Fracture risk associated with parkinsonism and anti-Parkinson drugs.
We studied fracture risk associated with parkinsonism (including Parkinson's disease) and drugs used to treat these conditions in a case-control study. Cases were all subjects with any fracture during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. Exposure was a diagnosis of parkinsonism or use of anticholinergic drugs, levodopa alone or in combination with carbidopa, and/or catechol-O-methyl transferase (COMT) inhibitors, dopamine agonists, or monoamine oxidase B (MAO-B) inhibitors and a number of other confounders. Parkinsonism was associated with a crude odds ratio (OR) of any fracture of 2.2 (95% confidence interval [95% CI] 2.0-2.5) and an adjusted OR of 1.2 (95% CI 1.0-1.4), the risk being higher especially in males younger than 75 years. Levodopa was associated with an increased overall fracture risk and an increased risk of hip fractures in high doses. Dopamine agonists, anticholinergic drugs, and MAO-B inhibitors were not associated with increased fracture risk except for hip fractures at high doses for MAO-B inhibitors and hip fractures at median doses for dopamine agonists. Neuroleptics were associated with increased risk of fractures in almost all skeletal sites and doses. In conclusion, parkinsonism was associated with increased risk of fractures, especially among males younger than 75 years, and the risk was significantly attenuated upon adjustment for confounders. Use of neuroleptics and, to some degree, levodopa was associated with increased risk of fractures.
Vestergaard
Peter
P
Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000, Aarhus C, Denmark. p-vest@post4.tele.dk
Rejnmark
Lars
L
Mosekilde
Leif
L
D000328:Adult; D000367:Age Factors; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002230:Carbidopa / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D065098:Catechol O-Methyltransferase Inhibitors; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D020734:Parkinsonian Disorders / Q000150:complications* / Q000188:drug therapy*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D000978:Antiparkinson Agents; D065098:Catechol O-Methyltransferase Inhibitors; D018491:Dopamine Agonists; D004791:Enzyme Inhibitors; D008996:Monoamine Oxidase Inhibitors; D007980:Levodopa; D002230:Carbidopa