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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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Gonzalez-Latapi P, Lo RY. Bone First or Brain First: "Picking at the Bones" of Parkinson's Disease. Mov Disord 2023; 38:1579-1581. [PMID: 37718269 DOI: 10.1002/mds.29567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Paulina Gonzalez-Latapi
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raymond Y Lo
- Department of Neurology, Hualien Tzu Chi Hospital and Tzu Chi University, Hualien, Taiwan
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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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Amato A, Baldassano S, Vasto S, Schirò G, Davì C, Drid P, Dos Santos Mendes FA, Caldarella R, D’Amelio M, Proia P. Effects of a Resistance Training Protocol on Physical Performance, Body Composition, Bone Metabolism, and Systemic Homeostasis in Patients Diagnosed with Parkinson's Disease: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013022. [PMID: 36293598 PMCID: PMC9602560 DOI: 10.3390/ijerph192013022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 05/14/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments and it is correlated with loss of bone mineral density. This study aimed to analyze the effects of resistance training on bone metabolism, systemic homeostasis, body composition, and physical performance in people with PD. Thirteen subjects (age 64.83 ± 5.70) with PD diagnosis were recruited. Participants performed neuromuscular tests, body composition assessment, and blood sample analysis at baseline, and after an 11 weeks-training period. Each training session lasted 90 min, three times a week. The participants had significant improvements in the timed up and go (p < 0.01), sit to stand (p < 0.01), dominant peg-board (p < 0.05), dominant foot-reaction time (p < 0.01), and functional reach tests (p < 0.05). They showed better pressure foot distributions in the left forefoot (p < 0.05) and hindfoot (p < 0.05) and increased cervical right lateral bending angle (p < 0.05). The protocol affects bone metabolism markers osteocalcin (p < 0.05), calcium (p < 0.01), PTH (p < 0.01), the C-terminal telopeptide (CTX) (p < 0.01), and vitamin D (p < 0.05). Eleven weeks of resistance training improved manual dexterity, static and dynamic balance, reaction time, cervical ROM, and reduced bone loss in people with PD.
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Affiliation(s)
- Alessandra Amato
- Sport and Exercise Sciences Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, 90128 Palermo, Italy
| | - Sara Baldassano
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, 90128 Palermo, Italy
- Correspondence: (S.B.); (P.P.)
| | - Sonya Vasto
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, 90128 Palermo, Italy
| | - Giuseppe Schirò
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Chiara Davì
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | - Rosalia Caldarella
- Department of Laboratory Medicine, “P. Giaccone” University Hospital, 90127 Palermo, Italy
| | - Marco D’Amelio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Patrizia Proia
- Sport and Exercise Sciences Research Unit, Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, 90128 Palermo, Italy
- Correspondence: (S.B.); (P.P.)
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Spindler P, Tkatschenko D, Alzoobi Y, Kuebler D, Kühn AA, Schneider GH, Prinz V, Vajkoczy P, Faust K. Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study. J Neurol Surg A Cent Eur Neurosurg 2022; 84:247-254. [PMID: 35100633 DOI: 10.1055/s-0041-1741535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND With increasing prevalence of Parkinson's disease (PD), instrumentation surgery of the thoracolumbar spine of PD patients grows in importance. Poor operative results with high rates of revision surgery have been reported. The goal of this study was to compare the biomechanical complications of thoracolumbar instrumentation surgery of patients with and without PD. METHODS In a retrospective case-control study, we compared 16 PD patients with a matched cohort of 104 control patients regarding the following postinstrumentation complications: (1) adjacent joint disease, (2) material failure, and (3) material loosening. Also, we compared the spinal bone density, which is the main prognostic criteria for failed instrumentation surgery, between the groups. RESULTS We found the rate of material revision to be significantly higher in PD patients (43.8 vs. 13.5%, p = 0.008, odds ratio (OR) = 5.0). Furthermore, the indications for revision surgery differed between the groups, with more hardware failures in the PD group and more adjacent segment degeneration in the control group. PD patients profited from modern operation techniques (percutaneous instrumentation and CT-navigated screw implantation). Hospitalization was significantly longer for PD patients (20.2 ± 15.1 vs. 14.1 ± 8.9 days, p = 0.03). CONCLUSION PD patients exhibit challenging biomechanical demands on instrumenting the spine. Besides osteoporosis, especially sagittal imbalance, gait disturbance, and altered muscle tone may be contributive. PD patients may particularly profit from navigated and less invasive surgical techniques.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Dimitri Tkatschenko
