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Master Thesis

Maladie de Parkinson et augmentation du risque fracturaire : résultats d'une méta-analyse, physiopathologie et prise en charge

Abstract : Parkinson's disease (PD) and osteoporosis (OP) are both age-related diseases recognized as a Public Health issue because of their impact on quality of life, autonomy and mortality. PD patients have an increased risk of falls and a reduced bone mineral density related to multifactorial factors. Previous meta-analyses have reported an increased risk of fractures in PD, especially peripheral fractures.
The aim of this study was to update the association between PD and OP fracture risk at all sites, including vertebral fracture and to discuss the pathophysiology of this association and the bone health management that could be proposed. Methods.a search was performed for eligible studies on PubMed and Embase databases up to February 2, 2019. Cohort studies controlled or not, were selected. For each study, the authors extracted the risk of fracture for each anatomic site, or estimated it based on sample size and number of patients with fractures. Single risk ratios were then pooled to estimate a global risk ratio of fracture within a meta-analysis procedure using the inverse variance approach. Heterogeneity analysis was also performed with Cochran's Q-test and I2 value. RevMan software was used and p-value below 5% was defined as significant. Twelve retrospective and prospective cohort studies, that totally involved 1,246,431 participants, were included for analysis. On the whole, PD patients had an increased risk of fracture at all sites (overall RR 2.17, 95% CI 1.81-2.59. Vertebral fracture risk was also significantly increased (RR 1.84, 95% CI (1.46-2.59), I2= 53%). The highest risk of fracture in PD population was hip fracture (overall RR 2.55, 95% CI (2.20-2.97); I2 =68%). A sensitivity analysis, excluding a study which exclusively enrolled fallers, confirmed the increase of hip fracture risk in PD patients with a negligible level of heterogeneity (RR 2.69, 95% CI (2.45-2.97); I2=0%).
This study confirms the significant increased risk of fracture in PD, especially hip fractures but also vertebral fractures, recognized as a severe fracture associated with increased morbidity and mortality and predicting future fractures. Currently, assessment of fracture risk is not included in guidelines for PD patients care, although there are efficient treatments available. Based on these findings, fracture risk assessment should be recommended in PD.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03125394
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Submitted on : Friday, January 29, 2021 - 1:38:22 PM
Last modification on : Tuesday, July 13, 2021 - 3:24:00 AM

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Marion Louvois. Maladie de Parkinson et augmentation du risque fracturaire : résultats d'une méta-analyse, physiopathologie et prise en charge. Médecine humaine et pathologie. 2020. ⟨dumas-03125394⟩

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