duration. Osteoporos Int 2023; 34:81-89. [PMID: 36205727 DOI: 10.1007/s00198-022-06562-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/21/2022] [Indexed: 01/07/2023]
Abstract
UNLABELLED Fracture risk was elevated in Parkinson's disease (PD) patients compared with controls in this nationwide study. Among PD patients, the risk of fracture increased linearly with PD severity, whereas no difference in fracture risk was observed according to PD duration. INTRODUCTION Parkinson's disease (PD) is reported to be associated with a high risk of fractures. Several studies found an association between severity and duration of PD and falls or bone mineral density, but those factors have not been considered in most previous research. The aim of this study was to determine the fracture risk in PD patients according to their disease severity and duration. METHODS This population-based, retrospective cohort study used data from the Korean National Health Insurance Service database. The study population included 10,333 patients with prevalent PD and 6,501,464 comparison cohort. Fracture risks according to the prevalence, severity, and duration of PD were evaluated using Cox proportional hazard methods. RESULTS Fracture risk was elevated in PD patients at all sites compared with controls (adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.44-1.56 for any fracture). When comparing fracture sites, hip fractures showed the largest risk increase in PD patients (aHR 2.16, 95% CI 1.95-2.38). Among PD patients, the risk of any fracture increased linearly with PD severity and was highest in patients with severe disease (aHR 1.65, 95% CI 1.53-1.79 compared with controls). Meanwhile, no significant association was observed between PD duration and fracture risk. CONCLUSIONS The prevalence of PD was related to an increased risk of fractures in this nationwide study, and PD severity was linearly associated with fracture risk. PD prevalence and severity should be considered when evaluating the risk factors of fracture in clinical practice.
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Affiliation(s)
- Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Bin Cho
- Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyu Na Lee
- Department of Biomedicine and Health Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Sohyun Chun
- International Health Center, Samsung Medical Center, 81 Irwon-Ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Clinical Research Design and Evaluation/Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Center for Wireless and Population Health Systems, University of California, La Jolla, San Diego, CA, USA.
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Channer B, Matt SM, Nickoloff-Bybel EA, Pappa V, Agarwal Y, Wickman J, Gaskill PJ. Dopamine, Immunity, and Disease. Pharmacol Rev 2023; 75:62-158. [PMID: 36757901 PMCID: PMC9832385 DOI: 10.1124/pharmrev.122.000618] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022] Open
Abstract
The neurotransmitter dopamine is a key factor in central nervous system (CNS) function, regulating many processes including reward, movement, and cognition. Dopamine also regulates critical functions in peripheral organs, such as blood pressure, renal activity, and intestinal motility. Beyond these functions, a growing body of evidence indicates that dopamine is an important immunoregulatory factor. Most types of immune cells express dopamine receptors and other dopaminergic proteins, and many immune cells take up, produce, store, and/or release dopamine, suggesting that dopaminergic immunomodulation is important for immune function. Targeting these pathways could be a promising avenue for the treatment of inflammation and disease, but despite increasing research in this area, data on the specific effects of dopamine on many immune cells and disease processes remain inconsistent and poorly understood. Therefore, this review integrates the current knowledge of the role of dopamine in immune cell function and inflammatory signaling across systems. We also discuss the current understanding of dopaminergic regulation of immune signaling in the CNS and peripheral tissues, highlighting the role of dopaminergic immunomodulation in diseases such as Parkinson's disease, several neuropsychiatric conditions, neurologic human immunodeficiency virus, inflammatory bowel disease, rheumatoid arthritis, and others. Careful consideration is given to the influence of experimental design on results, and we note a number of areas in need of further research. Overall, this review integrates our knowledge of dopaminergic immunology at the cellular, tissue, and disease level and prompts the development of therapeutics and strategies targeted toward ameliorating disease through dopaminergic regulation of immunity. SIGNIFICANCE STATEMENT: Canonically, dopamine is recognized as a neurotransmitter involved in the regulation of movement, cognition, and reward. However, dopamine also acts as an immune modulator in the central nervous system and periphery. This review comprehensively assesses the current knowledge of dopaminergic immunomodulation and the role of dopamine in disease pathogenesis at the cellular and tissue level. This will provide broad access to this information across fields, identify areas in need of further investigation, and drive the development of dopaminergic therapeutic strategies.
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Affiliation(s)
- Breana Channer
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
| | - Stephanie M Matt
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
| | - Emily A Nickoloff-Bybel
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
| | - Vasiliki Pappa
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
| | - Yash Agarwal
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
| | - Jason Wickman
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
| | - Peter J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania (B.C., S.M.M., E.A.N-B., Y.A., J.W., P.J.G.); and The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania (V.P.)
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Behl T, Arora A, Singla RK, Sehgal A, Makeen HA, Albratty M, Meraya AM, Najmi A, Bungau SG. Understanding the role of "sunshine vitamin D " in Parkinson's disease: A review. Front Pharmacol 2022; 13:993033. [PMID: 36601055 PMCID: PMC9807223 DOI: 10.3389/fphar.2022.993033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Next to Alzheimer's disease, Parkinson's disease constitutes the second most widespread neurological disorder, primarily affecting the older population. Its symptoms are noticeable with advancing age including tremors, postural imbalance, and slow movements, and over time, these symptoms get aggravated, progressing to osteoporosis, osteopenia, and risk of fractures. These symptoms correlate to low bone density and hence weakened bones; thus, vitamin D proves to be an intricate component of the pathogenesis of the disease. Moreover, lower serum concentrations of vitamin D have been found in diseased subjects. Supplementation with vitamin D can retard the aggravation of non-motor as well as motor symptoms of Parkinson's disease that include cognitive improvement along with the decline in risk of fractures. Also, vitamin D is extremely crucial for brain functioning, targeting dopaminergic neurons, and almost the entire functioning of the brain is affected. However, further exploration is required to determine the toxic dose of vitamin D in Parkinson's subjects. This "sunshine vitamin" surely can be a ray of sunshine for neurologically diseased subjects.
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Affiliation(s)
- Tapan Behl
- School of Health Science and Technology, University of Petroleum and Energy Studies, Bidholi, Uttarakhand, India,*Correspondence: Tapan Behl, ; Rajeev K. Singla, , ; Simona Gabriela Bungau,
| | - Arpita Arora
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China,School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India,*Correspondence: Tapan Behl, ; Rajeev K. Singla, , ; Simona Gabriela Bungau,
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India
| | - Hafiz A. Makeen
- Pharmacy Practice Research Unit, Clinical Pharmacy Department, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Albratty
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Abdulkarim M. Meraya
- Pharmacy Practice Research Unit, Clinical Pharmacy Department, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Asim Najmi
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Simona Gabriela Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania,Doctoral School of Biomedical Sciences, University of Oradea, Oradea, Romania,*Correspondence: Tapan Behl, ; Rajeev K. Singla, , ; Simona Gabriela Bungau,
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The Dashboard Vitals of Parkinson's: Not to Be Missed Yet an Unmet Need. J Pers Med 2022; 12:jpm12121994. [PMID: 36556215 PMCID: PMC9780936 DOI: 10.3390/jpm12121994] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
The vitals of Parkinson's disease (PD) address the often-ignored symptoms, which are considered either peripheral to the central core of motor symptoms of PD or secondary symptoms, which, nevertheless, have a key role in the quality of life (QoL) and wellness of people with Parkinson's (PwP) [...].
