Mind the Gap: Predictors of Osteoporosis Treatment Following Fragility Fracture in Parkinsonism

Fracture risk is increased in Parkinson's yet this risk is often not addressed.

Our objective was to study the extent to which osteoporosis was treated, and predictors of treatment in a large representative cohort with parkinsonism.

The clinical practice research datalink (CPRD) GOLD data contains anonymized UK primary care data. We identified fragility fractures (hip, vertebrae, wrist/distal radius, humerus, rib, pelvis and unspecified osteoporotic) amongst prevalent parkinsonism patients between 2010 and 2019, and ascertained whether bone protective medications and/or vitamin D/calcium supplements were prescribed in the pre-fracture period or in the 48-weeks post-fracture. Logistic regression was used to determine predictors of prescriptions.

There were 21,581 people with parkinsonism (mean age 74.7 ± 9.8 years, 40% female), with a mean of 3.1 ± 2.5 years of available data. One thousand eight hundred twenty-three experienced at least one fragility fracture. Prior to a fragility fracture 12% had a prescription for bone protective medication. This increased to 38% and 53% in the 16 and 48-weeks post-fracture, respectively. 24% already had a prescription for vitamin D/calcium which increased to 73% at 48-weeks post-fracture. Female gender (OR = 2.06 [1.69-2.51], p < 0.001) and sustaining a vertebral fracture (OR = 2.06 [1.53-2.77], p < 0.001) increased the odds of bone protection prescriptions. However, sustaining a rib fracture (OR = 0.34 [0.19-0.60], p < 0.001) or residing in a care home (OR = 0.58 [0.38-0.88], p = 0.01) decreased the odds.

There is an osteoporosis treatment gap in Parkinson's rendering an already high-risk population at further risk of fracture. Men and those with rib fractures are two groups who are least likely to receive potentially beneficial treatment.