Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Calcif Tissue Int. 2010 Feb;86(2):132-41. doi: 10.1007/s00223-009-9327-6. Epub 2010 Jan 5.
Parkinson's disease (PD) patients have been reported to have lower bone mineral density (BMD) and higher fracture risk than individuals without PD. We assessed the association between hyperhomocysteinemia due to levodopa intake and BMD in PD patients. We measured serum homocysteine (Hcy) concentrations and BMD in the proximal femur and lumbar spine of PD patients aged 55 years or older (n = 95) and three age-/gender-matched control subjects (n = 285). The prevalence of osteoporosis was higher in both men (2.5-fold) and women (1.7-fold) with PD than in controls, and adjusted odds ratios for osteoporosis were 3.57 (95% confidence interval [CI], 1.25-10.20) for men and 2.54 for women (95% CI, 1.31-4.93) with PD. Serum Hcy concentrations were significantly higher in PD patients (median = 13.0 micromol/l) than controls (median = 11.5 micromol/l) (P = 0.005). Serum Hcy concentrations were independently associated with BMD values at all proximal femur sites in all subjects (P = 0.005 to 0.012). In PD patients, higher serum Hcy concentrations were independently associated with higher fracture risk (P = 0.029). PD patients taking higher doses of levodopa had significantly higher serum Hcy concentrations (P = 0.013), and greater levodopa intake was associated with lower BMD values in some areas (P = 0.008 to 0.029). In conclusion, these findings indicate that hyperhomocysteinemia due to levodopa intake may be one additional risk factor for osteoporosis and fracture in PD patients. Reducing Hcy may be a therapeutic modality for treating osteoporosis in PD patients taking levodopa.
帕金森病（PD）患者的骨密度（BMD）低于非 PD 患者，骨折风险更高。我们评估了左旋多巴摄入引起的高同型半胱氨酸血症与 PD 患者 BMD 的关系。我们测量了 95 名 55 岁及以上 PD 患者和 285 名年龄/性别匹配对照者的血清同型半胱氨酸（Hcy）浓度和股骨近端及腰椎 BMD。PD 患者中骨质疏松的患病率男性（2.5 倍）和女性（1.7 倍）均高于对照组，PD 患者骨质疏松的调整后比值比分别为男性 3.57（95%可信区间 [CI]，1.25-10.20）和女性 2.54（95%CI，1.31-4.93）。PD 患者的血清 Hcy 浓度明显高于对照组（中位数=13.0μmol/L）（中位数=11.5μmol/L）（P=0.005）。血清 Hcy 浓度与所有受试者股骨近端各部位的 BMD 值独立相关（P=0.005 至 0.012）。在 PD 患者中，较高的血清 Hcy 浓度与较高的骨折风险独立相关（P=0.029）。服用较高剂量左旋多巴的 PD 患者的血清 Hcy 浓度显著升高（P=0.013），左旋多巴摄入量与某些部位的 BMD 值降低有关（P=0.008 至 0.029）。总之，这些发现表明，左旋多巴摄入引起的高同型半胱氨酸血症可能是 PD 患者骨质疏松和骨折的另一个危险因素。降低 Hcy 可能是治疗服用左旋多巴的 PD 患者骨质疏松症的一种治疗方法。
