Risk of fracture amongst patients with Parkinson's disease and other forms of parkinsonism

Isobel Sleeman, Zhu Chung Che, Carl Counsell

Research output: Contribution to journalArticle

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4 Downloads (Pure)

Abstract

Introduction

Postural instability, a core feature of parkinsonism, leads to an increased risk of falls and fractures. However, the risk of fracture has not been assessed in an incident cohort of Parkinson's disease and atypical parkinsonism.

Objectives

We determined the absolute and relative fracture risk and predictive variables in a prospective incident cohort of parkinsonian patients and controls.

Methods

Fracture data for 326 incident parkinsonian cases (198 Parkinson's disease, 128 atypical parkinsonism) and 261 controls was recorded annually in the Parkinsonism Incidence in North-East Scotland study. Incidence rates were determined for all fractures and major fractures. Kaplan-Meier curves were used to determine time to first fracture for each group. Stepwise, multivariate Cox regression analysis was used to identify risk factors for fracture in parkinsonian patients.

Results

Mean age at recruitment was 74.5 years in all parkinsonian patients (age at diagnosis) and 75 years in controls. The incidence of any fracture was 5.5 (95% CI 4.3–7.0) and 2.0 (1.3–2.9)/100 participant-years for the parkinsonian and control groups respectively, whilst for major fractures due to falls it was 4.2 (3.2–5.5) and 1.4 (0.9–2.2)/100 participant-years respectively. Independent predictors for fractures in parkinsonian patients were osteoporosis, female gender and falling during the follow up period. There was no difference in fracture rates between those with Parkinson's disease and atypical parkinsonism.

Conclusion

The fracture rate in parkinsonism from the time of diagnosis (about 5% per year) is over three times greater than controls. Fracture risk should be routinely assessed in all parkinsonian patients.
Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalParkinsonism & Related Disorders
Volume29
Early online date26 May 2016
DOIs
Publication statusPublished - Aug 2016

Fingerprint

Parkinsonian Disorders
Parkinson Disease
Incidence
Accidental Falls
Scotland
Osteoporosis
Regression Analysis
Control Groups
Parkinson Disease, Familial, Type 1

Keywords

  • Parkinson's disease
  • Parkinsonism
  • Fracture
  • Cohort study
  • Predictive factors

Cite this

Risk of fracture amongst patients with Parkinson's disease and other forms of parkinsonism. / Sleeman, Isobel; Che, Zhu Chung; Counsell, Carl.

In: Parkinsonism & Related Disorders, Vol. 29, 08.2016, p. 60-65.

Research output: Contribution to journalArticle

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abstract = "IntroductionPostural instability, a core feature of parkinsonism, leads to an increased risk of falls and fractures. However, the risk of fracture has not been assessed in an incident cohort of Parkinson's disease and atypical parkinsonism.ObjectivesWe determined the absolute and relative fracture risk and predictive variables in a prospective incident cohort of parkinsonian patients and controls.MethodsFracture data for 326 incident parkinsonian cases (198 Parkinson's disease, 128 atypical parkinsonism) and 261 controls was recorded annually in the Parkinsonism Incidence in North-East Scotland study. Incidence rates were determined for all fractures and major fractures. Kaplan-Meier curves were used to determine time to first fracture for each group. Stepwise, multivariate Cox regression analysis was used to identify risk factors for fracture in parkinsonian patients.ResultsMean age at recruitment was 74.5 years in all parkinsonian patients (age at diagnosis) and 75 years in controls. The incidence of any fracture was 5.5 (95{\%} CI 4.3–7.0) and 2.0 (1.3–2.9)/100 participant-years for the parkinsonian and control groups respectively, whilst for major fractures due to falls it was 4.2 (3.2–5.5) and 1.4 (0.9–2.2)/100 participant-years respectively. Independent predictors for fractures in parkinsonian patients were osteoporosis, female gender and falling during the follow up period. There was no difference in fracture rates between those with Parkinson's disease and atypical parkinsonism.ConclusionThe fracture rate in parkinsonism from the time of diagnosis (about 5{\%} per year) is over three times greater than controls. Fracture risk should be routinely assessed in all parkinsonian patients.",
keywords = "Parkinson's disease, Parkinsonism, Fracture, Cohort study, Predictive factors",
author = "Isobel Sleeman and Che, {Zhu Chung} and Carl Counsell",
note = "Acknowledgements We thank all the participants who took part, the research fellows (Kate Taylor, Robert Caslake, David McGhee, Angus Macleod) and nurses (Clare Harris, Joanna Gordon, Anne Hayman, Hazel Forbes) who helped assess the participants, and the study secretaries (Susan Kilpatrick, Pam Rebecca) and data management team (Katie Wilde, David Ritchie). The PINE study was funded by the BMA Doris Hillier award, Parkinson's UK, the RS McDonald Trust, NHS Grampian Endowments, SPRING and the BUPA Foundation. None of the funders had any influence in the study design, the collection, analysis and interpretation of the data, the writing of the report or the decision to submit the article for publication.",
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T1 - Risk of fracture amongst patients with Parkinson's disease and other forms of parkinsonism

