Fractures are more common during the 5-year prodromal period of Parkinson disease (PD), according to study results published in Neurology.

Fall-related injuries that are secondary to motor impairment occur more commonly in patients with PD during the prodromal period of the disease. The objective of the current study was to assess the risk for noncranial fractures during the prodromal period of PD as compared with control participants.

The population-based case-control study included Medicare beneficiaries in the United States from 2004 to 2009 who were aged 66 to 90 years in 2009. Fractures were identified from the Barell Injury Matrix and classified by body region. Statistical analyses were completed to explore the association between fracture and PD in yearly time intervals before PD diagnosis/control reference date.

The study cohort included 89,632 incident cases with PD (mean age, 78.8 years; 50.2% women) and 117,760 control participants (mean age, 76.0 years; 57.0% women). During the 5 years before PD diagnosis/control reference date, there were 22,780 fractures (25.4%) in the PD group and 16,826 fractures (14.3%) in the control group. Among both the patient and control group, a majority of the injuries were attributed to falls (74.6% and 72.8%, respectively).


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There was a positive association between PD and fractures at each time point in the 5 years before diagnosis (<3 months, 3-<12 months, 1-<2 years, 2-<3 years, 3-<4 years, and ≥5 years). The association between fracture and prodromal PD became stronger as the date of PD diagnosis/control reference date approached (P ≤.02), with an adjusted odds ratio of 1.69 (95% CI, 1.56-1.84) at 3 to <12 months before diagnosis and 1.10 (95% CI, 1.00-1.21) at 4 to <5 years before PD diagnosis.

Study limitations included potential misdiagnoses of PD and fractures, missing data on important variables associated with fractures, and limitations related to the use of data from the Medicare database.

“Medical providers and researchers should be aware of opportunities to diagnose and treat PD earlier and aggressively manage and treat fractures in order to prevent secondary fractures given the high risk [for] associated morbidity and mortality,” concluded the researchers.

Reference

Camacho-Soto A, Gross A, Nielsen SS, et al. Fractures in the prodromal period of Parkinson disease [published online April 28, 2020]. Neurology. doi:10.1212/WNL.0000000000009452