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Dorothee Kuebler
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
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Novotnij D, Zhukova N, Shperling L, Stolyarova V, Zhukova I, Agasheva A, Shtaimets S, Druzhinina O, Shirokikh I. Vitamin D and other indicators of calcium-phosphorus metabolism as possible predictors of Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:56-64. [DOI: 10.17116/jnevro202212208156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Assessment of real life eating difficulties in Parkinson's disease patients by measuring plate to mouth movement elongation with inertial sensors. Sci Rep 2021; 11:1632. [PMID: 33452324 PMCID: PMC7810687 DOI: 10.1038/s41598-020-80394-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder with both motor and non-motor symptoms. Despite the progressive nature of PD, early diagnosis, tracking the disease’s natural history and measuring the drug response are factors that play a major role in determining the quality of life of the affected individual. Apart from the common motor symptoms, i.e., tremor at rest, rigidity and bradykinesia, studies suggest that PD is associated with disturbances in eating behavior and energy intake. Specifically, PD is associated with drug-induced impulsive eating disorders such as binge eating, appetite-related non-motor issues such as weight loss and/or gain as well as dysphagia—factors that correlate with difficulties in completing day-to-day eating-related tasks. In this work we introduce Plate-to-Mouth (PtM), an indicator that relates with the time spent for the hand operating the utensil to transfer a quantity of food from the plate into the mouth during the course of a meal. We propose a two-step approach towards the objective calculation of PtM. Initially, we use the 3D acceleration and orientation velocity signals from an off-the-shelf smartwatch to detect the bite moments and upwards wrist micromovements that occur during a meal session. Afterwards, we process the upwards hand micromovements that appear prior to every detected bite during the meal in order to estimate the bite’s PtM duration. Finally, we use a density-based scheme to estimate the PtM durations distribution and form the in-meal eating behavior profile of the subject. In the results section, we provide validation for every step of the process independently, as well as showcase our findings using a total of three datasets, one collected in a controlled clinical setting using standardized meals (with a total of 28 meal sessions from 7 Healthy Controls (HC) and 21 PD patients) and two collected in-the-wild under free living conditions (37 meals from 4 HC/10 PD patients and 629 meals from 3 HC/3 PD patients, respectively). Experimental results reveal an Area Under the Curve (AUC) of 0.748 for the clinical dataset and 0.775/1.000 for the in-the-wild datasets towards the classification of in-meal eating behavior profiles to the PD or HC group. This is the first work that attempts to use wearable Inertial Measurement Unit (IMU) sensor data, collected both in clinical and in-the-wild settings, towards the extraction of an objective eating behavior indicator for PD.
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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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Louvois M, Ferrero S, Barnetche T, Roux CH, Breuil V. High risk of osteoporotic fracture in Parkinson's disease: Meta-analysis, pathophysiology and management. Rev Neurol (Paris) 2020; 177:660-669. [PMID: 33019997 DOI: 10.1016/j.neurol.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
- M Louvois
- Université Côte d'Azur (UCA), Service de Rhumatologie, CHU de Nice, hôpital pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice Cedex 1, France
| | - S Ferrero
- Université Côte d'Azur (UCA), Service de Rhumatologie, CHU de Nice, hôpital pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice Cedex 1, France
| | - T Barnetche
- Department of Rheumatology, FHU ACRONIM, CHU Pellegrin, Bordeaux, France
| | - C H Roux
- Université Côte d'Azur (UCA), Service de Rhumatologie, CHU de Nice, hôpital pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice Cedex 1, France
| | - V Breuil
- Université Côte d'Azur (UCA), Service de Rhumatologie, CHU de Nice, hôpital pasteur 2, 30, voie Romaine, CS 51069, 06001 Nice Cedex 1, France; UMR E-4320 MATOs CEA/iBEB/SBTN, Université Nice Sophia Antipolis, Faculté de Médecine, 28, avenue de Valombrose, 06107 Nice Cedex 2, France.