AU - Sleeman, Isobel

AU - Che, Zhu Chung

AU - Counsell, Carl

N1 - Acknowledgements We thank all the participants who took part, the research fellows (Kate Taylor, Robert Caslake, David McGhee, Angus Macleod) and nurses (Clare Harris, Joanna Gordon, Anne Hayman, Hazel Forbes) who helped assess the participants, and the study secretaries (Susan Kilpatrick, Pam Rebecca) and data management team (Katie Wilde, David Ritchie). The PINE study was funded by the BMA Doris Hillier award, Parkinson's UK, the RS McDonald Trust, NHS Grampian Endowments, SPRING and the BUPA Foundation. None of the funders had any influence in the study design, the collection, analysis and interpretation of the data, the writing of the report or the decision to submit the article for publication.

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Y1 - 2016/8

N2 - IntroductionPostural instability, a core feature of parkinsonism, leads to an increased risk of falls and fractures. However, the risk of fracture has not been assessed in an incident cohort of Parkinson's disease and atypical parkinsonism.ObjectivesWe determined the absolute and relative fracture risk and predictive variables in a prospective incident cohort of parkinsonian patients and controls.MethodsFracture data for 326 incident parkinsonian cases (198 Parkinson's disease, 128 atypical parkinsonism) and 261 controls was recorded annually in the Parkinsonism Incidence in North-East Scotland study. Incidence rates were determined for all fractures and major fractures. Kaplan-Meier curves were used to determine time to first fracture for each group. Stepwise, multivariate Cox regression analysis was used to identify risk factors for fracture in parkinsonian patients.ResultsMean age at recruitment was 74.5 years in all parkinsonian patients (age at diagnosis) and 75 years in controls. The incidence of any fracture was 5.5 (95% CI 4.3–7.0) and 2.0 (1.3–2.9)/100 participant-years for the parkinsonian and control groups respectively, whilst for major fractures due to falls it was 4.2 (3.2–5.5) and 1.4 (0.9–2.2)/100 participant-years respectively. Independent predictors for fractures in parkinsonian patients were osteoporosis, female gender and falling during the follow up period. There was no difference in fracture rates between those with Parkinson's disease and atypical parkinsonism.ConclusionThe fracture rate in parkinsonism from the time of diagnosis (about 5% per year) is over three times greater than controls. Fracture risk should be routinely assessed in all parkinsonian patients.

AB - IntroductionPostural instability, a core feature of parkinsonism, leads to an increased risk of falls and fractures. However, the risk of fracture has not been assessed in an incident cohort of Parkinson's disease and atypical parkinsonism.ObjectivesWe determined the absolute and relative fracture risk and predictive variables in a prospective incident cohort of parkinsonian patients and controls.MethodsFracture data for 326 incident parkinsonian cases (198 Parkinson's disease, 128 atypical parkinsonism) and 261 controls was recorded annually in the Parkinsonism Incidence in North-East Scotland study. Incidence rates were determined for all fractures and major fractures. Kaplan-Meier curves were used to determine time to first fracture for each group. Stepwise, multivariate Cox regression analysis was used to identify risk factors for fracture in parkinsonian patients.ResultsMean age at recruitment was 74.5 years in all parkinsonian patients (age at diagnosis) and 75 years in controls. The incidence of any fracture was 5.5 (95% CI 4.3–7.0) and 2.0 (1.3–2.9)/100 participant-years for the parkinsonian and control groups respectively, whilst for major fractures due to falls it was 4.2 (3.2–5.5) and 1.4 (0.9–2.2)/100 participant-years respectively. Independent predictors for fractures in parkinsonian patients were osteoporosis, female gender and falling during the follow up period. There was no difference in fracture rates between those with Parkinson's disease and atypical parkinsonism.ConclusionThe fracture rate in parkinsonism from the time of diagnosis (about 5% per year) is over three times greater than controls. Fracture risk should be routinely assessed in all parkinsonian patients.

KW - Parkinson's disease

KW - Parkinsonism

KW - Fracture

KW - Cohort study

KW - Predictive factors

U2 - 10.1016/j.parkreldis.2016.05.026

DO - 10.1016/j.parkreldis.2016.05.026

M3 - Article

VL - 29

SP - 60

EP - 65

JO - Parkinsonism & Related Disorders

JF - Parkinsonism & Related Disorders

SN - 1353-8020

ER -