Hip Fracture Care in Parkinson Disease: A Retrospective Analysis of 1,239 Patients

Abstract

Introduction Compared to other patients, Parkinson disease (PD) patients may experience suboptimal outcomes after hip fracture. The purpose of this study was to describe and compare characteristics and outcomes of hip fracture patients with PD to those without PD. Methods This retrospective cohort study included all patients admitted for hip fracture within a large healthcare system between July 1, 2017 and June 30, 2019. Demographics, injury characteristics, Charlson Comorbidity Index (CCI), treatment characteristics, and outcomes including complications, readmissions, and mortality were extracted. Patients with PD were compared to those without PD. Chi-square tests, two-sample t-tests, and Fisher exact tests were conducted to identify group differences. Results A total of 1239 patients were included (4.0% PD and 96.0% non-PD). PD patients were mostly male (59.2%) compared to mostly female non-PD patients 69.4%, P < .001). PD patients on average had a higher CCI (2.3 vs 1.7, P = .040) and more frequently had dementia (42.9% vs 26.7%, P = .013). No PD patients were discharged home without additional assistance compared to 8.1% of patients without PD. More PD patients were discharged to a skilled nursing facility (SNF) than non-PD patients (65.3% vs 48.2%, P = .021). Only 22.4% of PD patients were previously prescribed osteoporosis medication, and only 16.3% were referred for osteoporosis follow-up after fracture. In-house complications, readmissions, and mortality up to 1 year were comparable between groups ( P>.191). Conclusions Outcomes between PD patients and non-PD patients were mostly equivalent, but more PD patients required discharge to a higher-level care environment compared to non-PD patients. Although PD seems to be a risk factor for hip fracture regardless of age and sex, most patients had not undergone proper screening or preventative treatment for osteoporosis. These results emphasize the need for early bone health evaluation, multidisciplinary collaboration, and care coordination in preventing and treating hip fractures in PD.

U.S. Tax Credits to Promote Practical Proactive Preventative Care for Parkinson’s Disease

“…One powerful example of potential savings will be in prevention of hip fractures, which cost the American Healthcare system ∼$50,000 per person. About 1/3 of persons with Parkinson’s will experience at least one hip fracture within 10 years of diagnosis [ 42 ]. The opportunity for improvement each year will be billions of dollars for the system.…”

Letter to the Editor Regarding “Hip Fracture Care in Parkinson Disease: A Retrospective Analysis of 1,239 Patients”

“…Fernando A. Huyke-Hernández et al 1 recently published “Hip Fracture Care in Parkinson Disease: A Retrospective Analysis of 1239 Patients” in Geriatric Orthopaedic Surgery and Rehabilitation , which has aroused our interest. The authors focus on the importance of bone health variables such as osteoporosis and osteopenia in the care of hip fractures in patients with Parkinson's disease (PD).…”