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Dual-energy X-ray absorptiometry (DXA) imaging of BMD in a male PD patient: (A) the whole body, (B) spine, and (C) left hip. (a–c) The patients’ BMD vs. a male Chinese control of the whole body (a), spine (b), and left hip (c). In (a–c), the first cure line stands for baseline in the different ages; the second cure line stands for the boundary between normal BMD and osteopenia; the third cure line stands for the boundary between osteopenia and osteoporosis, and the round dot stands for the patients’ BMD.
Source publication
Key points:
Significantly lower BMD in PD compared to healthy subjects in both genders.Less than 35 mg(2)/dl(2) of Ca-P product in >80% of PD patients.Significant correlations between BMD and severity of PD.Lower BMD at H&Y stage III/IV than that at H&Y stage I/II.
Objectives:
Although several lines of evidence have suggested that patients with...
Context in source publication
Citations
... Gao et al. (29) discovered that BMD in PD patients was significantly lower when compared to healthy controls during a cross-sectional study of 54 patients dealing PD and 59 age-matched controls. According to this study, the BMD scores of the total hip, lumbar and the femoral neck were reduced in females compared to males in the healthy group. ...
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.
... Sample size: The sample size estimation was done based on a study by Gao et al. [23] that compared the difference in bone mineral density between cases of Parkinson's disease and healthy controls. Assuming an aBMD of 0.670 g/cm 2 at the neck of femur in cases and 0.740 g/cm 2 in controls and a case-control ratio of 1:1, with 80% power at an alpha error of 5% a total of 42 was required in each group. ...
... On subgroup analysis of PD based on disease severity, we found a significantly lower BMD in the subgroup with more severe disease in comparison with the group with less severe disease and controls. These findings were identical to the previous studies done by Jones et al., [27] and Gao et al. [23] who found significantly declining BMD with increasing severity of Parkinsonism and relatively more BMD loss in patients with worsening mobility and gait instability. ...
... There was no correlation with L-Dopa dosage. Previous studies showed mixed results, with Gao et al. [23] showing a negative correlation with BMD, severity of disease, and also L-Dopa dosage. Jones et al. [32] showed lower BMD with worsening disease stage, and Kao et al. [33] showed a similar correlation between PD and BMI as that in our study. ...
Objective
Parkinson’s disease (PD) is a neurodegenerative condition that is characterized by bradykinesia, rigidity, and gait instability. Inherent to this condition is an increased predisposition to falls and fractures. Bone health in Parkinson’s disease in India has not been studied thus far. This study aimed to assess the bone mineral density (BMD), trabecular bone score (TBS), and hip structural analysis (HSA) in Indian men with PD and compare them with matched controls.
Methodology
A case-control study done at a tertiary care center from southern India. Bone biochemistry, BMD, TBS, and HSA were assessed.
Results
Among 40 cases and 40 age, gender, and body mass index (BMI)-matched controls, there was no significant difference in BMD between both groups. The mean (SD) TBS at the lumbar spine [1.349 (0.090)] was significantly ( P = 0.019) lower in men with PD as compared to matched controls [1.401 (0.089)]. Among the parameters of HSA, the buckling ratios were significantly higher at the femoral neck [11.8 (2.2) vs 9.4 (2.2); P = 0.001] and inter-trochanteric region [9.4 (2.1) vs 7.8 (1.4); P = 0.002] among cases as compared to matched controls. Vitamin D deficiency was significantly higher in this cohort of patients as was bone turnover marker indicating bone loss and a high bone turnover state.
Conclusion
A comprehensive bone health assessment comprising BMD, TBS, and HSA may be required to capture all aspects of bone strength in Indian men with PD as BMD assessment as a stand-alone tool may not suffice to obtain all information pertaining to fracture risk in these individuals.
