Objective: Optimise bone health in people with Parkinson’s Disease

Background: People with Parkinson’s Disease (PD) have an increased risk of osteoporosis and associated fractures due to factors such as impaired gait, postural instability, sarcopenia, medications, cognitive impairment and recurrent falls. Addressing bone health is important to reduce disability, morbidity and mortality. Our hospital runs a weekly PD interdisciplinary ‘huddle’ for patients with PD; a thorough assessment is performed and a proforma completed for each patient who attends.

Method: Retrospective audit of patients on PD huddle database. Data collected from medical records.

Results: 33 patients included. 10 (30%) were female. Median age was 79 years (range 66-94years). 27 (88%) had a diagnosis of Idiopathic PD, 3 (9%) had Dementia with Lewy Body and 1 (3%) had vascular parkinsonism. The median duration of diagnosis was 6.5 years (range 0-27 years).

12 (36%) had a diagnosis of osteoporosis. Of these, 4 were not on osteoporosis treatment. 9 (27%) had a history of a fragility fracture – 3 of these were not on osteoporosis treatment. 9 (27%) had a DXA scan.

The most common osteoporosis treatment was denosumab (n=7), followed by alendronate (n=1). 13 patients were on vitamin D and/or calcium supplementation.

82% had a gait impairment with 55% using a mobility aid. 66% had a history of falls. 52% had orthostatic hypotension. 64% had a vision impairment. 70% had a cognitive impairment.

23 (70%) of patients had falls risk medications identified – including antihypertensives (n=15), antipsychotics (n=4), antidepressants (n=6), diuretics (n=2), opioids (n=2) and benzodiazepines (n=1).  11 (33%) patients were on 1 falls risk medication, 7 (21%) were on 2 medications and 4 (12%) were on 3 or more medications.

Mean SARC-F was 4.8 (SD ±3.5). Median Body Mass Index (BMI) was 25.6 (range 18.5 – 43.1). Mean Timed Up and Go (TUG) was 19.8 seconds (SD ±1.4 seconds). Of note, 3 patients were unable to complete the TUG assessment due to impaired mobility.

Conclusion: This audit demonstrates multiple risk factors for fractures and suboptimal bone health treatment in patients with PD attending our service. Our current assessment does not routinely identify or address these factors. As a result of this audit, the PD huddle assessment proforma will be modified to incorporate bone health assessment into the interdisciplinary review.

References: 1. WHO (2022) Parkinson Disease. WHO. https://www.who.int/news-room/fact-sheets/detail/parkinson-disease. Accessed 16th January 2022
2. Kim TL, Byun SJ, Seong MY, Oh BM, Park SJ, Seo HG (2022) Fracture risk and impact of osteoporosis in patients with Parkinson’s disease: a nationwide database study. J Bone Miner Metab 40 (4):602-612. doi:10.1007/s00774-022-01322-w
3. Tan YJ, Lim SY, Yong VW, Choo XY, Ng YD, Sugumaran K, Md Shah MN, Raja Aman RRA, Paramasivam SS, Mohd Ramli N, Grossmann M, Tan AH (2021) Osteoporosis in Parkinson’s Disease: Relevance of Distal Radius Dual-Energy X-Ray Absorptiometry (DXA) and Sarcopenia. J Clin Densitom 24 (3):351-361. doi:10.1016/j.jocd.2020.07.001

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MDS Abstracts - https://www.mdsabstracts.org/abstract/bone-health-in-parkinsons-disease/