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Sooragonda BG, Agarwal S, Benjamin RN, Prabhakar AT, Sivadasan A, Kapoor N, Cherian KE, Jebasingh FK, Aaron S, Thomas N, Mathew V, Asha HS, Paul TV. Bone Mineral Density and Body Composition in Males with Motor Neuron Disease: A Study from Teaching Hospital in Southern Part of India. Ann Indian Acad Neurol 2020; 24:211-216. [PMID: 34220065 PMCID: PMC8232495 DOI: 10.4103/aian.aian_293_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/26/2020] [Accepted: 05/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Osteoporosis and sarcopenia are important aspects of motor neuron disease (MND). Individuals with amyotrophic lateral sclerosis (MND-ALS) have an increased risk of falls and fractures. Currently, the standard of care does not involve a routine assessment of bone mineral density (BMD) and body composition in these patients. We aimed to assess BMD, bone mineral parameters and body composition in men with MND and compared them with healthy controls. Methods Consecutive males between 50 and 80 years of age diagnosed as MND-ALS by revised El Escorial criteria and able to walk unassisted attending Neurology outpatient clinic were recruited into the study. Age, gender and body mass index (BMI) matched healthy controls were recruited from the local community. BMD and body composition were assessed by dual-energy x-ray absorptiometry (DXA). Bone mineral parameters and bone turnover markers (BTMs) were also assessed in them. Results A total of 30 subjects with MND-ALS and 33 controls were recruited. The mean age (years) was 59.2 in cases and 61.2 in controls. The mean BMD (g/cm2) between the two groups was similar; however, BTMs were significantly higher in the MND group (P < 0.05). Subjects with MND-ALS had significantly lower mean appendicular lean mass (ALM) (19.9 versus 22.4 kg; P = 0.007) and ALM corrected for BMI than the healthy control group (0.858 versus 0.934 kg/kg/m2; P = 0.034). Sarcopenic obesity (Percentage fat mass >27% + ALM/BMI <0.786 kg/kg/m2) was more prevalent in MND-ALS compared to controls (44.5% versus 16.7%; P = 0.03). Conclusion Although BMD was not significantly different between subjects with MND-ALS and healthy controls, BTMs were significantly higher in the MND group indicating a high bone turnover state. Sarcopenia and sarcopenic obesity were also more in MND-ALS group than controls. Routine assessment for bone health parameters and body composition indices may be included in management of the patients with MND.
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Affiliation(s)
| | - Sandeep Agarwal
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - A T Prabhakar
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajith Sivadasan
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kripa E Cherian
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Felix K Jebasingh
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hesarghatta S Asha
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas V Paul
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
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Fagerberg P, Klingelhoefer L, Bottai M, Langlet B, Kyritsis K, Rotter E, Reichmann H, Falkenburger B, Delopoulos A, Ioakimidis I. Lower Energy Intake among Advanced vs. Early Parkinson's Disease Patients and Healthy Controls in a Clinical Lunch Setting: A Cross-Sectional Study. Nutrients 2020; 12:E2109. [PMID: 32708668 PMCID: PMC7400863 DOI: 10.3390/nu12072109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Unintentional weight loss has been observed among Parkinson's disease (PD) patients. Changes in energy intake (EI) and eating behavior, potentially caused by fine motor dysfunction and eating-related symptoms, might contribute to this. The primary aim of this study was to investigate differences in objectively measured EI between groups of healthy controls (HC), early (ESPD) and advanced stage PD patients (ASPD) during a standardized lunch in a clinical setting. The secondary aim was to identify clinical features and eating behavior abnormalities that explain EI differences. All participants (n = 23 HC, n = 20 ESPD, and n = 21 ASPD) went through clinical evaluations and were eating a standardized meal (200 g sausages, 400 g potato salad, 200 g apple purée and 500 mL water) in front of two video cameras. Participants ate freely, and the food was weighed pre- and post-meal to calculate EI (kcal). Multiple linear regression was used to explain group differences in EI. ASPD had a significantly lower EI vs. HC (-162 kcal, p < 0.05) and vs. ESPD (-203 kcal, p < 0.01) when controlling for sex. The number of spoonfuls, eating problems, dysphagia and upper extremity tremor could explain most (86%) of the lower EI vs. HC, while the first three could explain ~50% vs. ESPD. Food component intake analysis revealed significantly lower potato salad and sausage intakes among ASPD vs. both HC and ESPD, while water intake was lower vs. HC. EI is an important clinical target for PD patients with an increased risk of weight loss. Our results suggest that interventions targeting upper extremity tremor, spoonfuls, dysphagia and eating problems might be clinically useful in the prevention of unintentional weight loss in PD. Since EI was lower in ASPD, EI might be a useful marker of disease progression in PD.