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Jeong SH, Hong N, Lee HS, Han S, Lee YG, Lee Y, Rhee Y, Sohn YH, Lee PH. Low skull bone density is associated with poor motor prognosis in women with Parkinson’s disease. Front Aging Neurosci 2022; 14:1053786. [DOI: 10.3389/fnagi.2022.1053786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Parkinson’s disease (PD) and osteoporosis are degenerative diseases that have shared pathomechanisms. To investigate the associations of skull bone density with nigrostriatal dopaminergic degeneration and longitudinal motor prognosis in female patients with PD. We analyzed the data of 260 drug-naïve female PD patients aged ≥50 years old who were followed-up for ≥3 years after their first visit to the clinic with baseline dopamine transporter (DAT) imaging. We measured skull bone density as a surrogate marker for systemic bone loss by calculating the Hounsfield unit (HU) in computed tomography scans. A Cox proportional hazard model was built to compare the rates of levodopa-induced dyskinesia (LID) or wearing-off according to skull HU. Longitudinal changes in levodopa-equivalent dose (LED) during a 3-year follow-up were assessed using a linear mixed model. A lower skull HU was associated with lower baseline DAT availability in striatal subregions; however, this relationship was not significant after adjusting for age, disease duration, body mass index, and white matter hyperintensities. After adjusting for confounding factors, a lower skull HU was significantly associated with an increased risk of LID development (hazard ratio = 1.660 per 1 standard deviation decrease, p = 0.007) and wearing-off (hazard ratio = 1.613, p = 0.016) in younger (<67 years) but not in older patients. Furthermore, a lower skull HU was associated with a steeper increase in LED during follow-up in younger patients only (β = –21.99, p < 0.001). This study suggests that baseline skull bone density would be closely linked to motor prognosis in drug naïve women with PD.
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Nam JS, Kim YW, Shin J, Chang JS, Yoon SY. Hip Fracture in Patients with Parkinson's Disease and Related Mortality: A Population-Based Study in Korea. Gerontology 2021; 67:544-553. [PMID: 33735882 DOI: 10.1159/000513730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) are prone to falls, thereby increasing the risk of fractures and mortality. This population-based study investigated the risk of hip fractures and their effect on mortality in patients with PD in Korea. METHODS National Health Insurance Service-National Sample Cohort data were used. Patients newly diagnosed with PD between 2006 and 2015 and age- and sex-matched individuals were classified into the PD group and the comparison group, respectively, with a 1:9 ratio. The Cox proportional hazards model was used to calculate hazard ratios (HRs), and the Kaplan-Meier method to identify survivorship. RESULTS In total, 26,570 individuals were enrolled in the study: 2,657 in the PD cohort and 23,913 in the matched comparison cohort. The PD group had about a 2 times higher risk of hip fracture than the comparison group (3.95 vs. 1.94%, p < 0.001). According to sex, the difference between the PD and comparison groups for the risk of hip fracture was greater in males than in females. The highest difference in HR for hip fracture between the PD and comparison groups was found in individuals aged between 60 and 69 years. Regarding post-fracture mortality in patients with PD, the mortality risk was twice as high in the patients with hip fracture than in those without. The effect of hip fracture on mortality between these 2 groups was also the highest in individuals aged between 60 and 69 years. CONCLUSION The PD group showed an approximately 2 times higher risk of hip fracture compared with the comparison group, and the post-fracture mortality rate was 2 times higher in the patients with PD with hip fracture than in those without. Those aged 60-69 years were associated with the highest risk of hip fracture and post-hip fracture mortality among patients with PD.
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Affiliation(s)
- Je Shik Nam
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea,
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Özcan H, Acaröz Candan S, Gül T. Bone Mineral Density Loss in Parkinson's Disease: Impact of Clinical Subtypes. Exp Aging Res 2021; 47:373-385. [PMID: 33719928 DOI: 10.1080/0361073x.2021.1895593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: This study aimed to compare the BMD status among the clinical subtypes of PD and healthy controls.Methods: Sixty patients with PD and 30 healthy age- and sex-matched controls were included in this study. The patients were divided into postural instability gait difficulty-dominant type (PIGDDT) group and tremor-dominant type (TDT) group based on the Unified Parkinson's Disease Rating Scale (UPDRS) score. BMD was measured using dual-energy X-ray absorptiometry scans in femoral and lumbar regions.Results: The T-scores in femoral and lumbar regions were similar in all groups. The prevalence of osteopenia was higher than the prevalence of osteoporosis in all three groups for femoral regions. The prevalence of osteoporosis in the intertrochanteric region and total femur in the PIGDDT group was higher than in the TDT group and controls. Our data showed a trend toward higher prevalence of osteoporosis in the PIGDDT group.Conclusion: The prevalence of osteopenia and osteoporosis may differ between clinical subtypes of PD and healthy controls. Osteopenia is more common than osteoporosis for all groups. The patients with PIGDDT of PD tended to have higher prevalence of osteoporosis, even at early stages of disease, compared to those with TDT and healthy controls.
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Affiliation(s)
- Hakan Özcan
- Faculty of Medicine, Orthopedics and Traumatology, Ordu University, Ordu, Turkey
| | - Sevim Acaröz Candan
- Faculty of Health Sciences, Physiotherapy and Rehabilitation, Ordu University, Ordu, Turkey
| | - Tuba Gül
- Faculty of Medicine, Neurology, Ordu University, Ordu, Turkey
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Liu B, Chen G, Yu Z, Ji C, Liang T, He J, Dai W, Shao Y, Jiang H, Zhang W, Yang H, Luo Z. Bone Mineral Density and Related Scores in Parkinson's Disease: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 146:e1202-e1218. [PMID: 33271382 DOI: 10.1016/j.wneu.2020.11.132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common degenerative neurologic disorder in older adults, and increasing attention has been paid to bone health in PD. Although several studies have shown that patients with PD have a lower bone mineral density (BMD) than do non-PD controls, there have been no systematic reviews in recent years. METHODS PubMed, Medline, and Web of Science were used to search relevant studies up to May 2020. BMD, BMD T score, and BMD Z score of patients with and without PD were statistically analyzed. Meta-analysis was conducted using Review Manager version 5.3. RESULTS This meta-analysis included 17 studies comprising 10,289 individuals. In the meta-analysis, adults with PD had lower total body, total hip, total radius, lumbar spine, total femur, femur neck, right-hand, and left-hand BMD than did non-PD controls. The T score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, total femur BMD, and femur neck BMD in adults with PD were lower than those in non-PD controls. Futhermore, the Z score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, and femur neck BMD was lower in adults with PD than in non-PD controls. CONCLUSIONS Patients with PD had a lower BMD, BMD T score, and BMD Z score compared with non-PD controls. Therefore, clinicians should routinely monitor BMD of patients with PD to prevent falling and fragility fractures in older adults and optimize BMD before surgical treatment of severe spinal deformity caused by PD.
