Objective: We set out to quantify the five-year risk of hip fracture for a cohort of 780 patients for whom a new diagnosis of Parkinson’s disease (PD) has been made in a movement disorder clinic, and to compare the their outcome after hip fracture with that seen in the general population.

Background: Hip fracture is the commonest serious injury and reason for an older person to need emergency anaesthesia and surgery. People with PD have an increased risk of both falls and osteoporosis and would be expected to be at an increased risk of hip fracture.

Method: Our Geriatrician-led movement disorder service has recorded follow-up data for 2,679 patients. We used National Hip Fracture Database (NHFD)[1] records to identify which of these were among 5,414 patients who had presented to our local trauma unit with hip fracture in the ten years 2008-18. We excluded those without a diagnosis of PD, and identified a cohort of 12 with a new diagnosis of PD made between 2008 and 2012, for whom 5 years of follow up was possible.

Results: In total 12 of the 780 people diagnosed with PD between 2008 and 2012 had sustained a total of 13 hip fractures within 5 years of their PD diagnosis. Seven were women, and the mean age at diagnosis of PD was 81. Median time from diagnosis to hip fracture is 685 days. By the time of fracture the person with PD had a mean Hoehn and Yahr score of 2.0 and a mean levodopa equivalent dose of 300mg. One third had dementia. We found a median overall length of hospital stay of 42 days, compared to 34 days for patients without PD (using NHFD, presenting to the same hospital, 2015 to 2018).

Conclusion: Patients with PD have an increased length of stay in hospital, implying poorer outcomes and reinforcing the necessity for bone health assessment at the earliest opportunity. The progressive nature of PD combined with our 1.6% figure for 5-year risk of hip fracture will probably leave the average patient with a new diagnosis of PD with a 10-year risk of hip fracture in excess of 3.2%. This approaches the threshold at which bone mineral density measurement should routinely be considered[2], so bone health and falls assessment must be part of the routine care of a person diagnosed with PD[3].

References: [1] National Hip Fracture Database, http://www.nhfd.co.uk [2] FRAX, http://www.sheffield.ac.uk/FRAX/tool.aspx [3] Lyell V, Henderson E, Devine M, Gregson C. Assessment and management of fracture risk in patients with Parkinson’s disease. Age and Ageing. 2015 44;1:34–41

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hip-fracture-in-patients-with-a-new-diagnosis-of-parkinsons-disease-estimating-the-5-year-risk/