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Affiliation(s)
- Petter Fagerberg
- Department of Biosciences and Nutrition, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.L.); (I.I.)
| | - Lisa Klingelhoefer
- Department of Neurology, Technical University Dresden, 01099 Dresden, Germany; (L.K.); (E.R.); (H.R.); (B.F.)
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Billy Langlet
- Department of Biosciences and Nutrition, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.L.); (I.I.)
| | - Konstantinos Kyritsis
- Electrical and Computer Engineering Department, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.K.); (A.D.)
| | - Eva Rotter
- Department of Neurology, Technical University Dresden, 01099 Dresden, Germany; (L.K.); (E.R.); (H.R.); (B.F.)
| | - Heinz Reichmann
- Department of Neurology, Technical University Dresden, 01099 Dresden, Germany; (L.K.); (E.R.); (H.R.); (B.F.)
| | - Björn Falkenburger
- Department of Neurology, Technical University Dresden, 01099 Dresden, Germany; (L.K.); (E.R.); (H.R.); (B.F.)
| | - Anastasios Delopoulos
- Electrical and Computer Engineering Department, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.K.); (A.D.)
| | - Ioannis Ioakimidis
- Department of Biosciences and Nutrition, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.L.); (I.I.)
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Schini M, Vilaca T, Poku E, Harnan S, Sutton A, Allen IE, Cummings SR, Eastell R. The risk of hip and non-vertebral fractures in patients with Parkinson's disease and parkinsonism: A systematic review and meta-analysis. Bone 2020; 132:115173. [PMID: 31790846 DOI: 10.1016/j.bone.2019.115173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that is common in older individuals. PD patients have an increased risk of fractures compared to the general population, perhaps due to multiple falls. However, the fracture risk has not been fully assessed. To assess the impact of PD on the risk of hip and non-vertebral fractures, we conducted a systematic review and meta-analysis. Comprehensive searches of three key bibliographic databases were conducted to identify reviews and primary studies relating to the risk of fractures in patients with PD. Search terms included all relevant terms for Parkinson's disease and for fractures. We selected observational studies with data on the risk of fractures in adults with PD compared to controls without the diagnosis. Study quality was assessed using the Newcastle Ottawa Scale. The random-effects model was used to pool the results. Eighteen studies were included in the review. Seventeen independent studies (14 cohort and 3 case-control studies) were included in the hip fracture analysis. Nine studies (all cohorts, no case-control studies) were included in the non-vertebral fracture analysis. Study quality was judged to be moderate to good. Overall, PD patients had an increased risk for both hip fractures (2.40, 95% CI 2.04 to 2.82) and non-vertebral fractures (1.80, 95% CI 1.60 to 2.01) compared to controls. The relative risk for hip fractures was higher in men (2.93, 95% CI 2.05 to 4.18) than in women (1.81, 95% CI 1.61 to 2.04). There were no effects of the study design, geographical region, or criteria for diagnosing Parkinson's disease on these estimates of fracture risk. There is an increase in the risk of hip and non-vertebral fractures in patients with Parkinson's disease and we recommend a re-evaluation of the clinical guidelines on bone health in patients with PD to address this.
