Melton L Joseph, Leibson Cynthia L, Achenbach Sara J, Bower James H, Maraganore Demetrius M, Oberg Ann L, Rocca Walter A
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Mov Disord. 2006 Sep;21(9):1361-7. doi: 10.1002/mds.20946.
In an inception cohort of 196 Olmsted County, Minnesota, residents with Parkinson's disease (PD) first recognized in 1976 to 1995, we tested whether the increased risk of bone fractures is associated with concomitant dementia. Using the data resources of the Rochester Epidemiology Project, information about PD, dementia, other clinical risk factors for fracture and fracture events was obtained from review of complete inpatient and outpatient medical records spanning each subject's residence in the community. Compared to an equal number of age- and sex-matched non-PD referent subjects from the community, PD patients were at a 2.2-fold increased risk of fractures generally and a 3.2-fold greater risk of hip fractures specifically. Adjusting for age, the independent predictors of overall fracture risk in the PD subjects included female sex (hazard ratio [HR] 1.6; 95% confidence interval [CI], 1.1-2.3), dementia (HR, 1.6; 95% CI, 1.1-2.4) and chronic depression, which was associated with a reduced risk (HR, 0.4; 95% CI, 0.2-0.8). Hip fractures were predicted by dementia (HR, 2.2; 95% CI, 1.2-4.1). The increased fracture risk in patients with PD is not entirely explained by concomitant dementia, and additional study is needed to determine the relative contributions to fracture risk of falls versus bone loss in these patients.
在明尼苏达州奥尔姆斯特德县196名于1976年至1995年首次确诊为帕金森病（PD）的居民起始队列中，我们测试了骨折风险增加是否与同时存在的痴呆症有关。利用罗切斯特流行病学项目的数据资源，通过查阅涵盖每位受试者社区居住期间完整的住院和门诊医疗记录，获取了有关PD、痴呆症、其他骨折临床风险因素及骨折事件的信息。与来自社区中年龄和性别匹配的同等数量非PD对照受试者相比，PD患者总体骨折风险增加2.2倍，髋部骨折风险尤其增加3.2倍。校正年龄后，PD受试者总体骨折风险的独立预测因素包括女性（风险比[HR]1.6；95%置信区间[CI]，1.1 - 2.3）、痴呆症（HR，1.6；95%CI，1.1 - 2.4）和慢性抑郁症，慢性抑郁症与风险降低相关（HR，0.4；95%CI，0.2 - 0.8）。髋部骨折由痴呆症预测（HR，2.2；95%CI，1.2 - 4.1）。PD患者骨折风险增加并非完全由同时存在的痴呆症解释，需要进一步研究以确定跌倒与骨质流失对这些患者骨折风险的相对影响。
