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Risk of fracture in patients with Parkinson’s disease

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Abstract

Summary

The aim of the study was to determine fracture risk in incident Parkinson’s disease (PD) patients. This study showed that fracture risk assessment may be indicated among patients with PD, in particular when they have recently used selective serotonin re-uptake inhibitors or high-dose antipsychotics, or have a history of fracture, falling, low body mass index (BMI) or renal disease.

Introduction

PD is a movement disorder associated with falling and detrimental effects on bone. Both are recognized risk factors for fracture. Therefore, the aim was to determine fracture risk in incident PD patients stratified by treatment, severity, duration of disease and related comorbidities.

Methods

We conducted a retrospective cohort study using the UK General Practice Research Database (1987–2011). Each PD patient was matched by age, sex, calendar time and practice to a control patient without history of PD.

Results

We identified 4,687 incident PD patients. Compared to controls, a statistically significant increased risk was observed for any fracture (adjusted hazard ratio [AHR], 1.89; 95 % confidence interval [CI], 1.67–2.14), osteoporotic fracture (AHR, 1.99; 95 % CI, 1.72–2.30) and hip fracture (AHR 3.08; 95 % CI, 2.43–3.89). Fracture risk further increased with history of fracture, falling, low BMI, renal disease, antidepressant use and use of high-dose antipsychotics.

Conclusion

This study showed that incident PD patients have a statistically significant increased risk of fracture. Therefore, fracture risk assessment may be indicated among PD patients, who, besides the general risk factors for fracture, like increasing age and female gender, have recently used selective serotonin re-uptake inhibitors or high-dose antipsychotics or have a history of fracture, falling, low BMI or renal disease.

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Acknowledgments

This work was funded in part by the European Calcified Tissue Society and the NIHR, Biomedical Research Unit in Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford.

Conflicts of interest

The department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, employing SP, MTB, AB and FV has received unrestricted research funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the private–public funded Top Institute Pharma (www.tipharma.nl) (includes cofunding from universities, government and industry), the EU Innovative Medicines Initiative (IMI), EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board, the Dutch Ministry of Health and industry (including GlaxoSmithKline, Pfizer and others). CC, WW and CN report no disclosures.

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Pouwels, S., Bazelier, M.T., de Boer, A. et al. Risk of fracture in patients with Parkinson’s disease. Osteoporos Int 24, 2283–2290 (2013). https://doi.org/10.1007/s00198-013-2300-2

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  • DOI: https://doi.org/10.1007/s00198-013-2300-2

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