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Affiliation(s)
- Bo Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Guangdong Chen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhaohui Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Chenchen Ji
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Ting Liang
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Jiaheng He
- The Fifth Department of Orthopedics, The 903th Hospital of People's Liberation Army, Hangzhou, Zhejiang, China
| | - Wangying Dai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Yijie Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huaye Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wen Zhang
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Zongping Luo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China.
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Kelly RR, Sidles SJ, LaRue AC. Effects of Neurological Disorders on Bone Health. Front Psychol 2020; 11:612366. [PMID: 33424724 PMCID: PMC7793932 DOI: 10.3389/fpsyg.2020.612366] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment.
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Affiliation(s)
- Ryan R. Kelly
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Sara J. Sidles
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda C. LaRue
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
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Schootemeijer S, van der Kolk NM, Bloem BR, de Vries NM. Current Perspectives on Aerobic Exercise in People with Parkinson's Disease. Neurotherapeutics 2020; 17:1418-1433. [PMID: 32808252 PMCID: PMC7851311 DOI: 10.1007/s13311-020-00904-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurological disorder characterized by motor and non-motor symptoms for which only symptomatic treatments exist. Exercise is a widely studied complementary treatment option. Aerobic exercise, defined as continuous movement of the body's large muscles in a rhythmic manner for a sustained period that increases caloric requirements and aims at maintaining or improving physical fitness, appears promising. We performed both a scoping review and a systematic review on the generic and disease-specific health benefits of aerobic exercise for people with PD. We support this by a meta-analysis on the effects on physical fitness (VO2max), motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor section), and health-related quality of life (39-item Parkinson's disease Questionnaire (PDQ-39)). Aerobic exercise has generic health benefits for people with PD, including a reduced incidence of cardiovascular disease, a lower mortality, and an improved bone health. Additionally, there is level 1 evidence that aerobic exercise improves physical fitness (VO2max) and attenuates motor symptoms (MDS-UPDRS motor section) in the off-medication state, although the long-term effects (beyond 6 months) remain unclear. Dosing the exercise matters: improvements appear to be greater after training at higher intensities compared with moderate intensities. We found insufficient evidence for a beneficial effect of aerobic exercise on health-related quality of life (PDQ-39) and conflicting results regarding non-motor symptoms. Compliance to exercise regimes is challenging for PD patients but may be improved by adding exergaming elements to the training program. Aerobic exercise seems a safe intervention for people with PD, although care must be taken to avoid falls in at-risk individuals. Further studies are needed to establish the long term of aerobic exercise, including a focus on non-motor symptoms and health-related quality of life.
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Affiliation(s)
- Sabine Schootemeijer
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Nicolien M van der Kolk
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Nienke M de Vries
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands
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Lv L, Tan X, Peng X, Bai R, Xiao Q, Zou T, Tan J, Zhang H, Wang C. The relationships of vitamin D, vitamin D receptor gene polymorphisms, and vitamin D supplementation with Parkinson's disease. Transl Neurodegener 2020; 9:34. [PMID: 32867847 PMCID: PMC7460797 DOI: 10.1186/s40035-020-00213-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
In recent years, many studies have investigated the correlations between Parkinson's disease (PD) and vitamin D status, but the conclusion remains elusive. The present review focuses on the associations between PD and serum vitamin D levels by reviewing studies on the associations of PD with serum vitamin D levels and vitamin D receptor (VDR) gene polymorphisms from PubMed, Web of Science, Cochrane Library, and Embase databases. We found that PD patients have lower vitamin D levels than healthy controls and that the vitamin D concentrations are negatively correlated with PD risk and severity. Furthermore, higher vitamin D concentrations are linked to better cognitive function and mood in PD patients. Findings on the relationship between VDR gene polymorphisms and the risk of PD are inconsistent, but the FokI (C/T) polymorphism is significantly linked with PD. The occurrence of FokI (C/T) gene polymorphism may influence the risk, severity, and cognitive ability of PD patients, while also possibly influencing the effect of Vitamin D3 supplementation in PD patients. In view of the neuroprotective effects of vitamin D and the close association between vitamin D and dopaminergic neurotransmission, interventional prospective studies on vitamin D supplementation in PD patients should be conducted in the future.
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Affiliation(s)
- Lingling Lv
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xuling Tan
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xinke Peng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Rongrong Bai
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Qile Xiao
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ting Zou
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Jieqiong Tan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, 410078, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, 410078, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, 410078, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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Parkinson's disease and the non-motor symptoms: hyposmia, weight loss, osteosarcopenia. Aging Clin Exp Res 2020; 32:1211-1218. [PMID: 31989535 DOI: 10.1007/s40520-020-01470-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022]
Abstract
Non-motor symptoms (NMSs) are common in Parkinson's disease (PD) and can precede, sometimes for several years. NMSs include, other than gastrointestinal symptoms like constipation and dysphagia, also hyposmia, weight loss and osteosarcopenia. These three NMSs seem to be inter-related and affect patients' health and quality of life. Unfortunately, patients with these symptoms usually are not initially seen by a neurologist, and by the time they are consulted, nearly ~ 80% of the dopaminergic neurons in the substantia nigra have died. To date, no guidelines exist for screening, assessment and management of NMSs in general. A better understanding of these specific NMSs, likely in the context of others, will make it possible to approach and optimise the treatment of the motor symptoms thereby enhancing the welfare of PD patients. Identifying the NMSs could be very helpful, and among them, hyposmia, weight loss and osteosarcopenia may play an important role in solving the limitations in the diagnosis of PD. A strict collaboration between general practitioners, clinicians, geriatricians and neurologists can be one approach towards the diagnosis of pre-PD. Waiting until the motor symptoms develop and the patient is finally visited by the neurologist could be too late, considering the catastrophic prognosis of the disease.
