Volume 3 • Issue 1 • 1000112 J Alzheimers Dis ParkinsonismISSN:2161-0460 JADP an open access journal

Open AccessCase Report

Lai et al., J Alzheimers Dis Parkinsonism 2013, 3:1 DOI: 10.4172/2161-0460.1000112

Keywords: Chronic osteomyelitis; Older people; Parkinson’s disease

Parkinson’s disease is a common neurodegenerative disease mainly affecting the older people. Despite the real causes of Parkinson’s disease remain unknown, extensive evidence has shown that chronic neuroinflammation associated with central and systemic inflammation might play a key role in the pathogenesis of Parkinson’s disease [1-3]. On the other hand, chronic osteomyelitis is also a chronic inflammatory disorder mainly caused by bacterial infection [4,5]. Therefore, we make a hypothesis that chronic osteomyelitis could be associated with an increased risk of Parkinson’s disease through chronic inflammatory process. In order to explore this issue, we conducted this case-control study by utilizing the database from the Taiwan National Health Insurance program. The details of insurance program can be cited in previous studies [6-8]. This present study included 4686 subjects aged 65 years or older with new diagnosis of Parkinson’s disease as the cases (2457 men, mean age 77.0 years and standard deviation 6.18 years, and 2229 women, mean age 76.3 years and standard deviation 6.51 years, respectively) (based on International Classification of Diseases 9th Revision-Clinical Modification, ICD-9 332), and 18744 subjects without Parkinson’s disease as the controls (9828 men, mean age 76.4 years and standard deviation 6.64 years, and 8916 women, mean age 75.6 years and standard deviation 7.02 years, respectively). The date of diagnosing Parkinson’s disease was defined as the index date. The cases and the controls were matched with age, gender, and index date from 2000 to 2010. Chronic osteomyelitis (ICD-9 730.1x) was diagnosed before the diagnosis of Parkinson’s disease. We analyzed the data separately by gender. In order to reduce biased results, subjects with other major psychiatric diseases (ICD - 9 291-293, 294.0, 294.8, 294.9, 295, 296.0, 296.1, 296.4–296.9, 297 and 298) or mental retardation (ICD - 9 317 - 319) were excluded from this study.

In men, there were 13 subjects with chronic osteomyelitisamong Parkinson disease cases (0.53%) and 55 subjects with chronic osteomyelitis among controls (0.56%) (Chi-square test for p>0.05). In women, there were 12 subjects with chronic osteomyelitis among

*Corresponding author: Kuan-Fu Liao, Department of Internal Medicine, Taichung Tzu Chi General Hospital, No.66, Sec. 1, Fongsing Road, Tanzi District, Taichung City, 427, Taiwan, Tel: 886-4-2205-2121; Fax: 886-4-2203-3986; E-mail: kuanfuliao@yahoo.com.tw

Received March 28, 2013; Accepted May 18, 2013; Published May 22, 2013

Citation: Lai SW, Liu JC, Tseng CH, Muo CH, Liao KF (2013) No Association between Chronic Osteomyelitis and Parkinson’s Disease in Older People in Taiwan. J Alzheimers Dis Parkinsonism 3: 112. doi:10.4172/2161-0460.1000112

Copyright: © 2013 Lai SW, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

No Association between Chronic Osteomyelitis and Parkinson’s Disease in Older People in TaiwanShih-Wei Lai1,2, Juhn-Cherng Liu1,3, Chun-Hung Tseng1,4, Chih-Hsin Muo5,6 and Kuan-Fu Liao 7,8*

1School of Medicine, China Medical University, Taichung, Taiwan2Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan3Department of Radiology, China Medical University Hospital, Taichung, Taiwan4Department of Neurology, China Medical University Hospital, Taichung, Taiwan5Department of Public Health, China Medical University, Taichung, Taiwan6Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan7Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan 8Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan

AbstractThe aim of this study is to explore whether chronic osteomyelitis is associated with an increased risk of

Parkinson’s disease in older people in Taiwan. By using the database from the Taiwan National Health Insurance program, this case-control study consisted of 4686 subjects aged 65 years or older with newly diagnosed Parkinson’s disease as the case group and 18744 subjects without Parkinson’s disease as the control group. After adjusting for cofounding factors, multivariable logistic regression analysis showed no association between chronic osteomyelitis and Parkinson’s disease in both gender (odds ratio = 0.71, 95% CI = 0.37-1.36 in men, and odds ratio = 0.90, 95% CI = 0.45-1.83 in women, respectively). We conclude that no association can be detected between chronic osteomyelitis and Parkinson’s disease in older people in Taiwan.

Parkinson disease cases (0.54%) and 37 subjects with chronic osteomyelitis among control subjects (0.41%) (Chi-square test for p>0.05). After controlling for cofounding factors, multivariable logisticregression analysis showed that no association could be detectedbetween chronic osteomyelitis and Parkinson’s disease in both gender(odds ratio = 0.71, 95% CI = 0.37-1.36 in men, and odds ratio = 0.90,95% CI = 0.45-1.83 in women, respectively) (Table 1).

Despite the literature has shown that chronic inflammatory process might be involved in chronic osteomyelitis and Parkinson’s disease, [1-5] however, no relevant studies can be cited to date. In this present study,no association is found between chronic osteomyelitis and Parkinson’sdisease in both genders. However, only 117 patients with chronicosteomyelitis were selected. That is, the number of chronic osteomyelitisis probably too small to reach clinical significance. Therefore, additionalstudies with large sample size are warranted to clarify this issue.

