Ahn Sung-Ho, Lee Hye Sun, Lee Jun-Hyuk
Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Cachexia Sarcopenia Muscle. 2025 Jun;16(3):e13860. doi: 10.1002/jcsm.13860.
Parkinson's disease (PD) increases fracture risk owing to postural instability and bone fragility, with femur fractures being the most frequent and clinically significant. Many patients with PD experience weight loss as the disease progresses, and low body mass index (BMI) is a well-established fracture risk factor. However, the relationship between longitudinal BMI changes and femur fracture risk in PD remains unclear. We investigated this association using nationwide cohort data.
This retrospective cohort study used data from the Korean National Health Insurance Service (2009-2014). Overall, 19 422 patients newly diagnosed with PD who underwent three consecutive biennial health screenings were included in the analysis. Based on BMI measurements collected over a median exposure period of 4.01 years (2009-2014), changes were identified using Gaussian finite mixture modelling, classifying participants into two groups: stable BMI (n = 16 839) and decreasing BMI (n = 2583). The primary outcome was new-onset femur fracture, defined as hospitalization with the International Classification of Diseases (Tenth Revision) code S72, identified between 2015 and 2022. Multivariable Cox proportional hazard regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for new-onset femur fracture in the decreasing BMI group compared to the stable group.
The mean age of participants was 65.6 ± 8.8 years, 57.0% were women, and the average baseline BMI was 24.2 ± 3.0 kg/m. Compared with the stable group, the decreasing BMI group was older, had a higher baseline BMI, and a lower proportion of current drinkers and regular exercisers. The proportion of women and the prevalence of obesity, hypertension, type 2 diabetes, dyslipidaemia and osteoporosis were also higher in the decreasing group. During a median follow-up of 8.46 years, 1156 femur fractures occurred. The incidence rate was higher in the decreasing BMI group than in the stable group (10.50 vs. 7.58 per 1000 person-years). In the unadjusted analysis, the decreasing BMI group exhibited a significantly increased risk of femur fractures (HR 1.41, 95% CI: 1.21-1.65, p < 0.001). The association remained significant after multivariable adjustment, with an HR of 1.20 (95% CI: 1.02-1.41, p = 0.027).
Patients with PD who experience a decline in BMI over time have a higher risk of femur fracture than those with a stable BMI. Monitoring longitudinal changes in BMI among patients with PD may serve as a practical tool for the early identification of fracture risk and the implementation of preventive strategies.
帕金森病（PD）由于姿势不稳和骨质脆弱而增加骨折风险，其中股骨骨折最为常见且具有临床意义。许多PD患者在疾病进展过程中会出现体重减轻，低体重指数（BMI）是公认的骨折危险因素。然而，PD患者BMI的纵向变化与股骨骨折风险之间的关系仍不清楚。我们使用全国队列数据调查了这种关联。
这项回顾性队列研究使用了韩国国民健康保险服务（2009 - 2014年）的数据。总体而言，19422例新诊断为PD且连续接受三次两年一次健康筛查的患者纳入分析。基于在中位暴露期4.01年（2009 - 2014年）收集的BMI测量值，使用高斯有限混合模型确定变化情况，将参与者分为两组：BMI稳定组（n = 16839）和BMI下降组（n = 2583）。主要结局是新发股骨骨折，定义为因国际疾病分类（第十版）编码S72住院，在2015年至2022年期间确定。多变量Cox比例风险回归分析用于估计BMI下降组与稳定组相比新发股骨骨折的风险比（HR）和95%置信区间（CI）。
参与者的平均年龄为65.6±8.8岁，57.0%为女性，平均基线BMI为24.2±3.0kg/m²。与稳定组相比，BMI下降组年龄更大，基线BMI更高，当前饮酒者和定期锻炼者的比例更低。下降组中女性比例以及肥胖、高血压、2型糖尿病、血脂异常和骨质疏松症的患病率也更高。在中位随访8.46年期间，发生了1156例股骨骨折。BMI下降组的发病率高于稳定组（每1000人年分别为10.50和7.58）。在未调整分析中，BMI下降组股骨骨折风险显著增加（HR 1.41，95%CI：1.21 - 1.65，p < 0.001）。多变量调整后该关联仍然显著，HR为1.20（95%CI：1.02 - 1.41，p = 0.027）。
随着时间推移BMI下降的PD患者比BMI稳定的患者发生股骨骨折的风险更高。监测PD患者BMI的纵向变化可能是早期识别骨折风险和实施预防策略的实用工具。