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16
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Sin MK, Khemani P. Pain and Musculoskeletal Disorders: Common Nuisances in Parkinson Disease. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chou TFA, Chang CY, Huang CC, Chang MC, Chen WM, Huang TF. The outcome for surgical fixation of distal radial fractures in patients with idiopathic Parkinson's disease: a cohort study. J Orthop Surg Res 2020; 15:125. [PMID: 32238187 PMCID: PMC7110736 DOI: 10.1186/s13018-020-01642-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Idiopathic Parkinson’s disease (PD) is a progressive neurologic disorder causing postural instability and unsteady gait. These patients are at increased risk for fractures and have inferior outcomes after treatment. Several studies have evaluated the incidence and outcome of PD patients after hip fractures. However, there are limited studies assessing the outcome of upper extremity fractures in these patients. In this study, we evaluated the outcome of PD patients that received surgical intervention for distal radial fractures (DRF). We hypothesize that these patients have an inferior outcome after surgery in comparison with non-PD patients. Methods Between May 2005 and May 2017, we retrospectively reviewed all of the patients with DRF and subsequently underwent open reduction and internal fixation (ORIF) at a level 1 trauma center. All of the surgeries were performed by fellowship-trained orthopedic surgeons. The inclusion criteria include patients with a definitive diagnosis of PD, non-pathological DRF, and a minimum follow-up of 1 year or up until the time of treatment failure was noted. Each PD patient was matched for age and gender to 3 non-PD patients. The primary objective was to determine the failure rate after surgical fixation for DRF. The secondary outcomes include time to treatment failure, reoperation rate, readmission rate, length of hospital stay, and postoperative complications. Results A total of 88 patients were included in this study (23 PD, 65 non-PD patients). All underwent ORIF and received standard postoperative follow-ups. The overall treatment failure rate in PD was 39.1% vs. 4.6% in the non-PD group (p < 0.05). The time to treatment failure were 9.11 ± 3.86 weeks and 14.67 ± 5.8 weeks for PD and non-PD, respectively (p < 0.05). PD patients had a significantly higher rate of failure when k-wires and ESF were used (p < 0.05%), while loss of reduction was the most common mode of failure in PD (44.4%). The length of hospital stay for PD was 5.3 ± 4.69 days compared with 3.78 ± 0.96 days for non-PD (p = 0.01). There were 3 PD patients readmitted within 30 days after surgery, and 1 patient had pneumonia after the surgery. Conclusion This study revealed that patients with PD have a high treatment failure rate despite surgical intervention for DRF. PD patients had a longer hospital stay and had a shorter time to treatment failure. In treating PD patients complicated with DRF, the surgeon must take into consideration the complex disease course of PD and the associated comorbidities such as osteoporosis, frail status, and frequent falls. Rehabilitation and disposition plans should be discussed in advance and longer hospital stays should be expected. Level of evidenceLevel IV, retrospective cohort study
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Affiliation(s)
- Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, No. 201, Sec. 2, Shi-pai Road, Beitou District, Taipei City, 11217, Taiwan, ROC
| | - Chun Yao Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China
| | - Chun-Ching Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China.,Department of Exercise and Health, National Taipei University of Nursing and Health Science, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, No. 201, Sec. 2, Shi-pai Road, Beitou District, Taipei City, 11217, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, No. 201, Sec. 2, Shi-pai Road, Beitou District, Taipei City, 11217, Taiwan, ROC
| | - Tung-Fu Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China. .,Department of Orthopaedics, School of Medicine, National Yang-Ming University, No. 201, Sec. 2, Shi-pai Road, Beitou District, Taipei City, 11217, Taiwan, ROC. .,Department of Exercise and Health, National Taipei University of Nursing and Health Science, No. 201, Sec. 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China.
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Ozturk E, Gundogdu I, Tonuk B, Umay E, Kocer B, Cakci A. Bone mineral density and serum vitamin D status in Parkinson's disease: Are the stage and clinical features of the disease important? Neurol India 2020; 68:394-400. [DOI: 10.4103/0028-3886.283755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sheu H, Liao JC, Lin YC. The fate of thoracolumbar surgeries in patients with Parkinson's disease, and analysis of risk factors for revision surgeries. BMC Musculoskelet Disord 2019; 20:106. [PMID: 30871524 PMCID: PMC6417282 DOI: 10.1186/s12891-019-2481-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background Compared to patients without Parkinson’s disease (PD), patients with PD who underwent spinal surgeries were reported to have a relatively high complication rate. However, studies that analyze surgical risk factors for these patients are limited. Methods From October 2004 to April 2015, patients with PD who underwent spinal surgeries at our department were reviewed. Patients who underwent lumbar or thoracolumbar instrumented surgeries due to degeneration or deformity disease were included. Any reason for revision surgery was recorded. Risk factors including patients’ factors, surgical factors, and lumbo-pelvic radiographic parameters were analyzed. Patients’ factors included patients’ underlying diseases, body mass index (BMI), osteoporotic status, and PD’s severity using the modified Hoehn and Yahr staging scale. Surgical factors included surgical levels, extending to thoracic spine or not, corrective osteotomy, with anterior approach or not, and interbody device. Radiographic parameters included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), coronal Cobb’s angles, and score for spino-pelvic realignment achievement. Results A total of 66 patients were enrolled. The mean age at surgery was 69.0 years old. The mean follow-up time was 51.2 months. Twenty-six revision surgeries were required in 19 patients (29%). Risk factors for revision surgery included modified Hoehn and Yahr stage ≥3 (p < 0.001), cancer history (p = 0.024), osteoporosis (P = 0.012) and underwent corrective osteotomy (p = 0.035). According to binary logistic regression analysis, the modified Hoehn and Yahr stage ≥3 (p < 0.001) was the only independent risk factor. The Kaplan-Meier analysis revealed patients with long instrumentation (surgical levels > 3), T-spine instrumentation, and lower score of spino-pelvic realignment achievement tended to have earlier revision. Conclusion For PD patients planning for elective thoracolumbar surgery, aggressive control status of PD before or after surgery is necessary to prevent surgical complications. Longer surgical levels and corrective osteotomy also tended to have earlier revision. A better score in spino-pelvic realignment achievement after surgery could reduce occurrence of revision.
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Affiliation(s)
- Huan Sheu
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No._5, Fu-Shin Street, Kweishian, Taoyuan, 333, Taiwan
| | - Jen-Chung Liao
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No._5, Fu-Shin Street, Kweishian, Taoyuan, 333, Taiwan.
| | - Yu-Chih Lin
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No._5, Fu-Shin Street, Kweishian, Taoyuan, 333, Taiwan
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Ali SJ, Ellur G, Khan MT, Sharan K. Bone loss in MPTP mouse model of Parkinson's disease is triggered by decreased osteoblastogenesis and increased osteoclastogenesis. Toxicol Appl Pharmacol 2018; 363:154-163. [PMID: 30529163 DOI: 10.1016/j.taap.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/16/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022]
Abstract
Bone loss is a non-motor symptom of Parkinson's disease (PD). It is unclear whether a patient's immobility or the endocrine changes in the body causes bone deterioration. To address this issue, we used an animal model of the disease where Swiss albino mice were injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) on day 1 and were left untreated for eight weeks. Behavioral phenotypes of PD, and striatal acetylcholinesterase and dopamine levels were measured. Cortical and trabecular bones were assessed by μ-CT and histology. Gene expression studies were done through quantitative real-time PCR. Effect of MPP+ and MPTP-treated mice serum on MC3T3E-1, SH-SY5Y, and primary osteoclast cells were also studied. Our results demonstrated that MPTP treatment leads to PD like symptoms. It shows a loss of trabecular bone mass and quality by decreasing osteoblast and increased osteoclast number and activity. This effect was accompanied by reduced osteogenic and elevated osteoclastogenic genes expression. While MPP+ had a cytotoxic effect on dopaminergic neurons, it did not affect bone cells. However, ex-vivo treatment of the serum from MPTP-treated mice decreased osteoblastogenesis and increased osteoclastogenesis in cell culture. In conclusion, our study suggests that MPTP-induced parkinsonian features in mice leads to trabecular bone loss by decreased bone formation and increased bone resorption due to changes in the serum circulating factors. This study characterizes the microarchitectural and cellular changes in the skeleton of a mouse model of PD that can be further utilized to investigate therapeutic avenues to treat bone loss in PD patients.
