Amelioration of osteopenia and hypovitaminosis D by 1 alpha-hydroxyvitaminD3 in elderly patients with Parkinson's disease

Objectives-A high prevalence of hip and other fractures in elderly patients with Parkinson's disease has been linked to reduced bone mass arising from a defect of renal synthesis of 1, 25-dihydroxyvitamin D (1, 25-[OH](2)D). Treatment with 1 alpha-hydroxyvitamin D3 (1 alpha(OH)D3; an active form of vitamin D) was evaluated for maintaining bone mass and reducing the inciden ce of hip and other nonvertebral fractures in patients with Parkinson's dis ease. Methods-In a double blind, randomised trial, 86 elderly patients with Parki nson's disease (mean Hoehn and Yahr stage, 3; mean age 70.6 years) were ran domised to receive either 1 mu g 1 alpha(OH)D-3 daily (treatment group, n=4 3) or a placebo (n=43) for 18 months. Bone mineral densities in the second metacarpals were determined by computed radiographic densitometry. Serum bo ne turnover indices were measured serially, and incidence of nonvertebral f ractures was recorded. Results-Bone mineral densities decreased 1.2% in the treatment group compar ed with 6.7% in the placebo group during 18 months (p<0.0001). At baseline in both groups, the serum concentration of 1, 25-[OH](2)D was reduced. Para thyroid hormone was abnormally increased in 15 patients (17%) and correlate d negatively with serum 25-hydroxyvitamin D, indicating compensatory hyperp arathyroidism. Eight patients sustained fractures (six at the hip and two a t other sites) in the placebo group, and one hip fracture occurred among tr eated patients (odds ratio 9.8; p=0.0028). Conclusion-By increasing serum 1, 25-[OH](2)D concentrations, treatment wit h 1 alpha(OH)D3 can reduce the risk of hip and other non-vertebral fracture s in osteoporotic elderly patients with Parkinson's disease by slowing the loss of bone mineral densities.