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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 520-521
Early Loss of Bone Mineral Density in Parkinson's Disease Patients
Jasmine Parihar1, Vinay Goyal2
1 Department of Neurology, Lady Hardinge Medical College, New Delhi, India
2 Department of Neurology, Medanta, The Medicity, Gurugram, Haryana, India
|Date of Submission||11-Jun-2020|
|Date of Decision||12-Jun-2020|
|Date of Acceptance||21-Jun-2020|
|Date of Web Publication||24-Apr-2021|
Director Neurology, Medanta, The Medicity, Gurugram - 263 153, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Parihar J, Goyal V. Early Loss of Bone Mineral Density in Parkinson's Disease Patients. Neurol India 2021;69:520-1
We read the article by Ozturk et al., and commentary by Singh and Garg with great interest. This small study validates an already known fact from previous studies., We want to add the following points regarding osteoporosis in Parkinson's disease (PD).
A multi-centric cohort study (The Global Longitudinal Study of Osteoporosis in Women) found PD to be the most vital single contributor to fracture risk compared with other studied factors [age-adjusted hazard ratio: 2:2; 95% CI (1.6, 3.1); P < 0.001].
A systematic review and meta-analysis evaluated 23 studies to find the relationship of PD with osteoporosis, bone mineral density (BMD), and fracture risk. This study found that PD patients had significantly lower BMD than controls; overall combined mean difference, −0.06; 95% CI [−0.08, −0.03]. The PD patients were thus at higher risk of osteoporosis [OR 2.61; 95% CI (.69, 4.03)] and fractures [OR 2.28; 95% CI (1.83, 2.83)] compared with healthy controls. It also reported females at a higher risk for osteoporosis and osteopenia than male patients [OR 0.45; 95% CI (0.29, 0.68)].
Yet another meta-analysis of 15 studies indicated that PD patients are at a higher risk for osteoporosis [OR 1.18, 95% CI (1.09, 1.27)] than healthy controls. However, this study found a higher risk for osteoporosis in males than females [OR 2.44; 95% CI (1.37, 4.34) vs. 1.16; 95% CI (1.07, 1.26), respectively].
There is sufficient evidence to suggest low bone mineral density and low vitamin D levels in the early stages of PD. Ozturk et al. reported significantly lower lumbar and femoral BMD values and serum vitamin D levels in patients with PD in stages as early as 1–1.5 when compared to controls, concluding the need for early screening. Singh and Garg also highlighted the importance of early screening for osteoporosis in PD.
Kao et al. found no significant difference in osteoporosis prevalence in different stages of PD. 55% of patients in stages 1–2 and 82% of those in stages >2 had severe osteoporosis. A study by Wood et al., with 105 patients, also found no significant effect of PD duration on osteoporosis. In this study, 34 out of 44 patients with PD and osteoporosis were in stages 1–2.
Hence the need for early screening for osteoporosis is justified for all patients with PD. Early diagnosis is crucial for the timely management and prevention of fractures in these patients who are predisposed to falls.
This is yet to be evaluated that will supplementation of vitamin D and calcium in these patients will reduce the incidence of fractures, which is the main reason to worry about while treating osteoporosis.
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Conflicts of interest
There are no conflicts of interest.
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