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Affiliation(s)
- Shaheen Jafri Ali
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysuru, India
| | - Govindraj Ellur
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysuru, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Md Touseef Khan
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysuru, India
| | - Kunal Sharan
- Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysuru, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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Coomber R, Alshameeri Z, Masia AF, Mela F, Parker MJ. Hip fractures and Parkinson's disease: A case series. Injury 2017; 48:2730-2735. [PMID: 28985911 DOI: 10.1016/j.injury.2017.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/20/2017] [Indexed: 02/02/2023]
Abstract
There are no specific guidelines for treating Parkinson's disease patients who present with a hip fracture. Here we present a large cohort of patients with Parkinson's disease who suffered hip fractures. Our aim was to assess for differences between a Parkinson's disease population and a non-Parkinson's disease population with hip fractures and make recommendations on management guidelines. We performed a comprehensive analysis of prospectively collected data on all patients with hip fracture who were admitted into our department over a period of 29 years. In total 9225 patients with hip fractures were included in this study, 452 (4.9%) patients had Parkinson's disease. The mobility scores were worse pre- and post-operatively in the Parkinson's group as were mini-mental scores and ASA grade. Post-operative complications were similar between the two groups, with no difference in dislocation rate or wound complications. However, other outcomes including mobility and mortality rate at 1year were worse in the Parkinson's group. These patients also had a longer hospital stay and were more likely to be immobile and discharged to an institution. We recommend that Parkinson's disease patients should be assessed more thoroughly in the peri-operative period and arrangement for rehab and discharge planning should commence as soon as possible following admission. The consent process should reflect longer hospital stays, worse mobility, higher mortality and increased likelihood of discharge to institution but concern over increased complications, specifically dislocation was not evident in our data.
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Affiliation(s)
- Ross Coomber
- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ UK.
| | - Zeiad Alshameeri
- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ UK.
| | - Antonio Francesco Masia
- Department of Surgical, Microsurgical and Medical Sciences, Institute of Orthopaedic Clinic, Univeristy of Sassari, Sassari, Italy.
| | - Federico Mela
- Department of Surgical, Microsurgical and Medical Sciences, Institute of Orthopaedic Clinic, Univeristy of Sassari, Sassari, Italy.
| | - Martyn J Parker
- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ UK.
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Metta V, Sanchez TC, Padmakumar C. Osteoporosis: A Hidden Nonmotor Face of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:877-890. [PMID: 28805587 DOI: 10.1016/bs.irn.2017.05.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoporosis is a "hidden nonmotor face" of Parkinson's disease and a cause of considerable morbidity in the older general population and in Parkinson's disease patients. Some regard this as a "hidden epidemic." Women are overrepresented and have considerable problems related to osteoporosis. In general osteoporosis leads to reduced mobility aggravating the motor syndrome of PD. The nonmotor aspects and impact of osteoporosis in PD have remained unexplored. Possible nonmotor consequences include a range of pain syndromes related to local pain, fractures, falls, and injuries as well as pathological fractures and radiculopathy. In addition depression, sleep dysfunction, dementia, as well as fear of falling also complicate the clinical picture. Quality of life deteriorates both for the patient and career. Pathways of care do not always include assessments for osteoporosis and needs to become obligatory particularly in older female PD patients. Active management strategies then need to be undertaken for osteoporosis in PD. Related motor and nonmotor consequences also highlight the importance of multidisciplinary treatment in PD particularly when dealing with osteoporosis.
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Affiliation(s)
- Vinod Metta
- Imperial College Hospitals NHS, London, United Kingdom; University College London, London, United Kingdom.
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Aithal S, Sequeira R, Edwards C, Singh I. Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes. Geriatrics (Basel) 2017; 2:geriatrics2020017. [PMID: 31011027 PMCID: PMC6371118 DOI: 10.3390/geriatrics2020017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 11/16/2022] Open
Abstract
Background: The risk of falls is higher in patients with Parkinsonism (PwP) as compared to other older adults, leading to adverse outcomes including fragility fractures. Osteoporosis is under-recognised and the current prevalence of fragility fractures is not well-studied. The objectives of this study are to determine the prevalence of fragility fractures in PwP, to measure the relationship of fractures with demography, severity and to measure predictors of adverse outcomes in this population. Method/Description: This was a retrospective observational cohort study based on the analysis of existing data for all the patients attending Caerphilly Movement Disorder Clinic. Information on demographics, the severity of Parkinsonism and fragility fractures was extracted electronically from the clinical workstation, clinic letters and coding from January 2015 to October 2016. Results: 397 people (mean age = 77.1 ± 9.4, 46% females) were studied. Of these, 77% (306/397) had Parkinsonism and 80% (244/306) had idiopathic Parkinson’s disease (PD). The mean Hoehn & Yahr Score at the time assessment was 3.09 ± 1.16. Additionally, 23.5% (72/306) were deemed to have osteoporosis based on the radiological evidence of fragility fractures. The PwP who sustained fractures were comparatively older (80.4 ± 12.1) and 70% (50/72) were females. The most common site for fractures was vertebral (47.2%; 34/72). Also, 22.2% of the sample (16/72) had suffered a fragility fracture before the diagnosis of PD. However, a majority (77.8%; 56/72) had sustained a fracture during the course of PD with a mean lapse of 6 years (range = 0–13 years) from initial diagnosis. Only 40% (29/72) of patients were prescribed osteoporosis drugs as per guidelines. There is a significant correlation of advancing age, severity and duration of PD with fragility fractures. The single best predictor of mortality is severity of PD, followed by age and fractures. Conclusions: There is a high prevalence of fragility fractures in patients attending movement disorder clinics, although 60% do not receive evidence-based medical treatment for the underlying osteoporosis. The prevalence of fragility fractures is positively correlated with the duration and severity of PD. We acknowledge the relatively small sample size as the study’s limitation.
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Affiliation(s)
- Shridhar Aithal
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Ruford Sequeira
- Geriatric Medicine, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Chris Edwards
- Consultant Clinical Scientist, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport NP20 2UB, UK.