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Affiliation(s)
- Marian Schini
- Department of Oncology and Metabolism, University of Sheffield, UK.
| | - Tatiane Vilaca
- Department of Oncology and Metabolism, University of Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - Susan Harnan
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | | | | | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, UK
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14
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Singh M, Garg K. Osteoporosis in parkinson's disease – Need of screening in early stages. Neurol India 2020; 68:401-402. [DOI: 10.4103/0028-3886.284375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Zhang H, Zhang J, Mao C, Li K, Wang F, Chen J, Liu C. Relationship between 25-Hydroxyvitamin D, bone density, and Parkinson's disease symptoms. Acta Neurol Scand 2019; 140:274-280. [PMID: 31389003 DOI: 10.1111/ane.13141] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Vitamin D deficiency is widespread in patients with Parkinson's disease (PD). Our aim was to determine whether serum vitamin D levels correlated with bone mineral density (BMD) and non-motor symptoms in patients with PD. MATERIALS & METHODS A consecutive series of 182 patients with PD and 185 healthy controls were included. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured by immunoassay, while BMD of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. Associations between serum vitamin D levels and clinical data were evaluated using partial correlation analysis. RESULTS Patients with PD had significantly lower serum 25(OH)D levels relative to healthy controls (49.75 ± 14.11 vs 43.40 ± 16.51, P < 0.001). Furthermore, PD patients with lower vitamin D levels had a significantly higher frequency of falls (P = 0.033) and insomnia (P = 0.015). They also had significantly higher scores for the Pittsburgh Sleep Quality Index (PSQI; P = 0.014), depression (P = 0.020), and anxiety (P = 0.009). Finally, patients with PD also had a significantly lower mean BMD of the lumbar spine (P = 0.011) and femoral neck (P < 0.001). After adjusting for age, sex, and body mass index, vitamin D levels significantly correlated with falls, insomnia, and scores for the PSQI, depression, and anxiety. CONCLUSIONS In patients with PD, vitamin D levels significantly correlated with falls and some non-motor symptoms. However, no associations were found between BMD and the serum 25(OH)D levels in patients with PD. Thus, vitamin D supplementation is a potential therapeutic for non-motor PD symptoms.
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Affiliation(s)
- Hui‐Jun Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University Suzhou China
| | - Jin‐Ru Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University Suzhou China
| | - Cheng‐Jie Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University Suzhou China
| | - Kai Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University Suzhou China
| | - Fen Wang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience Soochow University Suzhou China
| | - Jing Chen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University Suzhou China
| | - Chun‐Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease The Second Affiliated Hospital of Soochow University Suzhou China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience Soochow University Suzhou China
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16
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Hosseinzadeh A, Khalili M, Sedighi B, Iranpour S, Haghdoost AA. Parkinson's disease and risk of hip fracture: systematic review and meta-analysis. Acta Neurol Belg 2018; 118:201-210. [PMID: 29767373 DOI: 10.1007/s13760-018-0932-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
The relationship between Parkinson's disease (PD) and risk of hip fracture yielded inconsistent results. Therefore, we conducted the present systematic review and meta-analysis of published observational studies to assess the association between PD and risk of hip fracture. PubMed, ISI, EMBASE, and Cochrane databases were searched systematically to identify studies assessing the relationship between PD and the risk of hip fracture up to July 01, 2017. In addition, to find related articles, the reference section of retrieved articles was checked. Random-effects model was used for calculation of pooled hazard ratio (HR) and 95% confidence intervals (CI). Thirteen independent studies containing 564,947 participants were included in the meta-analysis. The overall results of included studies showed PD to be associated with the risk of hip fracture (HRoverall = 3.13, 95% CI 2.53-3.87) in women 3.11 (2.51-3.86) and men 2.60 (2.19-3.09). Our meta-analysis showed the direct association between PD and the risk of hip fracture in both men and women. However, due to the limitations of this study, further well-designed studies are required to confirm our findings.
