Early bone health assessment is indicated in Parkinson's: Risk factor analysis in a UK population-based cohort study

BackgroundOsteoporosis and major osteoporotic fracture are more common in PD than controls, but evaluation of sociodemographic factors and preventive treatment is limited.MethodsIn a UK population-based nested case-control study, incidence rates of osteoporosis and major osteoporotic fracture were calculated, and risk factors and bone health treatments analyzed by multivariable regression.ResultsFalls, osteoporosis and major osteoporotic fracture were more likely before a diagnosis of PD compared to controls (P < 0.0001). After diagnosis, incident osteoporosis, HR 1.96 (1.90, 2.02) and incident fractures, HR 2.16 (2.11, 2.21) were more likely in PD than controls, both P < 0.005. Risks of fracture were increased in PD cases during 3 consecutive time periods post-diagnosis: 0-7 years, HR 2.15 (2.09, 2.21), 7-14 years, HR 2.36 (2.24, 2.48), and 14-21 years, HR 1.88 (1.62, 2.17), all P < 0.0001. Risks of osteoporosis and fracture increased with older age, female sex, greater deprivation and White ethnicity. In PD, anti-osteoporosis treatment was underutilized in men, OR 0.25 (0.24, 0.26) versus women, being lower than the relative risks of osteoporosis in men, HR 0.35 (0.32, 0.37) and fracture in men, HR 0.60 (0.57, 0.63). There was also underutilization of anti-osteoporosis treatment in the most deprived quintile, HR 0.85 (0.80, 0.90), despite significantly higher rates of osteoporosis, HR 1.14 (1.01, 1.28) and fracture, HR 1.17 (1.06, 1.30).ConclusionThe increased bone health risks at all stages including the prodrome, and across multiple risk categories, emphasizes the need for early bone health assessment and increased anti-osteoporosis treatment rates.