Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Department of Oncology & Metabolism, University of Sheffield, Sheffield, United Kingdom.
Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Sweden; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Bone. 2023 Mar;168:116651. doi: 10.1016/j.bone.2022.116651. Epub 2022 Dec 24.
The relative contributions of factors such as muscle strength, falls risk and low bone mineral density (BMD) to increased fracture risk in Parkinson's Disease (PD) were examined in an analysis of 5212 community-dwelling women age 75 years or more recruited to a randomised, double-blind, placebo-controlled study of the oral bisphosphonate, clodronate. Similar number of PD and non-PD subjects received treatment. Each participant had measurements of hip and forearm BMD, muscle strength (hand grip strength and maximum isometric quadriceps strength), ability in the sit-to-stand test, and postural stability. Incident radiographic and/or surgically verified fractures, and deaths, were recorded over an average follow-up of 3.8 years. A diagnosis of PD was made if it was self-reported and appropriate medication was recorded at the study entry. 47 of the women (0.9 %) had a diagnosis of PD at baseline. They were of similar age to those without PD, but reported higher disability scores and lower quality of life. While BMD at the forearm and hip regions was lower in PD, this only reached statistical significance at the femoral neck (0.61 ± 0.12 vs 0.65 ± 0.12 g/cm, p = 0.037). Right hand grip strength was non-significantly lower in PD, but maximum right quadriceps strength was much reduced (96.9 ± 49.3 vs 126.3 ± 59.2 N, p = 0.003). Eleven (23.4 %) of the women with PD sustained 12 fractures, while 609 women (11.8 %) without PD sustained 742 osteoporotic fractures. The risk of osteoporotic fracture associated with PD was 2.24-fold higher in women with PD (Cox-regression HR 2.24, 95 % CI 1.23-4.06) and this remained high when adjusted for death as a competing risk (2.17, 95 % CI 1.17-4.01, p = 0.013). Following adjustment for femoral neck BMD, PD remained a significant predictor of fracture (HR 2.04, 1.12-3.70, p = 0.020). Entering PD as a risk variable using the rheumatoid arthritis input as a surrogate resulted in a reduction in PD as a FRAX-independent risk factor, particularly when BMD was included in FRAX (1.65, 95 % CI), but the relationship between PD and fracture risk appears to remain of clinical significance. The study suggests that PD may be an independent input in future iterations of FRAX, possibly due to non-skeletal components of risk such as reduced lower limb muscle strength. Introducing measures of muscle strength and performance in FRAX could also be considered.
研究人员分析了 5212 名 75 岁或以上的社区居住女性的资料，这些女性参与了一项针对口服双膦酸盐氯屈膦酸盐的随机、双盲、安慰剂对照研究。研究中，相同数量的帕金森病（PD）和非 PD 患者接受了治疗。每位参与者都接受了髋关节和前臂骨密度、肌肉力量（手握力和最大等长股四头肌力量）、坐站测试能力和姿势稳定性的测量。平均随访 3.8 年后，记录了新发生的放射性和/或手术证实的骨折和死亡情况。如果患者自我报告并在研究入组时记录了适当的药物治疗，则诊断为 PD。47 名女性（0.9%）在基线时被诊断为 PD。她们与没有 PD 的女性年龄相仿，但报告的残疾评分更高，生活质量更低。尽管 PD 患者的前臂和髋部骨密度较低，但只有股骨颈部位的骨密度差异具有统计学意义（0.61±0.12 比 0.65±0.12g/cm，p=0.037）。PD 患者右手握力略低，但右侧股四头肌力量显著降低（96.9±49.3 比 126.3±59.2N，p=0.003）。11 名（23.4%）PD 患者发生了 12 处骨折，而 609 名无 PD 患者发生了 742 处骨质疏松性骨折。PD 患者发生骨质疏松性骨折的风险是无 PD 患者的 2.24 倍（Cox 回归 HR 2.24，95%CI 1.23-4.06），当调整死亡作为竞争风险时，这种风险仍然很高（2.17，95%CI 1.17-4.01，p=0.013）。在调整股骨颈骨密度后，PD 仍然是骨折的一个显著预测因素（HR 2.04，1.12-3.70，p=0.020）。将 PD 作为风险变量输入，使用类风湿关节炎输入作为替代物，可降低 PD 作为 FRAX 独立危险因素的作用，尤其是在 FRAX 中包含骨密度时（1.65，95%CI），但 PD 与骨折风险之间的关系似乎仍具有临床意义。该研究表明，PD 可能是 FRAX 未来迭代中的一个独立输入，这可能是由于风险的非骨骼成分，如下肢肌肉力量下降。在 FRAX 中引入肌肉力量和表现的测量也可以考虑。
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