Aithal Shridhar, Sequeira Ruford, Edwards Chris, Singh Inderpal
Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
Geriatric Medicine, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
Geriatrics (Basel). 2017 May 24;2(2):17. doi: 10.3390/geriatrics2020017.
The risk of falls is higher in patients with Parkinsonism (PwP) as compared to other older adults, leading to adverse outcomes including fragility fractures. Osteoporosis is under-recognised and the current prevalence of fragility fractures is not well-studied. The objectives of this study are to determine the prevalence of fragility fractures in PwP, to measure the relationship of fractures with demography, severity and to measure predictors of adverse outcomes in this population. This was a retrospective observational cohort study based on the analysis of existing data for all the patients attending Caerphilly Movement Disorder Clinic. Information on demographics, the severity of Parkinsonism and fragility fractures was extracted electronically from the clinical workstation, clinic letters and coding from January 2015 to October 2016. 397 people (mean age = 77.1 ± 9.4, 46% females) were studied. Of these, 77% (306/397) had Parkinsonism and 80% (244/306) had idiopathic Parkinson's disease (PD). The mean Hoehn & Yahr Score at the time assessment was 3.09 ± 1.16. Additionally, 23.5% (72/306) were deemed to have osteoporosis based on the radiological evidence of fragility fractures. The PwP who sustained fractures were comparatively older (80.4 ± 12.1) and 70% (50/72) were females. The most common site for fractures was vertebral (47.2%; 34/72). Also, 22.2% of the sample (16/72) had suffered a fragility fracture before the diagnosis of PD. However, a majority (77.8%; 56/72) had sustained a fracture during the course of PD with a mean lapse of 6 years (range = 0⁻13 years) from initial diagnosis. Only 40% (29/72) of patients were prescribed osteoporosis drugs as per guidelines. There is a significant correlation of advancing age, severity and duration of PD with fragility fractures. The single best predictor of mortality is severity of PD, followed by age and fractures. There is a high prevalence of fragility fractures in patients attending movement disorder clinics, although 60% do not receive evidence-based medical treatment for the underlying osteoporosis. The prevalence of fragility fractures is positively correlated with the duration and severity of PD. We acknowledge the relatively small sample size as the study's limitation.
与其他老年人相比，帕金森症患者（PwP）跌倒风险更高，会导致包括脆性骨折在内的不良后果。骨质疏松症未得到充分认识，目前脆性骨折的患病率也未得到充分研究。本研究的目的是确定PwP中脆性骨折的患病率，测量骨折与人口统计学、严重程度的关系，并测量该人群不良后果的预测因素。这是一项回顾性观察队列研究，基于对卡菲利运动障碍诊所所有就诊患者现有数据的分析。从临床工作站、诊所信件和编码中以电子方式提取了2015年1月至2016年10月期间的人口统计学、帕金森症严重程度和脆性骨折信息。共研究了397人（平均年龄=77.1±9.4岁，46%为女性）。其中，77%（306/397）患有帕金森症，80%（244/306）患有特发性帕金森病（PD）。评估时的平均Hoehn & Yahr评分为3.09±1.16。此外，根据脆性骨折的放射学证据，23.5%（72/306）被认为患有骨质疏松症。发生骨折的PwP年龄相对较大（80.4±12.1岁），70%（50/72）为女性。最常见的骨折部位是椎体（47.2%；34/72）。此外，22.2%的样本（16/72）在PD诊断之前就发生过脆性骨折。然而，大多数（77.8%；56/72）在PD病程中发生了骨折，从初始诊断起平均间隔6年（范围=0至13年）。只有40%（29/72）的患者按照指南服用了骨质疏松症药物。年龄增长、PD严重程度和病程与脆性骨折之间存在显著相关性。死亡率的最佳单一预测因素是PD严重程度，其次是年龄和骨折。在运动障碍诊所就诊的患者中，脆性骨折的患病率很高，尽管60%的患者未接受针对潜在骨质疏松症的循证医学治疗。脆性骨折的患病率与PD的病程和严重程度呈正相关。我们承认样本量相对较小是本研究的局限性。
