Fracture rates in Parkinson's disease compared with age- and gender-matched controls: a retrospective cohort study

Introduction: patients with Parkinson's disease (PD) are not routinely prescribed bone-protecting medication despite the fact that they are known to be at risk of falling. We investigated whether subjects with PD were more at risk of fractures than other patient groups in order to establish whether preventative measures should be targeted on those who have been diagnosed with PD. Methods: we performed a retrospective cohort study, reviewing the records of PD patients compared with age- and gender matched patients attending medical clinics. Power analysis indicated the need for 194 in each group for a 95% confidence level. Our study comprised 200 PD patients and 200 controls. All limb and vertebral fractures before the date of diagnosis, or control, were recorded. Results: 52% of patients in each group were female. The mean age of the PD patients was 75.6 years (43.7-96.0) and that of controls 75.2 years (43.9-95.9). The mean interval from diagnosis was 5.46 years, providing 1092 person-years of follow-up in both groups. Fractures were significantly more common in the PD group than the control group (PD 15%, controls 7.5%; p = 0.007). The commonest site of fracture was femur in PD patients (11 of 38 fractures) and forearm in the control group (5 of 16 fractures). Conclusion: the risk of fracture is significantly increased in PD relative to patients with other medical conditions. Hip fractures are commonly fatal in older people and partly preventable. Prospective studies of intervention to prevent fractures in PD are required.