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Affiliation(s)
- Ali Hosseinzadeh
- Research Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Malahat Khalili
- Research Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Behnaz Sedighi
- Department of Neurology, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Sohrab Iranpour
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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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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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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20
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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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21
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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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22
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Sarkiss CA, Fogg GA, Skovrlj B, Cho SK, Caridi JM. To operate or not?: A literature review of surgical outcomes in 95 patients with Parkinson's disease undergoing spine surgery. Clin Neurol Neurosurg 2015; 134:122-5. [PMID: 25988602 DOI: 10.1016/j.clineuro.2015.04.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 03/19/2015] [Accepted: 04/25/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with Parkinson's disease. Surgical treatment with spinal fusion can be complicated due to poor bone quality and muscular dysfunction in this patient population. The goal of this paper is to investigate surgical outcomes in Parkinson's patients undergoing spine surgery. METHODS We performed a literature review using the PubMed and Google Scholar search engines investigating "Parkinson's disease and spinal fusion surgery" from the period of 2000 to 2013. The inclusion criteria included only English articles with Parkinson's patients that underwent spinal surgery. We identified and reviewed all six articles that included ninety-five patients with Parkinson's disease who underwent spinal surgery. RESULTS A total of 95 patients with Parkinson's disease who underwent spinal fusion surgery were reviewed with average patient age of 69 and a 3:4 male to female ratio. With an average follow up of 40 months, 46 out of 73 patients (63%) were judged to have satisfactory outcomes with poor outcomes noted in the remaining 37%. These included but were not limited to pseudoarthrosis, hardware failure/pullout, development of adjacent level disease, persistent kyphosis or sagittal imbalance, and no improvement or worsening in their postoperative visual analog pain scale. There was a 45% (29/65) revision rate and a 59% (30/51) complication rate following the index procedure. CONCLUSION It remains unclear whether Parkinson's patients benefit from spinal fusion surgery. Further prospective research is warranted to investigate surgical outcomes in this subset of patients.
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Affiliation(s)
| | - Guy A Fogg
- Saba University School of Medicine, Saba, Bonaire, Sint Eustatius and Saba
| | - Branko Skovrlj
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, USA
| | - Samuel K Cho
- Icahn School of Medicine at Mount Sinai, Department of Orthopedic Surgery, New York, USA
| | - John M Caridi
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, USA
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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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24
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Peterson AL. A review of vitamin D and Parkinson's disease. Maturitas 2014; 78:40-4. [PMID: 24685289 DOI: 10.1016/j.maturitas.2014.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
The role of vitamin D in bone health has been known for over a century. More recent research has suggested that vitamin D may play a role in the muscular, immune, endocrine, and central nervous systems. Animal research suggests that vitamin D may have some protective effects against toxic insults that are known to damage dopamine cells, the primary cells to degenerate in PD. Persons with PD tend to have lower vitamin D levels than persons of similar ages without PD. Vitamin D levels are generally associated with bone mineral density (BMD) in persons with PD, but simply giving vitamin D does not appear to improve BMD. Results of genetic studies examining polymorphism of the vitamin D receptor and PD risk, severity, or age at onset have shown variable results, with FokI CC seeming to possibly carry some increased risk of PD. Amount of sun exposure and vitamin D levels in earlier life may influence the risk of developing PD. Cross-sectional research suggests a relationship between vitamin D levels and severity of PD symptoms. A single intervention study did show some improvement in PD with vitamin D supplementation. Vitamin D may have effects on PD symptoms and perhaps even on the risk of disease development or disease progression. More well designed intervention studies are needed to confirm the effect of vitamin D on PD symptoms. Human neuroprotection studies are needed, but probably not feasible until better biomarkers are established.
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Affiliation(s)
- Amie L Peterson
- Oregon Health Sciences University, Mail Code: OP32, 3181, SW Sam Jackson Park Road, Portland, OR 97239, USA; Portland VA, 3710 SW US Veterans Hospital Road, Mail Code: P3PADRECC, Portland, OR 97239, USA.
