Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

Abstract

Background:The risk of falls is higher in patients with Parkinsonism (PwP) as compared to other older adults, leading to adverse outcomes including fragility fractures. Osteoporosis is under-recognised and the current prevalence of fragility fractures is not well-studied. The objectives of this study are to determine the prevalence of fragility fractures in PwP, to measure the relationship of fractures with demography, severity and to measure predictors of adverse outcomes in this population. Method/Description: This was a retrospective observational cohort study based on the analysis of existing data for all the patients attending Caerphilly Movement Disorder Clinic. Information on demographics, the severity of Parkinsonism and fragility fractures was extracted electronically from the clinical workstation, clinic letters and coding from January 2015 to October 2016. Results: 397 people (mean age = 77.1 ± 9.4, 46% females) were studied. Of these, 77% (306/397) had Parkinsonism and 80% (244/306) had idiopathic Parkinson's disease (PD). The mean Hoehn & Yahr Score at the time assessment was 3.09 ± 1.16. Additionally, 23.5% (72/306) were deemed to have osteoporosis based on the radiological evidence of fragility fractures. The PwP who sustained fractures were comparatively older (80.4 ± 12.1) and 70% (50/72) were females. The most common site for fractures was vertebral (47.2%; 34/72). Also, 22.2% of the sample (16/72) had suffered a fragility fracture before the diagnosis of PD. However, a majority (77.8%; 56/72) had sustained a fracture during the course of PD with a mean lapse of 6 years (range = 0-13 years) from initial diagnosis. Only 40% (29/72) of patients were prescribed osteoporosis drugs as per guidelines. There is a significant correlation of advancing age, severity and duration of PD with fragility fractures. The single best predictor of mortality is severity of PD, followed by age and fractures. Conclusions: There is a high prevalence of fragility fractures in patients attending movement disorder clinics, although 60% do not receive evidence-based medical treatment for the underlying osteoporosis. The prevalence of fragility fractures is positively correlated with the duration and severity of PD. We acknowledge the relatively small sample size as the study's limitation.

Selecting best-suited “patient-related outcomes” in older people admitted to an acute geriatric or emergency frailty unit and applying quality improvement research to improve patient care

“…The study confirmed a high prevalence of fragility fractures of 22.6% in patients attending a Movement Disorder clinic. 84 Only 40% of PwP received evidence-based treatment for the underlying osteoporosis. QI work was undertaken by two consultant geriatricians, and case-based discussion (CBD) to assess falls and bone health for each patient with Parkinsonism with osteoporosis on a weekly basis was introduced.…”

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“…In addition known patients with dementia, stroke or Parkinsonism were also included considering the relatively high risk of falls and higher prevalence of osteoporosis. [6][7][8][9]13,14…”

“…However, there are marked geographic distributions in the incidence of osteoporotic fractures within communities which could be related to other factors related to lifestyles, ecology or environment. There are medical conditions like stroke, 6,7 dementia and parkinsonism 8,9 have a higher risk of fragility fractures due to higher bone loss and a higher risk of falls. Screening for osteoporosis should be considered in high-risk patients 7,8 and therapeutic interventions should be considered as per guidance.…”

Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients– An Observational Study

“…Undisputable, many trails confirm the assumption of a connection between a higher age and comorbidities [2]. High age and comorbidities, for example Parkinson, are well known for an increased level of suffering low impact fractures by falls [3]. Furthermore, low activity level, poor nutrition, and osteoporosis decrease the bone mass and increase the risk of fractures [4].…”