Parkinson's Disease and Low Bone Density and Falls in Older Men
Parkinson's Disease and Low Bone Density and Falls in Older Men
Objectives: To examine the association between Parkinson's disease (PD) and bone mineral density (BMD) and risk of falls.
Design: Cross-sectional and prospective cohort study.
Setting: Six U.S. clinical centers.
Participants: Five thousand nine hundred ninety-five community-dwelling, ambulatory men aged 65 and older.
Measurements: History of physician-diagnosed PD was ascertained from participant self-report. BMD was measured at the hip and spine using dual energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). Incident falls were ascertained for 1 year using mailed queries.
Results: Fifty-two participants (0.9%) reported a history of PD. In multivariate models, PD was associated with significantly lower BMD at the spine (-4.9%, P=.04) and total hip (-5.3%, P=.007) using DEXA and at the spine (-6.7%, P=.05) and total hip (-8.2%, P=.03) using QCT. PD was associated with a nearly three times greater age-adjusted risk of multiple future falls (odds ratio (OR)=2.91, 95% confidence interval (CI)=1.55-5.46). Further adjustment for history of multiple falls in the year before baseline attenuated this risk, but it remained significant (OR=2.30, 95% CI=1.15-4.59).
Conclusion: In this cohort of older men, PD was associated with lower BMD at the hip and spine, measured using areal and volumetric BMD, as well as increased falls. Clinicians should consider screening older men with PD for osteoporosis.
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder characterized by tremor, muscular rigidity, slowness of movement, and postural imbalance. PD increases in prevalence with age, rising from 0.6% in those aged 65 to 69 years to nearly 3% in those older than 80.
Case-control and retrospective data suggest that PD increases risk for fractures. A recent prospective study reported that PD more than doubled hip fracture risk, with this risk possibly being dependent on age and bone mineral density (BMD). An association between PD and fractures could be partially attributable to an increased fall risk in individuals with PD. In one prospective cohort study, nursing home residents with Parkinsonism had a 2.5 times greater odds of experiencing one or more falls, whereas in another, of community-dwellers with a history of falling, those with PD had nearly 10 times the risk of multiple falls.
Results from case-control studies have suggested an association between PD and lower BMD, which, if present, could affect PD patients' fracture risk independent of a risk attributable to falls. Although nearly all these studies found a negative association between PD and bone measures, half evaluated bone parameters not in wide clinical use, and none reported significant associations at more than one skeletal site. In addition, although the case-control design of earlier studies makes their findings prone to selection bias, these studies did not account for factors other than age and sex that might have explained an observed association between PD and BMD.
Therefore, it was desired to investigate further the association between PD and BMD in a large cohort of older community-dwelling men. Whether participants had been diagnosed with PD was determined, and their bone status was assessed at multiple skeletal sites using areal and volumetric BMD. Data on risk factors for PD and bone health were collected, and analyses were performed to determine whether observed associations between PD and BMD were independent of possibly confounding factors. Finally, participants were followed for incident falls for 1 year after baseline, and analyses were performed to determine whether PD independently predicted future falls after adjustment for potential confounding factors.
Objectives: To examine the association between Parkinson's disease (PD) and bone mineral density (BMD) and risk of falls.
Design: Cross-sectional and prospective cohort study.
Setting: Six U.S. clinical centers.
Participants: Five thousand nine hundred ninety-five community-dwelling, ambulatory men aged 65 and older.
Measurements: History of physician-diagnosed PD was ascertained from participant self-report. BMD was measured at the hip and spine using dual energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). Incident falls were ascertained for 1 year using mailed queries.
Results: Fifty-two participants (0.9%) reported a history of PD. In multivariate models, PD was associated with significantly lower BMD at the spine (-4.9%, P=.04) and total hip (-5.3%, P=.007) using DEXA and at the spine (-6.7%, P=.05) and total hip (-8.2%, P=.03) using QCT. PD was associated with a nearly three times greater age-adjusted risk of multiple future falls (odds ratio (OR)=2.91, 95% confidence interval (CI)=1.55-5.46). Further adjustment for history of multiple falls in the year before baseline attenuated this risk, but it remained significant (OR=2.30, 95% CI=1.15-4.59).
Conclusion: In this cohort of older men, PD was associated with lower BMD at the hip and spine, measured using areal and volumetric BMD, as well as increased falls. Clinicians should consider screening older men with PD for osteoporosis.
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder characterized by tremor, muscular rigidity, slowness of movement, and postural imbalance. PD increases in prevalence with age, rising from 0.6% in those aged 65 to 69 years to nearly 3% in those older than 80.
Case-control and retrospective data suggest that PD increases risk for fractures. A recent prospective study reported that PD more than doubled hip fracture risk, with this risk possibly being dependent on age and bone mineral density (BMD). An association between PD and fractures could be partially attributable to an increased fall risk in individuals with PD. In one prospective cohort study, nursing home residents with Parkinsonism had a 2.5 times greater odds of experiencing one or more falls, whereas in another, of community-dwellers with a history of falling, those with PD had nearly 10 times the risk of multiple falls.
Results from case-control studies have suggested an association between PD and lower BMD, which, if present, could affect PD patients' fracture risk independent of a risk attributable to falls. Although nearly all these studies found a negative association between PD and bone measures, half evaluated bone parameters not in wide clinical use, and none reported significant associations at more than one skeletal site. In addition, although the case-control design of earlier studies makes their findings prone to selection bias, these studies did not account for factors other than age and sex that might have explained an observed association between PD and BMD.
Therefore, it was desired to investigate further the association between PD and BMD in a large cohort of older community-dwelling men. Whether participants had been diagnosed with PD was determined, and their bone status was assessed at multiple skeletal sites using areal and volumetric BMD. Data on risk factors for PD and bone health were collected, and analyses were performed to determine whether observed associations between PD and BMD were independent of possibly confounding factors. Finally, participants were followed for incident falls for 1 year after baseline, and analyses were performed to determine whether PD independently predicted future falls after adjustment for potential confounding factors.
