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Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 520-521

Early Loss of Bone Mineral Density in Parkinson's Disease Patients


1 Department of Neurology, Lady Hardinge Medical College, New Delhi, India
2 Department of Neurology, Medanta, The Medicity, Gurugram, Haryana, India

Date of Submission11-Jun-2020
Date of Decision12-Jun-2020
Date of Acceptance21-Jun-2020
Date of Web Publication24-Apr-2021

Correspondence Address:
Vinay Goyal
Director Neurology, Medanta, The Medicity, Gurugram - 263 153, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314582

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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

How to cite this URL:
Parihar J, Goyal V. Early Loss of Bone Mineral Density in Parkinson's Disease Patients. Neurol India [serial online] 2021 [cited 2021 May 11];69:520-1. Available from: https://www.neurologyindia.com/text.asp?2021/69/2/520/314582




Sir,

We read the article by Ozturk et al.,[1] and commentary by Singh and Garg[2] with great interest. This small study validates an already known fact from previous studies.[3],[4] 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].[5]

A systematic review and meta-analysis evaluated 23 studies to find the relationship of PD with osteoporosis, bone mineral density (BMD), and fracture risk.[6] 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].[7]

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.[1] Singh and Garg also highlighted the importance of early screening for osteoporosis in PD.[2]

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.[3] A study by Wood et al., with 105 patients, also found no significant effect of PD duration on osteoporosis.[4] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ozturk EA, Gundogdu I, Tonuk B, Umay E, Kocer BG, Cakci A. Bone mineral density and serum vitamin D status in Parkinson's disease: Are the stage and clinical features of the disease important? Neurol India 2020;68:394-400.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Singh M, Garg K. Osteoporosis in Parkinson's disease – need of screening in early stages. Neurol India 2020;68:401-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kao CH, Chen CC, Wang SJ, Yeh SH. Bone mineral density in patients with Parkinson's disease measured by dual photon absorptiometry. Nucl Med Com 1994;15:173-7.  Back to cited text no. 3
    
4.
Wood B, Walker R. Osteoporosis in Parkinson's disease. Mov Disord 2005;20:1636-40.  Back to cited text no. 4
    
5.
Dennison EM, Compston JE, Flahive J, Siris ES, Gehlbach SH, Adachi JD, et al. Effect of co-morbidities on fracture risk: Findings from the global longitudinal study of osteoporosis in women (GLOW). Bone 2012;50:1288-93.  Back to cited text no. 5
    
6.
Torsney KM, Noyce AJ, Doherty KM, Bestwick JP, Dobson R, Lees AJ, et al. Bone health in Parkinson's disease: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2014;85:1159-66.  Back to cited text no. 6
    
7.
Zhao Y, Shen L, Ji HF. Osteoporosis risk and bone mineral density levels in patients with Parkinson's disease: A meta-analysis. Bone 2013;52:498-505.  Back to cited text no. 7
    




 

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