Multivariate Analysis Of Fractures In Patients With Parkinson’s Disease

PARTⅠ The analysis of clinical features of fractures in patients with Parkinson’s disease Objective:To analyze the clinical features of fractures in patients with Parkinson’s disease(PD).Methods:The data of PD patients admitted to the Department of Neurology of the Second Affiliated Hospital of Soochow University from January 2014 to December 2017 and healthy population of the senior medical examination center were collected.The collected patients were divided into two groups: Parkinson’s disease group was the PD group(298 cases)and normal control group(228 cases),and the PD group was further divided into two subgroups: PD fracture group(52 cases),PD no fracture group(246 cases).Patients with Parkinson’s disease were evaluated by UPDRS scores,HY stage,and cognitive-emotion scales;clinical physicochemical parameters such as vitamin D,serum calcium,creatinine,uric acid,and homocysteine were measured;Dual-energy x-ray absorptiometry(DEXA)was used to measure bone mineral density(BMD)in both groups.Results: One Analysis and comparison between PD group and normal control group:1.Body mass index(BMI)(23.07±3.56)kg/m~2,vitamin D [36.28(19.74)] nmol/L,serum calcium [2.26(0.15)] mmol/L,uric acid [276(96)] μmol/L,albumin [42.65(5.45)] g/L and lumbar spine bone mineral density [0.978(0.293)] g/cm~2 in the PD group were significantly lower than BMI(24.72±2.91)kg/m~2,vitamin D[39.06(16.59)] nmol/L,serum calcium [2.36(0.09)] mmol/L,uric acid [315(92)] μmol/L,albumin [45.20(2.58)] g/L and lumbar spine BMD [1.027(0.240)]g/cm~2 in the normal control group(P<0.05).Homocysteine [12.05(6.82)] μmol/L in the PD group was significantly higher than homocysteine [11.20(4.00)] μmol/L in the normal control group(P<0.05).2.There was no significant difference in gender,age,serum phosphorus,creatinine,alkaline phosphatase,and femoral neck BMD between the PD group and the normal control group(P>0.05).Two Analysis and comparison between PD fracture group and PD no fracture group:1.The general clinical features and clinical physicochemical indexes of PD patientsThe PD fracture group was dominated by women.Its BMI(21.71±3.05)kg/m~2,serum calcium [2.24(0.14)] mmol/L,albumin [39.79(4.53)] g/L,lumbar spine BMD[0.839(0.221)] g/cm~2 were significantly lower BMI(23.36 ± 3.60)kg/m~2,serum calcium [2.27(0.13)] mmol/L,albumin [42.87(4.03)] g/L,lumbar spine BMD [1.002(0.275)] g/cm~2 in the PD no fracture group(P<0.05).Its homocysteine [16.26(7.25)] μmol/L was significantly higher than homocysteine [13.89(8.45)] μmol/L in the PD no fracture group(P>0.05).2.Motor symptoms and non-motor symptoms of PD patientsOnset age of [68.67(8.04)] years of PD,UPDRS scores [49.13(20.85)] and HY stage [3.0(1.88)] in the PD fracture group were significantly higher than the age of onset [61.87(9.78)] years,UPDRS scores [41.97(18.15)],and HY stage [2.5(1.50)] in the PD no fracture group(P<0.05).MMSE [22.48(4.54)] and MoCA[18.38(5.96)] in the PD fracture group were significantly lower than MMSE[26.60(3.51)] and MoCA[22.83(5.23)] in the PD no fracture group(P<0.05).There was no significant difference in PD course,Levodopa equivalent daily dose(LED),UPDRSIV,HAMA,HAMD between the PD fracture group and the PD no fracture group(P>0.05).Conclusion:1.PD patients had lower BMI,vitamin D,serum calcium,uric acid,albumin,and lumbar spine bone density than normal subjects,but homocysteine was higher than normal subjects.2.PD patients with fractures were predominantly females,with older age,lower BMI,later onset of PD,more severe dyskinesia and cognitive impairment,significantly lower serum calcium and albumin,but higher alkaline phosphatase,and homocysteine;PD patients with fractures had lower lumbar bone density than those without fractures.PARTⅡ Multivariate Analysis of Fracture in patients with Parkinson’s DiseaseObjective:Analyze the factors that affect fractures in patients with Parkinson’s disease to identify protective factors and risk factors for fractures in patients with Parkinson’s disease.Methods:Patients with Parkinson’s disease that met the inclusion criteria in the Department of Neurology of the Second Affiliated Hospital of Soochow University from January 2014 to December 2017 were selected and divided into Parkinson’s disease group and Parkinson’s disease no fracture group according to whether fractures.Logistic multivariate regression analysis was performed on the factors,namely gender,age,BMI,onset age,UPDRS scores,HY stage,MMSE,MoCA,serum calcium,albumin,alkaline phosphate,homocysteine,lumbar spine BMD,that might affect the fracture of PD patients.Results:1.In 298 PD patients,the incidence of PD fracture was 17.45%.2.Logistic regression analysis of fractures in PD patients showed that the independent risk factors for PD fracture were age(OR=2.063,95%CI:1.269-3.353,P=0.003),homocysteine(OR=1.949,95%CI:1.218-3.118,P=0.005)and alkaline phosphatase(OR=1.932,95%CI:1.160-3.218,P=0.011),and that the independent protective factors were lumbar spine BMD(OR=0.444,95%CI: 0.272-0.725,P= 0.001)and albumin(OR=0.540,95% CI: 0.305-0.956,P=0.035).Conclusion:Age,homocysteine,alkaline phosphatase,lumbar spine BMD,and albumin are closely related to the occurrence of fractures in patients with PD.The independent risk factors for fractures in patients with PD are age,homocysteine,and alkaline phosphatase,and the independent protective factors for fractures in patients with PD are lumbar spine BMD and albumin.