| | - Inderpal Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
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Khlebtovsky A, Djaldetti R, Rodity Y, Keret O, Tsvetov G, Slutzcki-Shraga I, Benninger F. Progression of postural changes in Parkinson’s disease: quantitative assessment. J Neurol 2017; 264:675-683. [DOI: 10.1007/s00415-017-8402-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/11/2022]
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Beydoun HA, Beydoun MA, Mishra NK, Rostant OS, Zonderman AB, Eid SM. Comorbid Parkinson's disease, falls and fractures in the 2010 National Emergency Department Sample. Parkinsonism Relat Disord 2016; 35:30-35. [PMID: 27887896 DOI: 10.1016/j.parkreldis.2016.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/06/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a progressive, neurodegenerative disorder of multifactorial etiology affecting ∼1% of older adults. Research focused on linking PD to falls and bone fractures has been limited in Emergency Department (ED) settings, where most injuries are identified. We assessed whether injured U.S. ED admissions with PD diagnoses were more likely to exhibit comorbid fall- or non-fall related bone fractures and whether a PD diagnosis with a concomitant fall or bone fracture is linked to worse prognosis. METHODS We performed secondary analyses of 2010 Healthcare Utilization Project National ED Sample from 4,253,987 admissions to U.S. EDs linked to injured elderly patients. ED discharges with ICD-9-CM code (332.0) were identified as PD and those with ICD-9-CM code (800.0-829.0) were used to define bone fracture location. Linear and logistic regression models were constructed to estimate slopes (B) and odds ratios (OR) with 95% confidence intervals (CI). RESULTS PD admissions had 28% increased adjusted prevalence of bone fracture. Non-fall injuries showed stronger relationship between PD and bone fracture (ORadj = 1.33, 95% CI: 1.22-1.45) than fall injuries (ORadj = 1.06, 95% CI: 1.01-1.10). PD had the strongest impact on hospitalization length when bone fracture and fall co-occurred, and total charges were directly associated with PD only for fall injuries. Finally, PD status was not related to in-hospital death in this population. CONCLUSION Among injured U.S. ED elderly patient visits, those with PD had higher bone fracture prevalence and more resource utilization especially among fall-related injuries. No association of PD with in-hospital death was noted.
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Affiliation(s)
- Hind A Beydoun
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - May A Beydoun
- National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
| | | | - Ola S Rostant
- National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
| | - Alan B Zonderman
- National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
| | - Shaker M Eid
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Binks S, Dobson R. Risk Factors, Epidemiology and Treatment Strategies for Metabolic Bone Disease in Patients with Neurological Disease. Curr Osteoporos Rep 2016; 14:199-210. [PMID: 27525980 DOI: 10.1007/s11914-016-0320-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Metabolic bone disease is a major public health concern, especially when it manifests as hip fracture which carries significant morbidity and mortality. Individuals with neurological disease are at higher risk of osteopenia, osteoporosis and fragility fracture compared to age-matched controls, yet this is under-appreciated by these patients. Clinician attention to this topic is therefore of importance and should address the bone health of men as well as women, a group in whom it may be an under-recognised problem. Evidence for optimal management of bone health in neurological disease remains to be defined, but a growing literature provides some useful guidance. This review focuses on two conditions, multiple sclerosis and Parkinson's disease, where research has been active over recent years. In neuroinflammation, shared immunological pathways between bone and brain are a current domain of interest and it will be intriguing to interrogate the action of emerging immunotherapies on these dual compartments.
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Affiliation(s)
- S Binks
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - R Dobson
- Blizard Institute, Queen Mary University, 4 Newark St, London, E1 2AT, UK.
- St Georges Hospital, Blackshaw Rd, London, SW17 0QT, UK.
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Kalilani L, Asgharnejad M, Palokangas T, Durgin T. Comparing the Incidence of Falls/Fractures in Parkinson's Disease Patients in the US Population. PLoS One 2016; 11:e0161689. [PMID: 27583564 PMCID: PMC5008740 DOI: 10.1371/journal.pone.0161689] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/10/2016] [Indexed: 12/23/2022] Open
Abstract
Patients with Parkinson’s disease (PD) may experience falls and/or fractures as a result of disease symptoms. There are limited data available from long-term studies estimating the incidence of falls/fractures in patients with PD. The objective was to compare the incidence rate of falls/fractures in PD patients with non-PD patients in a US population. This was a retrospective study using a US-based claims database (Truven Health MarketScan®) that compared the incidence rate of falls/fractures in PD subjects with non-PD subjects. The study period included the 12 months prior to index date (defined as earliest PD diagnosis [International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0]) and a postindex period to the end of data availability. Fractures were defined by inpatient/outpatient claims as a principal or secondary diagnosis and accompanying procedure codes during the postindex period. Incidence rates and 95% CIs for falls/fractures were calculated as the number of events per 10,000 person-years of follow-up using negative binomial or Poisson regression models. Twenty-eight thousand two hundred and eighty PD subjects were matched to non-PD subjects for the analysis (mean [SD] age, 71.4 [11.8] years; 53% male). A higher incidence rate (adjusted for comorbidities and medications) of all fall/fracture cases and by fall and fracture types was observed for PD subjects versus non-PD subjects; the overall adjusted incidence rate ratio comparing PD to non-PD subjects was 2.05; 95% CI, 1.88–2.24. The incidence rate of falls/fractures was significantly higher in subjects with PD compared with non-PD subjects in a US population.
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Affiliation(s)
- Linda Kalilani
- UCB Pharma, Raleigh, North Carolina, United States of America
- * E-mail:
| | | | | | - Tracy Durgin
- UCB Pharma, Atlanta, Georgia, United States of America
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Sleeman I, Che ZC, Counsell C. Risk of fracture amongst patients with Parkinson’s disease and other forms of parkinsonism. Parkinsonism Relat Disord 2016; 29:60-5. [DOI: 10.1016/j.parkreldis.2016.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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Malochet-Guinamand S, Durif F, Thomas T. Parkinson's disease: A risk factor for osteoporosis. Joint Bone Spine 2015; 82:406-10. [DOI: 10.1016/j.jbspin.2015.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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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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Abstract
Parkinson disease (PD) is a progressive, neurodegenerative movement disorder. PD was originally attributed to neuronal loss within the substantia nigra pars compacta, and a concomitant loss of dopamine. PD is now thought to be a multisystem disorder that involves not only the dopaminergic system, but other neurotransmitter systems whose role may become more prominent as the disease progresses (189). PD is characterized by four cardinal symptoms, resting tremor, rigidity, bradykinesia, and postural instability, all of which are motor. However, PD also may include any combination of a myriad of nonmotor symptoms (195). Both motor and nonmotor symptoms may impact the ability of those with PD to participate in exercise and/or impact the effects of that exercise on those with PD. This article provides a comprehensive overview of PD, its symptoms and progression, and current treatments for PD. Among these treatments, exercise is currently at the forefront. People with PD retain the ability to participate in many forms of exercise and generally respond to exercise interventions similarly to age-matched subjects without PD. As such, exercise is currently an area receiving substantial research attention as investigators seek interventions that may modify the progression of the disease, perhaps through neuroprotective mechanisms.