... Так, ряд авторов показали в наблюдательных исследованиях и метаанализах, что пациенты с болезнью Паркинсона имеют более высокий риск ОП и низкую МПК по сравнению с контролем. При этом оказалось, что тяжесть ОП коррелирует с тяжестью болезни Паркинсона [31,32]. Это объясняется тем, что дофаминовые рецепторы экспрессируются в остеобластах и остеокластах и влияют на гомеостаз костей [33]. ...
BACKGROUND : Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status.
AIM : To аssess comorbidity and geriatric status in elderly and senile patients with and without OP.
MATERIALS AND METHODS : The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 — patients with OP (n=178, 29.3%), group 2 — patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity according to the Charlson index, and a comprehensive geriatric score.
RESULTS : OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age-related diseases such as Alzheimer’s disease, Parkinson’s disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.
The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent.
CONCLUSION : Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.
... In a cross-sectional study, 55.8% of PD cases had sarcopenia compared to only 8.2% of controls 12 . There is also a strong negative correlation of BMD with the severity of PD, particularly for the lumbar spine 13,14 . Similarly, lower BMI, lumbar BMD, and sarcopenia were present in PD cases in the current study. ...
Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.
... Parkinson's disease (PD) is a progressive neurodegenerative basal ganglia syndrome characterized by bradykinesia and rigidity, resulting in limited daily activity and increased fall risk (Latt et al., 2009;Tassorelli et al., 2017). A number of studies have examined impacts of PD on bone, with PD being associated with decreased BMD and increased fracture risk (Vaserman, 2005;Wood and Walker, 2005;Fink et al., 2008;Gnädinger et al., 2011;Raglione et al., 2011;van den Bos et al., 2013;Gao et al., 2015;Sleeman et al., 2016). Meta-analysis indicates PD patients are at a higher risk for osteoporosis and have lower hip, lumbar spine, and femoral neck BMD compared to healthy controls . ...
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.
... In a cross-sectional study, 55.8% of PD cases had sarcopenia compared to only 8.2% of controls [13]. There is also a strong negative correlation of BMD with the severity of PD, particularly for the lumbar spine [14,15]. Similarly, lower BMI, lumbar YAM, and sarcopenia were present in PD cases in the current study. ...
Background
Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common with aging of society. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD) and a higher mechanical failure rate, compared with those with thoracolumbar junction collapse. The aim of this study was to identify differences in clinical and imaging features, and in outcomes of low lumbar OVC with or without PD and to discuss the appropriate treatment for lower lumbar OVC in patients with PD.
Methods
The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. Clinical symptoms, morphological features of affected vertebrae, neurological status, surgical procedures, and complications were compared in patients with and without PD.
Results
The main clinical symptoms were radicular leg pain in non-PD cases (68.8%) and a cauda equina sign in PD cases (72.7%). Rapid progression and destructive changes of OVC were seen in patients with PD at 24.5 ± 10.5 days after injury. The morphological features of OVC were flat-type in non-PD cases with old compression fracture at the thoracolumbar lesion, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar YAM, and severe sarcopenia, all of which can affect postoperative instrumentation-related complications. High postoperative complication rates may be due to vertebral fragility and longer fusion surgery.
Conclusions
Rapid progression and destructive changes of low lumbar OVC may occur in PD patients, and significantly more PD cases have a cauda equina sign and require urgent surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure, especially at an upper adjacent level. Given the progression of PD after surgery, invasive long-fusion surgery should be avoided for single low lumbar OVC. A surgical strategy considering the severities of PD and osteoporosis, and aggressive control of PD before and after surgery are important to prevent complications.
... In PD falls are the first cause of emergency hospitalization and 60% of people with PD fall each year [1,42]. Beside falls, PD is associated with low BMD, accelerated bone loss and BMD is negatively correlated to the severity of PD [24,25,33,[43][44][45][46]. The pathophysiology of OP in PD involved many factors but is yet partly misunderstood as reported in two reviews [11,12]. ...
