Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea.
Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
Osteoporos Int. 2018 May;29(5):1117-1124. doi: 10.1007/s00198-018-4409-9. Epub 2018 Feb 19.
Patients with Parkinson's disease (PD) were at higher risk of osteoporotic vertebral compression fractures (OVCF) compared to controls and had elevated mortality rates. Compared to conservative treatment, surgical treatment for OVCF in PD patients seemed to be associated with better outcomes.
The purpose of this study was to evaluate the risk of OVCF in patients with PD.
Data from patients over the age of 60 years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease.
OVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21-1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47-1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78-4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment.
Patients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.
本研究旨在评估帕金森病（PD）患者发生骨质疏松性椎体压缩性骨折（OVCF）的风险。
本研究收集了 2004 年至 2013 年间年龄在 60 岁以上被诊断为 PD 的患者的数据，这些数据来自韩国国家健康保险数据库（n=3370）。对照组（非 PD 组）由每年根据年龄和性别随机选择的与 PD 组相匹配的患者（每例 PD 患者 5 例；n=16850）组成。采用 Cox 比例风险回归分析评估骨质疏松症、OVCF、OVCF 手术与 PD 之间的关系。还评估了患者的家庭收入和居住地区。调整高血压、糖尿病和慢性肾脏病等混杂因素后，计算总生存率。
PD 组中有 12.5%的患者发生 OVCF，对照组中有 7.4%的患者发生 OVCF。PD 与骨质疏松症（风险比[HR]，1.32；95%置信区间[CI]，1.21-1.43；p<0.001）、OVCF（HR 1.66；95%CI，1.47-1.87；p<0.001）和 OVCF 手术（HR 2.69；95%CI，1.78-4.08；p<0.001）的风险增加相关。家庭收入与骨质疏松症、OVCF 或 OVCF 手术的发生无显著相关性。居住地区与骨质疏松症、OVCF 和 OVCF 手术有统计学上的相关性。调整潜在混杂因素后，PD 组的死亡率约为非 PD 组的 1.7 倍，PD 伴 OVCF 组的死亡率高于非 PD 组，但差异无统计学意义（p=0.09）。与保守治疗相比，PD 伴 OVCF 患者接受 OVCF 手术的生存率有更好的预后趋势。
PD 患者发生骨质疏松症和 OVCF 的风险显著增加。与保守治疗相比，PD 患者的 OVCF 手术治疗预后更好。
