Naylor Katie C, Tenis On Emma, Hardcastle Sarah A, Lyell Veronica, Gregson Celia L, Henderson Emily J
Ageing and Movement Research Group, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, UK.
Age Ageing. 2025 Mar 3;54(3). doi: 10.1093/ageing/afaf052.
In Parkinson's disease (PD), the propensity to fall and the higher risk of osteoporosis converge yielding a high fracture risk. Updated National Osteoporosis Guideline Group (NOGG) guidance recommends that PD should trigger a risk assessment, for example using the FRAX tool, yet clinical pathways remain sub-optimal. To address this, we generated an algorithm for the assessment and management of bone health specifically in PD.
Within the Proactive and Integrated Management and Empowerment in Parkinson's Disease randomised controlled trial (PRIME-UK RCT), bone-health metrics were collected, and all participants were offered a dual X-ray absorptiometry scan. The FRAX tool was used to obtain the 10-year probability of hip and major osteoporotic fracture (MOF), and the resulting NOGG risk-category recorded. Probabilities were recalculated including femoral-neck bone mineral density (FN-BMD) and/or with numeric adjustment for recurrent falls, and results compared.
Among 182 people with parkinsonism (mean age 73.8 years, 65% male, median disease duration 5 years), 28% reported a prior fragility fracture, and 40.7% recurrent falls over the previous year. 28.6% had MOF above NOGG intervention thresholds (IT); whilst 12.1% had a FN-BMD T-Score ≤ -2.5. Recalculation of FRAX with FN-BMD (n = 182) reduced fracture MOF and hip fracture probabilities; 12 (6.6%) deescalated below the IT, and 16 (8.8%) moved above the IT.
This 2024 BONE-PARK algorithm is informed by both the latest NOGG Guidelines and novel findings in a 'real-world' population. The algorithm will aid bone health assessment for people with PD.
在帕金森病（PD）中，跌倒倾向和较高的骨质疏松风险共同导致了高骨折风险。更新后的国家骨质疏松指南小组（NOGG）指南建议，PD应引发风险评估，例如使用FRAX工具，但临床路径仍未达到最佳状态。为了解决这一问题，我们生成了一种专门用于PD患者骨健康评估和管理的算法。
在帕金森病主动综合管理与赋权随机对照试验（PRIME-UK RCT）中，收集骨健康指标，并为所有参与者提供双能X线吸收测定扫描。使用FRAX工具获得髋部和主要骨质疏松性骨折（MOF）的10年概率，并记录由此得出的NOGG风险类别。重新计算概率，包括股骨颈骨密度（FN-BMD）和/或对反复跌倒进行数值调整，并比较结果。
在182名帕金森综合征患者中（平均年龄73.8岁，65%为男性，疾病中位持续时间5年），28%报告有既往脆性骨折，40.7%在过去一年中有反复跌倒。28.6%的患者MOF高于NOGG干预阈值（IT）；而12.1%的患者FN-BMD T值≤-2.5。用FN-BMD重新计算FRAX（n = 182）降低了骨折MOF和髋部骨折概率；12人（6.6%）降至IT以下，16人（8.8%）升至IT以上。
这种2024年的BONE-PARK算法既参考了最新的NOGG指南，也借鉴了“真实世界”人群中的新发现。该算法将有助于PD患者的骨健康评估。