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Affiliation(s)
- Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
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Musculoskeletal problems in Parkinson's disease: Neglected issues. Parkinsonism Relat Disord 2013; 19:666-9. [DOI: 10.1016/j.parkreldis.2013.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/24/2013] [Accepted: 03/10/2013] [Indexed: 11/30/2022]
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van den Bos F, Speelman AD, Samson M, Munneke M, Bloem BR, Verhaar HJJ. Parkinson's disease and osteoporosis. Age Ageing 2013; 42:156-62. [PMID: 23132148 DOI: 10.1093/ageing/afs161] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND patients with Parkinson's disease (PD) have a high risk of sustaining osteoporotic fractures as a result of falls and reduced bone mass. OBJECTIVE to summarise the underlying pathophysiological mechanisms of bone loss in PD by reviewing the available literature. METHODS a Medline search was performed for articles published between January 1975 and January 2011, using the keywords 'bone mineral density', 'bone loss', 'bone metabolism', 'osteoporosis', 'osteopenia', 'Parkinson's disease' and 'Parkinsonism'. RESULTS PD patients have a lower bone mineral density (BMD) than age-matched controls. Bone loss in PD is multifactorial, resulting from immobility, decreased muscle strength, and low body weight. Vitamin D deficiency is also important, not only because it reduces BMD, but also because cell function in the substantia nigra depends on vitamin D. Lastly, hyperhomocysteinaemia, an independent risk factor for osteoporosis, is common in PD, due to levodopa use, as well as vitamin B12 and folic acid deficiency. A few studies have demonstrated that treatment with bisphosphonates, vitamin D and calcium can increase BMD and reduce fractures in PD patients. CONCLUSION bone loss in PD is multifactorial. It is clinically important because of the concomitant risk of fractures. Screening for osteoporosis should be considered more often, and therapeutic interventions should be initiated.
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36
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Musculoskeletal problems in Parkinson’s disease. J Neural Transm (Vienna) 2013; 120:537-42. [DOI: 10.1007/s00702-012-0960-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022]
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Zhao Y, Shen L, Ji HF. Osteoporosis risk and bone mineral density levels in patients with Parkinson's disease: a meta-analysis. Bone 2013; 52:498-505. [PMID: 23000281 DOI: 10.1016/j.bone.2012.09.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/20/2012] [Accepted: 09/11/2012] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) and osteoporosis are common diseases which affect a substantial portion of the elderly population. Accumulating evidence supports that PD patients have a high risk for osteoporosis in recent years. The purpose of the present study is to perform a meta-analysis on the risk of osteoporosis and bone mineral density (BMD) levels in PD patients. METHODS We searched all articles indexed in Medline, SciVerse Scopus and Cochrane Library published up to January 2012 concerning the association between PD and risk of osteoporosis or BMD levels. In total, 15 studies were included in the meta-analysis. RESULTS The results indicated that PD patients are at higher risk for osteoporosis (summary OR=1.18, 95% CI=[1.09, 1.27]) than healthy controls. The gender subgroup analysis suggested that PD male patients have a higher risk for osteoporosis than female patients (female patients: summary OR=1.16, 95% CI=[1.07, 1.26]; male patients: summary OR=2.44, 95% CI=[1.37, 4.34]). Further meta-analysis showed that PD patients have a lower hip, lumbar spine and femoral neck BMD than healthy controls. The gender subgroup analysis found a lower BMD in PD female patients than controls, while no obvious difference was observed in PD male patients and controls. CONCLUSIONS This meta-analysis suggested that PD patients are at higher risk for osteoporosis and have lower BMD levels than healthy controls overall.
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Affiliation(s)
- Yan Zhao
- Shandong Provincial Research Center for Bioinformatic Engineering and Technique, Shandong University of Technology, Zibo 255049, PR China
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38
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Bone mineral density and vitamin D status in Parkinson's disease patients. J Neurol 2012; 260:754-60. [PMID: 23052606 DOI: 10.1007/s00415-012-6697-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
Bone loss is more common in Parkinson's disease (PD) than in the general population. Several factors may be involved in the development of bone loss, including malnutrition, immobilization, low body mass index, decreased muscle strength, vitamin D deficiency and medication use. This study investigates the prevalence of osteoporosis and possible risk factors associated with bone loss in early stage PD. In 186 PD patients (Hoehn and Yahr stage 1-2.5, mean age 64.1 years, 71 % men) bone mineral density (BMD) measurements were performed with DEXA. T- and Z-scores were calculated. Univariate linear regression analysis was performed to identify variables that contributed to BMD. 25-OH-vitamin D status of PD patients was compared with 802 controls (mean age 63.3 years, 50 % men) using linear regression analysis. Osteoporosis (11.8 %) and osteopenia (41.4 %) were common in PD patients. Mean Z-score for the hip was 0.24 (SD 0.93), and for the lumbar spine 0.72 (SD 1.91). Female gender, low weight, and low 25-OH-vitamin D were significantly correlated with BMD of the hip and lumbar spine. PD patients had lower 25(OH)D serum levels than controls (B = -10, p = 0.000). More than half of the patients with early stage PD had an abnormal BMD. Female gender, low weight, and low vitamin D concentration were associated with bone loss. Furthermore, vitamin D concentrations were reduced in PD patients. These results underscore the importance of proactive screening for bone loss and vitamin D deficiency, even in early stages of PD.
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Daniel SK, Lansang MC, Okun MS. Bone Mineral Density (BMD) in Male Patients with Parkinson's Disease. Int J Neurosci 2012; 122:523-7. [DOI: 10.3109/00207454.2012.685530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Arbouw MEL, Movig KLL, van Staa TP, Egberts ACG, Souverein PC, de Vries F. Dopaminergic drugs and the risk of hip or femur fracture: a population-based case-control study. Osteoporos Int 2011; 22:2197-204. [PMID: 20967420 PMCID: PMC3106160 DOI: 10.1007/s00198-010-1455-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 08/30/2010] [Indexed: 01/11/2023]
Abstract
SUMMARY The effect of dopaminergic medication on the risk of hip/femur fractures is not clear. Our results showed a nearly twofold increased risk of hip/femur fractures in current dopaminergic drug users. Concomitant use of antidepressants further increased this risk. Fracture risk assessment may be warranted in elderly users of dopaminergic drugs. INTRODUCTION Dopaminergic drugs, often used in the treatment of Parkinson's disease, have several pharmacological effects that may increase or decrease the risk of falling and fractures. Thus, the effect of dopaminergic medication on the risk of hip/femur fractures is not clear. The objective of the study was to examine the effect of dopaminergic medication and concomitant use of psychotropics on the risk of hip/femur fractures taking into account the timing of dopaminergic drug use. METHODS A population-based case-control study in the PHARMO database was conducted for the period 1991 to 2002. Cases were patients aged 18 years and older with a first hip or femur fracture and matched to four control patients by year of birth, sex and geographical region. RESULTS The study population included 6,763 cases and 26,341 controls. Current use of dopaminergic drugs (1-30 days before the index date) was associated with an increased risk of hip/femur fractures compared to never use (OR(adj) 1.76, 95% CI = 1.39-2.22), but this excess risk rapidly dropped to baseline levels when treatment had been discontinued >1 year ago. Concomitant use of antidepressants among current dopaminergic drug users further increased the risk of hip/femur fractures (OR(adj) 3.51, 95% CI = 2.10-5.87) while there was no additional risk with concomitant use of other psychotropics. CONCLUSIONS Although the observed association between dopaminergic drugs and fracture risk may not be entirely causal, due to absence of information on the (severity of the) underlying disease, fracture risk assessment may be warranted in elderly users of dopaminergic drugs.
