Fracture Risk Increases With Severity of Parkinson Disease

Fracture risk is significantly greater in patients with Parkinson disease (PD), particularly those with more severe disease, according to study findings published today in Osteoporosis International.

Motor symptoms such as resting tremor, rigidity, bradykinesia, and postural instability are known to have a substantial impact in PD, creating significant risk of falling among patients. Fall-related fractures are of notable risk in patients with PD, especially elderly individuals.

“With regard to fracture sites, hip fractures are common in patients with PD in many studies. These findings are important because major fractures, especially hip fractures, can lead to a significant increase in fracture-related mortality risk. However, PD is still not routinely taken into consideration when assessing the risk of fractures,” the study authors wrote.

“Large population-based research is required to clarify the relationship between PD and fracture risk. Furthermore, although fracture risk is affected by ethnicity, data on Asian patients with PD, including Koreans, are rare.”

Researchers conducted a population-based, retrospective analysis utilizing data from the Korean National Health Insurance Service database to investigate the association between PD and fracture risk in this nationwide cohort. Fracture risk according to patients’ disease severity and duration was also examined.

A total of 10,333 patients with PD (mean [SD] age, 68.02 [9.11] years) and 6,501,464 controls (mean [SD] age, 53.82 [10.24] years) were included in the study, in which fracture risks according to the prevalence, severity, and duration of PD were evaluated using Cox proportional hazard methods.

Among the 2 cohorts, mean age was signifcantly higher in the PD group, whereas the non-PD group exhibited higher proportions of men, lower income level, current smoking, heavy drinking, and regular physical activity. Additionally, the PD group had higher rates of comorbidities (diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease) than the non-PD group (all P < .0001).

During a mean (SD) 8.74 (1.89) years of follow-up, 22.8% patients of the PD group (n = 2358) and 8.9% of the non-PD group (n = 580,085) suffered fractures.

After adjusting for potential covariates, the Cox regression analysis showed an elevated risk of fracture among patients with PD at all sites compared with controls (for any fracture; adjusted HR [aHR], 1.49; 95% CI, 1.44-1.56). By fracture site, hip fractures showed the largest risk increase in patients with PD (aHR, 2.16; 95% CI, 1.95-2.38), followed by vertebral fracture (aHR, 1.52; 95% CI, 1.44-1.61), and other fracture (aHR, 1.22; 95% CI, 1.13-1.30).

Moreover, risk of any fracture was shown to increase linearly in patients with PD by the severity of disease, with the highest risk observed in patients with severe PD compared with controls (aHR, 1.65; 95% CI, 1.53-1.79). No signifcant association was observed between PD duration and fracture risk.

As the study was limited to subjects who underwent a national health examination, researchers said that selection bias might be associated with the results. They further concluded that findings highlight the need for PD prevalence and severity to be considered when evaluating the risk factors of fracture in clinical practice.

Reference

Koo HY, Cho EB, Kong SH, et al. Fracture risk in Parkinson’s disease according to its severity and duration. Osteoporos Int. Published online October 7, 2022. doi:10.1007/s00198-022-06562-0