Abnormal bone and calcium metabolism in immobilized Parkinson's disease patients

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Abnormal bone and calcium metabolism in immobilized Parkinson's disease

patients

Yoshihiro Sato, MD 1 *, Yoshiaki Honda, MD 1, Jun Iwamoto, MD 2,

Tomohiro Kanoko, PhD 3, Kei Satoh, MD 4

1Department of Neurology, Mitate Hospital, Tagawa, Japan

2Department of Sports Medicine, School of Medicine Keiko University,

Tokyo, Japan

3Department of Rehabilitation Medicine, Hirosaki University School of

Medicine, Hirosaki, Japan

4Department of Vascular Biology, Hirosaki University School of Medicine,

Hirosaki, Japan

email: Yoshihiro Sato (y-sato@...)

*Correspondence to Yoshihiro Sato, Department of Neurology, Mitate

Hospital, Tagawa 826-0041, Japan

Keywords

bone mineral density • hypercalcemia • immobilization • vitamin D

Abstract

To elucidate the influence of immobilization-induced hypercalcemia on

bone metabolism in Parkinson's disease (PD), we measured serum

biochemical indexes and bone mineral density (BMD) in the second

metacarpals of 142 elderly PD patients and 99 age-matched healthy

controls. Serum concentrations of 25-hydroxyvitamin D (25-OHD),

1,25-dihydroxyvitamin D (1,25-[OH]2D), ionized calcium, intact

parathyroid hormone (PTH), and intact bone Gla protein (BGP) were

measured. Urinary deoxypyridinoline (D-Pyr) was also measured. Increased

serum calcium levels (mean, 1.27 mmol/L) were observed in PD patients,

and the levels correlated negatively with the Unified Parkinson's

Disease Rating Scale III (UPDRS III), indicating the presence of

immobilization-induced bone resorption with resultant hypercalcemia.

Decreased serum concentrations of 1,25-[OH]2D (mean, 88.7 pmol/L) and

25-OHD (mean, 29.7 nmol/L) were noted. Serum PTH was decreased (mean,

25.2 ng/L). Serum BGP was decreased while urinary D-Pyr concentration

elevated. A negative correlation was observed between 1,25-[OH]2D levels

and serum calcium or UPDRS III (P < 0.0001). In disabled PD patients,

immobilization-induced hypercalcemia may inhibit secretion of PTH, which

in turn suppresses 1,25-[OH]2D production. 25-OHD insufficiency may also

contribute to decreased 1,25-[OH]2D. These abnormalities may be

corrected by the suppression of bone resorption with bisphoshonate, and

supplementations of calcium and vitamin D should be avoided in these

patients. © 2005 Movement Disorder Society

Received: 18 February 2005; Revised: 6 April 2005; Accepted: 22 April 2005

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ne Holden, MS, RD < fivestar@... >

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

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