Invernizzi Marco, Carda Stefano, Viscontini Giovanni Sguazzini, Cisari Carlo
Department of Clinical and Experimental Medicine - SCDU Medicina Fisica e Riabilitativa AOU Maggiore della Carità, Novara, Italy.
Parkinsonism Relat Disord. 2009 Jun;15(5):339-46. doi: 10.1016/j.parkreldis.2009.02.009. Epub 2009 Apr 5.
Patients affected by Parkinson's disease are at a high risk for fractures, mainly of the hip. These fractures are caused by falls due to postural imbalance, neurological impairment and reduced bone mass. The purpose of this study was (1) to investigate the correlations and the pathophysiological mechanisms underlying bone loss in Parkinson's disease and appraise bone loss or fracture risk reduction interventions; (2) to develop a research agenda that informs the design and development of risk reduction strategies. Osteoporosis and osteopenia are very common findings in patients with Parkinson's disease, affecting up to 91% of women and 61% of men. Reduced bone mass in Parkinsonian patients seems to be caused mainly by reduced mobility through a mechanism similar to that observed in other neurological diseases. Endocrine (such as vitamin D deficiency), nutritional and iatrogenic factors also play an important role in bone mass depletion. Female gender, disease duration and severity (Hoehn and Yahr stages III and IV), old age and low body mass index are related to more severe osteoporosis. Vitamin D supplementation and bisphosphonates seem to be effective in reducing the risk of nonvertebral fractures in patients affected by Parkinson's disease. Prevention and evaluation of osteoporosis through bone mass density assessment should be considered in all patients with Parkinson's disease.
帕金森病患者骨折风险很高，主要是髋部骨折。这些骨折是由姿势失衡、神经功能损害和骨量减少导致的跌倒引起的。本研究的目的是：（1）调查帕金森病骨丢失的相关性及潜在病理生理机制，并评估减少骨丢失或骨折风险的干预措施；（2）制定一项研究议程，为降低风险策略的设计和开发提供依据。骨质疏松症和骨质减少在帕金森病患者中非常常见，影响高达91%的女性和61%的男性。帕金森病患者骨量减少似乎主要是由于活动能力下降，其机制与其他神经疾病中观察到的类似。内分泌（如维生素D缺乏）、营养和医源性因素在骨量减少中也起重要作用。女性、疾病持续时间和严重程度（Hoehn和Yahr分期III和IV期）、老年和低体重指数与更严重的骨质疏松症有关。补充维生素D和双膦酸盐似乎对降低帕金森病患者非椎体骨折的风险有效。所有帕金森病患者都应考虑通过骨密度评估来预防和评估骨质疏松症。