... This weight change correlated with severity of disease leading to greater nutritional risk than healthy controls [21]. Indeed, accumulating evidence suggests a negative correlation between BMI in PD patients and severity of the disease, aging, comorbidities and higher daily levodopa dosing [22,23]. Previous studies showed that type II Diabetes Mellitus (II DM) is a risk factor for PD and that glucose metabolism alterations are often found in PD patients [5,24,25,26]. ...
... PD patients often present signs of cognitive impairment and they are at a higher risk of dementia aside from the risk of several comorbidities such as depression, anxiety and hallucinations [23,28,29]. Obsessive compulsive behavior and impulse behavior are attributed to the dopamine dysregulation, but these are still not well understood [30,31]. ...
α-Synuclein is a polypeptide encoded by the Snca gene, highly expressed in neurons, but it is also found in bones and adipose tissue. Co-expression analysis showed that Snca regulates skeletal homeostasis, and its deletion reduced estrogen deficiency-induced bone loss and weight gain. It is a major component of Lewy bodies (LB) in Parkinson’s disease (PD), leading to progressive immobilization and a range of nonmotor symptoms, including osteopenia, body composition alterations and insulin resistance. This thesis aimed to determine α-Synuclein’s intrinsic role in bone and adipose homeostasis. We discussed the PD pathophysiology emphasizing aspects of bone health and metabolism. By using in vivo models we showed conditional deletion of Snca in osteoblasts is insufficient to reduce bone loss after estrogen deficiency, however, sufficient to reduce weight gain and decrease marrow adipocyte expansion. Prrx1Cre off-target effects led to decreased in α-Synuclein expression in the brain, decreased serum catecholamines, and behavioral phenotypes. Mutant mice experienced a mild improvement in bone microarchitecture. Although not protected from diet-induced obesity, mutants showed smaller adipocytes in the inguinal fat, decreased adipogenesis and higher oxidative capacity, however, decreased insulin sensitivity. Interestingly, AdipoCre;Sncafl/fl mice showed no significant increase in inguinal adipose accrual, decreased weight gain and increased insulin sensitivity. In vitro models of loss of α-Synuclein led to fragmented mitochondria, decreased adipogenesis, and pAKT and, increased levels of AKT, pIRβ and pSHC. Mutated α-Synuclein overexpression (A53Ttg/tg) led to higher adipogenesis, mitochondria size and increased levels of pAKT/AKT. There was no change in colocalization of α-Synuclein to mitochondria in cells with differential α-Synuclein expression. After insulin treatment, α-Synuclein relocated to the nuclei in controls, however, this response was not seen in A53Ttg/tg. This work showed α-Synuclein regulates adipose tissue cell autonomously and it does affect, mildly, bone microarchitecture through its actions on osteoblasts. Moreover, we showed α-Synuclein regulates insulin response by affecting the levels of pAKT/AKT and phosphorylated insulin receptor β. Future research is essential to understand the local and systemic effects of α-Synuclein signaling on bone remodeling and adipose metabolism to shed light into possible treatment targets for osteoporosis and insulin resistance in PD patients.
... In addition to proper management of the DRF, detailed workup for osteoporosis and fall prevention measures are essential for PD patients to reduce postoperative complications. Since the bone mineral density in patients with PD is lower compared with healthy controls, appropriate medications such as bisphosphonates and denosumab should be initiated once osteoporosis is confirmed [18]. ...
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.
... Since the bone mineral density in patients with PD is lower compared with healthy controls, appropriate medications such as bisphosphonates and denosumab should be initiated once osteoporosis is confirmed. 18 There are several limitations in this study. This was a retrospective medical record review which may have certain bias due to the nature of the study design. ...
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 through 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 evidence: Level IV, Retrospective Cohort Study Keywords: Parkinson’s disease, distal radial fractures, osteoporosis, fracture nonunion Disclosure: We do not have any disclosures or conflicts of interest
