Background Parkinson’s disease (PD), a movement disorder characterized by tremor, slowness of movement and postural imbalance,is a recognised cause of disability in older adults. Sarcopenia, osteopenia/osteoporosis and muscle weakness (directly and indirectly) are risk factors for falls and, therefore, fractures, in older adults with PD.
Objectives The aim of the present study was to determine the prevalence of sarcopenia and osteopenia/osteoporosis in community-dwelling older adults with PD and to determine the effect of these conditions on disability in these patients.
Methods Seventy-eight PD patients attending the Geriatric Medicine and Neurology Clinics of our institution aged 65 years and older and 70 age-sex-body mass index matched controls were recruited. Data including demography, body mass index, diet, sunlight exposure, Hoehn and Yahr (H and Y) PD stage, disease duration, disease severity and history of previous falls and/or fractures were collected. Patients were assessed for disability with the 39-item Parkinson’s Disease quality of life questionnaire (PDQ39) and the Unified Parkinson’s disease rating scale (UPDRS). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA). Osteopenia was defined by a densitometric T-score for bone mineral density (BMD) (g/cm2) below -1.0 and osteoporosis by a T-score below -2.5. Appendicular skeletal lean body mass (ASM) was calculated by soft tissue DEXA and sarcopenia assessed by the formula (ASM)/Height (H)2. Sarcopenia was defined as a relative skeletal muscle index (RSMI) (appendicular skeletal muscle mass divided by height) below 5.45 kg/m2. Vitamin D (25-OHD-hydroxyvitamin D) levels, upper limb grip strength, cognition and falls risk was also assessed.
Results Seventy six per cent were male with a mean age of 71.8 years, mean H and Y of3.1 and mean total UPDRS score of 37.9. Sixty four per cent reported falls and 23% fractures. Sarcopenia was present in 62%, osteopenia in 73%and osteoporosis in 45% of cases scanned. In an adjusted logistic regression model, severe sarcopenia (OR: 3.1; 95% CI: 0.85–2.1; p=0.001) was associated with disability. PD patients had significantly decreased vitamin D levels, significantly reduced grip strength and mental performance and had more falls and/or fractures in comparison to healthy controls.
Conclusions The findings of the present study indicate that most patients with PD have significantly compromised bone and muscle health.PD is associated with an increased incidence of sarcopenia, osteopenia/osteoporosis, falls and fractures. The results demonstrate that sarcopenia is associated with significant disability. In PD patients, sarcopenia assessment by DEXA is thus feasible. PD is thus a risk factor for sarcopenia, osteopenia/osteoporosis and appropriate therapeutic interventions, for example, exercise programmes, should be initiated to slow or prevent disability.
Disclosure of Interest None Declared