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25
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Harris-Hayes M, Willis AW, Klein SE, Czuppon S, Crowner B, Racette BA. Relative mortality in U.S. Medicare beneficiaries with Parkinson disease and hip and pelvic fractures. J Bone Joint Surg Am 2014; 96:e27. [PMID: 24553896 PMCID: PMC3918936 DOI: 10.2106/jbjs.l.01317] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Parkinson disease is a neurodegenerative disease that affects gait and postural stability, resulting in an increased risk of falling. The purpose of this study was to estimate mortality associated with demographic factors after hip or pelvic (hip/pelvic) fracture in people with Parkinson disease. A secondary goal was to compare the mortality associated with Parkinson disease to that associated with other common medical conditions in patients with hip/pelvic fracture. METHODS This was a retrospective observational cohort study of 1,980,401 elderly Medicare beneficiaries diagnosed with hip/pelvic fracture from 2000 to 2005 who were identified with use of the Beneficiary Annual Summary File. The race/ethnicity distribution of the sample was white (93.2%), black (3.8%), Hispanic (1.2%), and Asian (0.6%). Individuals with Parkinson disease (131,215) were identified with use of outpatient and carrier claims. Cox proportional hazards models were used to estimate the risk of death associated with demographic and clinical variables and to compare mortality after hip/pelvic fracture between patients with Parkinson disease and those with other medical conditions associated with high mortality after hip/pelvic fracture, after adjustment for race/ethnicity, sex, age, and modified Charlson comorbidity score. RESULTS Among those with Parkinson disease, women had lower mortality after hip/pelvic fracture than men (adjusted hazard ratio [HR] = 0.63, 95% confidence interval [CI]) = 0.62 to 0.64), after adjustment for covariates. Compared with whites, blacks had a higher (HR = 1.12, 95% CI = 1.09 to 1.16) and Hispanics had a lower (HR = 0.87, 95% CI = 0.81 to 0.95) mortality, after adjustment for covariates. Overall, the adjusted mortality rate after hip/pelvic fracture in individuals with Parkinson disease (HR = 2.41, 95% CI = 2.37 to 2.46) was substantially elevated compared with those without the disease, a finding similar to the increased mortality associated with a diagnosis of dementia (HR = 2.73, 95% CI = 2.68 to 2.79), kidney disease (HR = 2.66, 95% CI = 2.60 to 2.72), and chronic obstructive pulmonary disease (HR = 2.48, 95% CI = 2.43 to 2.53). CONCLUSIONS Mortality after hip/pelvic fracture in Parkinson disease varies according to demographic factors. Mortality after hip/pelvic fracture is substantially increased among those with Parkinson disease.
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Affiliation(s)
- Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School
of Medicine, 4444 Forest Park, Campus Box 8502, St. Louis, MO 63108. E-mail address
for M. Harris-Hayes:
| | - Allison W. Willis
- Departments of Neurology (A.W.W. and B.A.R.) and
Orthopedic Surgery (S.E.K.), Washington University School of Medicine, 660 South
Euclid Avenue, Campus Box 8111, St. Louis, MO 63110
| | - Sandra E. Klein
- Departments of Neurology (A.W.W. and B.A.R.) and
Orthopedic Surgery (S.E.K.), Washington University School of Medicine, 660 South
Euclid Avenue, Campus Box 8111, St. Louis, MO 63110
| | - Sylvia Czuppon
- Program in Physical Therapy, Washington University School
of Medicine, 4444 Forest Park, Campus Box 8502, St. Louis, MO 63108. E-mail address
for M. Harris-Hayes:
| | - Beth Crowner
- Program in Physical Therapy, Washington University School
of Medicine, 4444 Forest Park, Campus Box 8502, St. Louis, MO 63108. E-mail address
for M. Harris-Hayes:
| | - Brad A. Racette
- Departments of Neurology (A.W.W. and B.A.R.) and
Orthopedic Surgery (S.E.K.), Washington University School of Medicine, 660 South
Euclid Avenue, Campus Box 8111, St. Louis, MO 63110
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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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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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L Ng K, Nguyễn L. Role of vitamin d in Parkinson's disease. ISRN NEUROLOGY 2012; 2012:134289. [PMID: 22619734 PMCID: PMC3349248 DOI: 10.5402/2012/134289] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/29/2011] [Indexed: 01/29/2023]
Abstract