FundingThis study was supported in part by Taiwan Department of

Health Clinical Trial and Research Center of Excellence (DOH102-TD-B-111-004). The funding agency did not influence the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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ISSN: 2161-0460

Citation: Lai SW, Liu JC, Tseng CH, Muo CH, Liao KF (2013) No Association between Chronic Osteomyelitis and Parkinson’s Disease in Older People in Taiwan. J Alzheimers Dis Parkinsonism 3: 112. doi:10.4172/2161-0460.1000112

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Volume 3 • Issue 1 • 1000112 J Alzheimers Dis ParkinsonismISSN:2161-0460 JADP an open access journal

Acknowledgements

The authors thank the National Health Research Institute in Taiwan for providing the insurance claims data.

References

1. Whitton PS (2007) Inflammation as a causative factor in the aetiology of Parkinson’s disease. Br J Pharmacol 150: 963-976.

2. Tansey MG, Goldberg MS (2010) Neuroinflammation in Parkinson’s disease: its role in neuronal death and implications for therapeutic intervention. Neurobiol Dis 37: 510-518.

3. Collins LM, Toulouse A, Connor TJ, Nolan YM (2012) Contributions of central and systemic inflammation to the pathophysiology of Parkinson’s disease. Neuropharmacology 62: 2154-2168.

4. Lew DP, Waldvogel FA (1997) Osteomyelitis. N Engl J Med 336: 999-1007.

5. Ciampolini J, Harding KG (2000) Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often? Postgrad Med J 76: 479-483.

6. Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, et al. (2010) Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 89: 295-299.

7. Lai SW, Su LT, Lin CH, Tsai CH, Sung FC, et al. (2011) Polypharmacy increases the risk of Parkinson’s disease in older people in Taiwan: a population-based study. Psychogeriatrics 11: 150-156.

8. Lai SW, Lin CH, Liao KF, Su LT, Sung FC, et al. (2012) Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatr Gerontol Int 12: 491-498.

Men Women

Crude Adjusted † Crude Adjusted †

Variable OR (95%CI) OR (95%CI) OR (95%CI) OR (95%CI)Age (every one year) 1.02 (1.01-1.02) 1.01 (1.00-1.02) 1.01 (1.01-1.02) 1.01 (1.00-1.02)

Co-morbidities before index date (yes vs. no)*

Chronic osteomyelitis 0.95 (0.52-1.73) 0.71 (0.37-1.36) 1.30 (0.68-2.50) 0.90 (0.45-1.83)

Obesity 1.17 (0.64-2.12) -- 1.74 (1.17-2.60) 1.43 (0.94-2.19)

Diabetes mellitus 1.36 (1.23-1.51) 0.86 (0.77-0.97) 1.52 (1.38-1.68) 0.98 (0.87-1.09)Hyperlipidemia 1.85 (1.68-2.04) 1.23 (1.11-1.37) 1.49 (1.35-1.63) 0.96 (0.86-1.07)Hypertension 2.51 (2.24-2.80) 1.48 (1.31-1.68) 2.80 (2.44-3.20) 1.82 (1.58-2.11)Cerebrovascular disease 1.86 (1.67-2.07) 1.30 (1.15-1.46) 1.67 (1.48-1.89) 1.12 (0.98-1.28)Dementia 4.70 (3.94-5.60) 3.29 (2.72-3.98) 4.79 (3.99-5.76) 3.44 (2.82-4.19)Major depressive disorder 3.41 (2.88-4.05) 2.09 (1.74-2.52) 3.32 (2.77-3.76) 2.19 (1.86-2.58)Chronic kidney disease 1.61 (1.37-1.88) 0.99 (0.83-1.17) 1.44 (1.19-1.74) 0.99 (0.81-1.21)Head injury 1.59 (1.40-1.79) 1.29 (1.13-1.48) 1.67 (1.47-1.91) 1.31 (1.13-1.50)

Tobacco use 1.75 (1.16-2.64) 1.32 (0.84-2.05) -- --

Alcoholism 1.76 (1.13-2.75) 1.24 (0.76-2.03) 3.33 (1.02-1.09) 2.80 (0.81-9.69)Polypharmacy 4.03 (3.67-4.43) 3.17 (2.85-3.52) 3.64 (3.30-4.01) 2.85 (2.55-3.17)

The co-morbidities included before index date were as follows: chronic osteomyelitis (ICD-9 730.1x), obesity (ICD-9 278.00 and 278.01), diabetes mellitus (ICD-9 250), hyperlipidemia (ICD-9 272.0, 272.1, 272.2, 272.3 and 272.4), hypertension (ICD-9 401-405), cerebrovascular disease (ICD-9 430–438), dementia (ICD-9 290.0, 290.1, 290.2, 290.3, 290.4, 294.1 and 331.0), major depressive disorder (ICD-9 296.2, 296.3, 300.4 and 311), chronic kidney disease (ICD-9 585, 586, 588.8 and 588.9), head injury (ICD-9 850-854 and 959.01), tobacco use (ICD-9 305.1) and alcoholism (ICD-9 303, 305.00, 305.01, 305.02, 305.03 and V11.3). Polypharmacy was defined as the daily average use of 5 or more drugs.

Table 1: Odds ratio and 95% confidence interval of Parkinson's disease associated with chronic osteomyelitis and other co-morbidities.