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Fracture risk in patients with parkinsonism: a population-based study in Olmsted County, Minnesota
O Johnell1, L J Melton, E J Atkinson
1Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN 55905.
Abstract:
In this population-based retrospective cohort study, the 138 Olmsted County, Minnesota residents first diagnosed with Parkinson's disease during 1967-79 were matched by age and sex to an equal number of control subjects from the community. Fractures were assessed through review of each subject's complete (inpatient and outpatient) medical records. At the time of diagnosis, County residents with parkinsonism were no more likely to have a history of selected fractures than control subjects (32% in each group). Subsequently, 33% of cases and 20% of controls experienced one or more new fractures during 696 person-years of follow-up (p = 0.008). The greatest increase in risk was seen for proximal femur fractures, confirming previous case-control studies. By 10 years after diagnosis, an estimated 27% of the parkinsonism cohort had experienced a new hip fracture. The pattern of fractures that was observed suggested that the increased risk was due more to specific types of falls than to disuse osteoporosis.
Insights
Parkinson's disease patients experience significantly more fractures, especially hip fractures, after diagnosis compared to controls. This increased risk appears linked to specific fall types rather than bone density loss.
Area of Science:
- Epidemiology
- Neurology
- Orthopedics
Background:
- Parkinson's disease (PD) is a neurodegenerative disorder affecting motor control.
- Fracture risk in PD patients is a growing concern, but the temporal relationship and specific fracture types require further elucidation.
Purpose of the Study:
- To investigate the incidence and patterns of fractures in Olmsted County residents diagnosed with Parkinson's disease.
- To compare fracture rates between PD patients and matched control subjects post-diagnosis.
Main Methods:
- Population-based retrospective cohort study utilizing medical records from Olmsted County, Minnesota.
- 138 PD patients diagnosed between 1967-1979 were matched by age and sex to 138 community control subjects.
- Fracture history was assessed through complete medical record review, with follow-up over 696 person-years.
Main Results:
- No difference in pre-diagnosis fracture history between PD cases and controls.
- PD patients had a significantly higher incidence of new fractures post-diagnosis (33% vs. 20%, p=0.008).
- Proximal femur fractures showed the greatest increase in risk; an estimated 27% of PD patients experienced a hip fracture within 10 years of diagnosis.
Conclusions:
- Parkinson's disease diagnosis is associated with a substantially increased risk of subsequent fractures, particularly hip fractures.
- The observed fracture pattern suggests that specific fall mechanisms, rather than disuse osteoporosis, are the primary contributors to this elevated risk.