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Dr. Okun

Post of the Week: Dopamine Drugs and Hip Fracture

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Dear forum members,


It is becoming increasingly evident that bone loss in both male and female PD patients occurs. There are many reasons for this (inactivity, lack of exercise, degeneration of brain circuits like the hypothalamus, etc.). One issue that has not been examined is the potential influence of dopamine drugs. This study is a large database look at people on and off dopamine drugs. There are a lot of ways this data may have been biased but it is interesting to consider that dopamine use may place people at risk for fractures.


If you have PD remember to get your bone density checked regularly and also to be sure to get on replacement therapies if it is found to be low.


Here is a recent study.


Osteoporos Int. 2010 Oct 22. [Epub ahead of print]

Dopaminergic drugs and the risk of hip or femur fracture: a population-based case-control study.

Arbouw ME, Movig KL, van Staa TP, Egberts AC, Souverein PC, de Vries F.


Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.


The effect of dopaminergic medication on the risk of hip/femur fractures is not clear. Our results showed a nearly twofold increased risk of hip/femur fractures in current dopaminergic drug users. Concomitant use of antidepressants further increased this risk. Fracture risk assessment may be warranted in elderly users of dopaminergic drugs.


INTRODUCTION: Dopaminergic drugs, often used in the treatment of Parkinson's disease, have several pharmacological effects that may increase or decrease the risk of falling and fractures. Thus, the effect of dopaminergic medication on the risk of hip/femur fractures is not clear. The objective of the study was to examine the effect of dopaminergic medication and concomitant use of psychotropics on the risk of hip/femur fractures taking into account the timing of dopaminergic drug use.


METHODS: A population-based case-control study in the PHARMO database was conducted for the period 1991 to 2002. Cases were patients aged 18 years and older with a first hip or femur fracture and matched to four control patients by year of birth, sex and geographical region.


RESULTS: The study population included 6,763 cases and 26,341 controls. Current use of dopaminergic drugs (1-30 days before the index date) was associated with an increased risk of hip/femur fractures compared to never use (OR(adj) 1.76, 95% CI = 1.39-2.22), but this excess risk rapidly dropped to baseline levels when treatment had been discontinued >1 year ago. Concomitant use of antidepressants among current dopaminergic drug users further increased the risk of hip/femur fractures (OR(adj) 3.51, 95% CI = 2.10-5.87) while there was no additional risk with concomitant use of other psychotropics.


CONCLUSIONS: Although the observed association between dopaminergic drugs and fracture risk may not be entirely causal, due to absence of information on the (severity of the) underlying disease, fracture risk assessment may be warranted in elderly users of dopaminergic drugs.


PMID: 20967420 [PubMed - as supplied by publisher]

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