Parkinson's disease (PD) is the second most common form of neurodegeneration in the elderly population. Clinically, it is characterized by tremor, rigidity, slowness of movement, and postural imbalance. A significant association between low serum vitamin D and PD has been demonstrated, suggesting that elevated vitamin D levels might provide protection against PD. Genetic studies have helped identify a number of proteins linking vitamin D to PD pathology, including the major histocompatibility complex (MHC) class II, the vitamin D receptor (VDR), cytochrome P450 2D6 (CYP2D6), chromosome 22, the renin-angiotensin system (RAS), heme oxygenase-1 (HO-1), poly(ADP-ribose) polymerase-1 gene (PARP-1), neurotrophic factor (NTF), and Sp1 transcription factor. Vitamin D has also been implicated in PD through its effects on L-type voltage-sensitive calcium channels (L-VSCC), nerve growth factor (NGF), matrix metalloproteinases (MMPs), prostaglandins (PGs) and cyclooxygenase-2 (COX-2), reactive oxygen species (ROS), and nitric oxide synthase (NOS). A growing body of evidence suggests that vitamin D supplementation may be beneficial for PD patients. Among the different forms of vitamin D, calcitriol (1,25-dihydroxyvitamin D3) is best indicated for PD, because it is a highly active vitamin D3 metabolite with an appropriate receptor in the central nervous system (CNS).
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Affiliation(s)
- Khanh L Ng
- Vietnamese American Medical Research Foundation, Westminster, CA 92683, USA
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Abstract
Parkinson disease (PD) is a neurodegenerative disorder characterized by progressive motor and nonmotor impairments. These impairments incline many patients towards a sedentary lifestyle, which has many deleterious consequences. Accumulating evidence suggests that patients with PD might benefit from physical activity and exercise in a number of ways, from general improvements in health to disease-specific effects and, potentially, disease-modifying effects (suggested by animal data). Many issues remain to be addressed, including the need to perform clinical trials to demonstrate these presumed benefits of physical activity and exercise in patients with PD. These trials must also address safety issues, such as an increased risk of falls and cardiovascular complications in more-active patients. Identifying ways to induce a sustained behavioral change, using specifically tailored programs that address potential barriers such as depression, apathy and postural instability, may lead to an improved quality of life in individuals with PD.
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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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Kampman MT, Eriksen EF, Holmøy T. Multiple sclerosis, a cause of secondary osteoporosis? What is the evidence and what are the clinical implications? Acta Neurol Scand 2011; 124:44-9. [PMID: 21711256 DOI: 10.1111/j.1600-0404.2011.01543.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both women and men with multiple sclerosis (MS) are at increased risk of developing osteoporosis. METHODS A non-systematic review of the prevalence,pathogenesis and treatment of osteoporosis in patients with multiple sclerosis. RESULTS MS and osteoporosis share aetiological risk factors such as smoking and hypovitaminosis D, as well as pathogenetic players such as osteopontin and osteoprotegerin. Recently, low bone mineral density (BMD) values have been measured shortly after diagnosis of clinically isolated syndrome and MS and in fully ambulatory persons with MS below 50 years of age. Studies consistently show that BMD at the femoral neck decreases with increasing MS-related disability. Osteoporosis-related fractures cause increased morbidity and mortality and add to the burden of having MS. CONCLUSION We argue that MS, like a number of other chronic diseases, is a cause of secondary osteoporosis. Therefore, bone health assessment should be a part of the integral management of persons with MS. We suggest that BMD be measured shortly after diagnosis, that BMD measurements be repeated depending on BMD values and individual osteoporosis risk profile, and that serum 25-hydroxyvitamin D be monitored. All persons with MS should receive bone health advice.
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Affiliation(s)
- M T Kampman
- Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway.
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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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Malaty IA, Lansang MC, Okun MS. NEUROENDOCRINOLOGIC CONSIDERATIONS IN PARKINSON DISEASE AND OTHER MOVEMENT DISORDERS. Continuum (Minneap Minn) 2009. [DOI: 10.1212/01.con.0000300028.61027.6f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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