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Affiliation(s)
- M. E. L. Arbouw
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - K. L. L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - T. P. van Staa
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - A. C. G. Egberts
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P. C. Souverein
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
| | - F. de Vries
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, P.O. Box 80082, 3508 TB Utrecht, The Netherlands
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
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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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Effects of whole-body vibration on sensorimotor performance in people with Parkinson disease: a systematic review. Phys Ther 2011; 91:198-209. [PMID: 21212374 DOI: 10.2522/ptj.20100071] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Earlier studies show that whole-body vibration (WBV) has beneficial effects on neuromuscular performance in older adults and may be a viable treatment option for people with Parkinson disease (PD). PURPOSE This systematic review was aimed at determining whether WBV improves sensorimotor performance in people with PD. DATA SOURCES The sources used in this review were MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Excerpta Medica database (EMBASE), the Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database (PEDro) (last searched in April 2010). STUDY SELECTION Randomized and nonrandomized controlled studies examining the effects of WBV in people with PD were selected. Six studies fulfilled the selection criteria and were included in this review. DATA EXTRACTION The PEDro score was used to evaluate methodological quality. The effects of WBV on various sensorimotor outcomes were noted. DATA SYNTHESIS Methodological quality was rated as good for 1 study (PEDro score of 6), fair for 4 studies (PEDro score of 4 or 5), and poor for 1 study (PEDro score of 2). Two studies showed that, compared with no intervention, WBV treatment led to significant reductions in tremor and rigidity, as measured with the Unified Parkinson Disease Rating Scale (UPDRS). The findings for other UPDRS cluster scores were conflicting, however. Two studies showed that longer-term WBV (3-5 weeks) did not result in better sensorimotor outcomes than conventional exercise training. LIMITATIONS The studies reviewed here are limited by their methodological weaknesses and small, heterogeneous samples. CONCLUSIONS There is insufficient evidence to prove or refute the effectiveness of WBV in enhancing sensorimotor performance in people with PD (ie, grade D recommendations). More good-quality trials are needed to establish the clinical efficacy of WBV in improving sensorimotor function in people with PD.
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Pang MYC. Whole body vibration therapy in fracture prevention among adults with chronic disease. World J Orthop 2010; 1:20-5. [PMID: 22474623 PMCID: PMC3302025 DOI: 10.5312/wjo.v1.i1.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/05/2010] [Accepted: 11/12/2010] [Indexed: 02/06/2023] Open
Abstract
Due to various physical impairments, individuals with chronic diseases often live a sedentary lifestyle, which leads to physical de-conditioning. The associated muscle weakness, functional decline and bone loss also render these individuals highly susceptible to falls and fragility fractures. There is an urgent need to search for safe and effective intervention strategies to prevent fragility fractures by modifying the fall-related risk factors and enhancing bone health. Whole body vibration (WBV) therapy has gained popularity in rehabilitation in recent years. In this type of treatment, mechanical vibration is delivered to the body while the individual is standing on an oscillating platform. As mechanical loading is one of the most powerful stimuli to induce osteogenesis, it is proposed that the mechanical stress applied to the human skeleton in WBV therapy might be beneficial for enhancing bone mass. Additionally, the vibratory signals also constitute a form of sensory stimulation and can induce reflex muscle activation, which could potentially induce therapeutic effects on muscle strength and important sensorimotor functions such as postural control. Increasing research evidence suggests that WBV is effective in enhancing hip bone mineral density, muscle strength and balance ability in elderly patients, and could have potential for individuals with chronic diseases, who often cannot tolerate vigorous impact or resistance exercise training. This article aims to discuss the potential role of WBV therapy in the prevention of fragility fractures among people with chronic diseases.
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Lam K, Li M, Mok V, Hui A, Woo J. A case control study on bone mineral density in Chinese patients with Parkinson’s disease. Parkinsonism Relat Disord 2010; 16:471-4. [DOI: 10.1016/j.parkreldis.2010.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 03/12/2010] [Accepted: 05/07/2010] [Indexed: 11/25/2022]
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Ciccolo JT, Carr LJ, Krupel KL, Longval JL. The Role of Resistance Training in the Prevention and Treatment of Chronic Disease. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827609354034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recent research suggests that resistance training (RT) in adults has the potential to prevent, treat, and possibly even reverse the impact of several chronic diseases. A properly designed progressive program can have profound effects on the musculoskeletal system, resulting in enhanced physical and mental health. In this review, the authors summarize recent research detailing the numerous benefits gained from participating in an RT program in those with or at risk for chronic disease. This includes increases in muscle mass and strength; enhanced physical function; reduced risks for osteoporosis and cardiovascular and metabolic diseases; improved management of cancer, neuromuscular disorders, HIV, and chronic obstructive pulmonary disease; and reductions in negative mood states. Given these benefits, numerous national organizations, including the committee commissioned to create the National Physical Activity Guidelines for Americans, have endorsed the participation in RT as a necessary component of maintaining health. Fortunately, the most current estimates show that a growing number of individuals are participating in RT, but these national estimates still fall below the goal of 30% set by Healthy People 2010. Future research will therefore need to focus on increasing the adoption and adherence of RT, as it carries the potential to dramatically affect public health.
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Affiliation(s)
- Joseph T. Ciccolo
- Alpert Medical School of Brown University, Providence, Rhode Island, , Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Lucas J. Carr
- Alpert Medical School of Brown University, Providence, Rhode Island, Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Katie L. Krupel
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jaime L. Longval
- Alpert Medical School of Brown University, Providence, Rhode Island
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Pang MYC, Mak MKY. Trunk muscle strength, but not trunk rigidity, is independently associated with bone mineral density of the lumbar spine in patients with Parkinson's disease. Mov Disord 2009; 24:1176-82. [PMID: 19412964 DOI: 10.1002/mds.22531] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Previous literature suggested that muscle forces applied to the skeleton may be an important factor in increasing bone mineral density (BMD). This purpose of this study was to determine whether trunk rigidity and trunk muscle strength were associated with lumbar spine BMD in patients with Parkinson's disease (PD). Forty-three PD patients and 29 controls participated in this study. Dual-energy X-ray absorptiometry was used to measure lumbar spine BMD of PD patients. Additionally, an isokinetic dynamometer was used to evaluate trunk rigidity and trunk muscle strength of all subjects. The results showed that PD patients had significantly lower trunk muscle strength, but more trunk rigidity than controls by 46.6 and 162.8%, respectively (P < 0.001). In bivariate correlation analysis, lumbar spine BMD was significantly related to trunk muscle strength (r = 0.475, P = 0.001), but not trunk rigidity (r = 0.271, P = 0.079). In multiple regression analysis, after adjusting for relevant factors, only trunk muscle strength remained independently associated with lumbar spine BMD, accounting for 10.0% of the variance (R(2) = 0.342, F(5,) (37) = 3.838, P = 0.007). Trunk muscle strength, but not trunk rigidity, is independently associated with lumbar spine BMD in patients with PD. Further randomized controlled studies are required to determine whether trunk muscle strengthening exercise is effective in enhancing lumbar spine BMD.
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Affiliation(s)
- Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China.
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Osteoporosis in Parkinson's disease. Parkinsonism Relat Disord 2009; 15:339-46. [DOI: 10.1016/j.parkreldis.2009.02.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/18/2009] [Accepted: 02/23/2009] [Indexed: 11/20/2022]
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