domingo, 15 de fevereiro de 2015

Avaliação e gestão do risco de fraturas em pacientes com doença de Parkinson

Peço desculpas por não traduzir. Estou sem computador. Tudo isso está sendo realizado por telefone. Quando for consertado as coisas voltarão ao normal. 

Veronica Lyell, Emily Henderson, Mark Devine, Celia GregsonDisclosures Age Ageing. 2015;44(1):34-41.

ABSTRACT AND INTRODUCTION Abstract Parkinson's disease (PD) is associated with substantially increased fracture risk, particularly hip fracture, which can occur relatively early in the course of PD. Despite this, current national clinical guidelines for PD fail to adequately address fracture risk assessment or the management of bone health. We appraise the evidence supporting bone health management in PD and propose a PD-specific algorithm for the fracture risk assessment and the management of bone health in patients with PD and related movement disorders. The algorithm considers (i) calcium and vitamin D replacement and maintenance, (ii) quantification of prior falls and fractures, (iii) calculation of 10-year major osteoporotic and hip fracture risks using Qfracture, (iv) application of fracture risk thresholds, which if fracture risk is high (v) prompts anti-resorptive treatment, with or without dual X-ray absorptiometry, and if low (vi) prompts re-assessment with FRAX and application of National Osteoporosis Guidelines Group (NOGG) guidance. A range of anti-resorptive agents are now available to treat osteoporosis; we review their use from the specific perspective of a clinician managing a patient population with PD. In conclusion, our current evidence base supports updating of guidelines globally concerning the management of PD, which presently fail to adequately address bone health. Introduction Parkinson's disease (PD), affecting almost 127,000 UK adults, is the second most common neurodegenerative condition after Alzheimer's disease. Prevalence is increasing within our ageing population, affecting an estimated 1% aged >60 years.[1] PD is primarily a motor disorder but at least doubles fracture risk; the hip being particularly vulnerable.[2,3] Even within the general population, 30 days following hip fracture 8.2% have died and fewer than half will have returned to their own home;[4] comorbid PD further challenges these outcomes. Globally, PD guidelines currently lack detail regarding assessment and management of bone health. Despite the 2004 US Surgeon General's report highlighting the importance of PD as a fracture risk,[5] the American Academy of Neurology clinical guidelines for PD (and falls) omit to mention fracture/osteoporosis risk assessment,[6,7] as do the 2012 Canadian PD guidelines[8] and 2010 Scottish SIGN guidelines.[9] Although in England, the National Institute for Health and Care Excellence (NICE) acknowledges fracture as a potential complication of PD, it only includes an appendix mentioning optional osteoporosis risk assessment, without providing details.[10,11] Despite the substantial fracture risk associated with PD, development of clear clinical guidelines has been difficult given the limited evidence base specific to PD. This, combined with heterogeneity in general bone health management, precludes a full systematic review. We aim to appraise the limited evidence supporting bone health management in PD, and interpret the broader bone health literature within the context of PD. We then propose a PD-specific algorithm for primary and secondary care assessment and management of fracture risk in patients with PD and related movement disorders.


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