Top

Osteoporosis International

Published in:

01-06-2015 | Original Article

Risk and adverse outcomes of fractures in patients with Parkinson’s disease: two nationwide studies

Authors: Y.-F. Huang, Y.-G. Cherng, S. P. C. Hsu, C.-C. Yeh, Y.-C. Chou, C.-H. Wu, T.-L. Chen, C.-C. Liao

Published in: Osteoporosis International | Issue 6/2015

Abstract

Summary

The association between Parkinson’s disease and fracture was not completely understood. This nationwide study investigated increased risk of fracture in patients with Parkinson’s disease. In the nested cohort study, Parkinson’s disease was associated with pneumonia, septicemia, stroke, urinary tract infection, and mortality after fracture admission.

Introduction

Falls are a common complication in people with Parkinson’s disease (PD). This study evaluated fracture risk and post-fracture outcomes in patients with PD.

Methods

We identified 1,423 adults aged 40 years and older newly diagnosed with PD using the Taiwan National Health Insurance Research Database from 2000 to 2003. Comparison cohort consisted of 5,692 adults without PD randomly selected from the same dataset, frequency matched in age and sex. Followed-up events of fracture from January 1, 2000, until December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HR) and 95 % confidence interval (CI) of fracture associated with PD were evaluated. Another nested cohort study of 397,766 hospitalized fracture patients analyzed for adjusted odds ratios (ORs) and 95 % CIs of adverse events after fracture among patients with and without PD between 2004 and 2010.

Results

The incidences of fracture for people with and without PD were 39.5 and 23.9 per 1,000 person-years, respectively (p < 0.0001). Compared with control, the adjusted HR of fracture was 2.25 (95 % CI 1.97–2.58) for PD patients. Previous PD was associated with risks of pneumonia (OR 1.44, 95 % CI 1.36–1.52), septicemia (OR 1.41, 95 % CI 1.33–1.49), stroke (OR 1.40, 95 % CI 1.32–1.50), urinary tract infection (OR 1.53, 95 % CI 1.46–1.61), and mortality (OR 1.25, 95 % CI 1.15–1.35) after fracture.

Conclusions

PD was associated with higher risk of fracture. Patients with PD had more complications and mortality after fracture. Fracture prevention and attention to post-fracture adverse events are needed for this susceptible population.

Samii A, Nutt JG, Ransom BR (2004) Parkinson’s disease. Lancet 363:1783–1793PubMedCrossRef

Pringsheim T, Jette N, Frolkis A, Steeves TD (2014) The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 29:1583–1590PubMedCrossRef

Nussbaum RL, Ellis CE (2003) Alzheimer’s disease and Parkinson’s disease. N Engl J Med 348:1356–1364PubMedCrossRef

De Rijk MC, Launer LJ, Berger K et al (2000) Prevalence of Parkinson’s disease in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 54:S21–S23PubMed

De Lau LM, Breteler MM (2006) Epidemiology of Parkinson’s disease. Lancet Neurol 5:525–535PubMedCrossRef

Huse DM, Schulman K, Orsini L, Castelli-Haley J, Kennedy S, Lenhart G (2005) Burden of illness in Parkinson’s disease. Mov Disord 20:1449–1454PubMedCrossRef

Berger K, Breteler MM, Helmer C et al (2000) Prognosis with Parkinson’s disease in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 54:S24–S27PubMed

Pickering RM, Grimbergen YAM, Rigney U et al (2007) A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord 22:1892–1900PubMedCrossRef

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRef

10.

Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475PubMedCrossRef

11.

Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jönsson B (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6:59–155PubMedCrossRef

12.

Genever RW, Downes TW, Medcalf P (2005) Fracture rates in Parkinson’s disease compared with age- and gender-matched controls: a retrospective cohort study. Age Ageing 34:21–24PubMedCrossRef

13.

Pouwels S, Bazelier MT, de Boer A, Weber WE, Neef C, Cooper C, de Vries F (2013) Risk of fracture in patients with Parkinson’s disease. Osteoporos Int 24:2283–2290PubMedCrossRef

14.

Fink HA, Kuskowski MA, Taylor BC, Schousboe JT, Orwoll ES, Ensrud KE (2008) Association of Parkinson’s disease with accelerated bone loss, fractures and mortality in older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int 19:1277–1282PubMedCrossRef

15.

Harris-Hayes M, Willis AW, Klein SE, Czuppon S, Crowner B, Racette BA (2014) Relative mortality in U.S. Medicare beneficiaries with Parkinson disease and hip and pelvic fractures. J Bone Joint Surg Am 96:e27PubMedCentralPubMedCrossRef

16.

Chen YY, Cheng PY, Wu SL, Lai CH (2012) Parkinson’s disease and risk of hip fracture: an 8-year follow-up study in Taiwan. Parkinsonism Relat Disord 18:506–509PubMedCrossRef

17.

Melton LJ 3rd, Leibson CL, Achenbach SJ, Bower JH, Maraganore DM, Oberg AL, Rocca WA (2006) Fracture risk after the diagnosis of Parkinson’s disease: influence of concomitant dementia. Mov Disord 21:1361–1367PubMedCrossRef

18.

Johnell O, Melton LJ 3rd, Atkinson EJ, O'Fallon WM, Kurland LT (1992) Fracture risk in patients with parkinsonism: a population-based study in Olmsted County, Minnesota. Age Ageing 21:32–38PubMedCrossRef

19.

Sato Y, Kaji M, Tsuru T, Oizumi K (2001) Risk factors for hip fracture among elderly patients with Parkinson’s disease. J Neurol Sci 182:89–93PubMedCrossRef

20.

Schneider JL, Fink HA, Ewing SK, Ensrud KE, Cummings SR (2008) The association of Parkinson’s disease with bone mineral density and fracture in older women. Osteoporos Int 19:1093–1097PubMedCrossRef

21.

Liao CC, Shen WW, Chang CC, Chang H, Chen TL (2013) Surgical adverse outcomes in patients with schizophrenia: a population-based study. Ann Surg 257:433–438PubMedCrossRef

22.

Liao CC, Lin CS, Shih CC, Yeh CC, Chang YC, Lee YW, Chen TL (2014) Increased risk of fracture and postfracture adverse events in patients with diabetes: two nationwide population-based retrospective cohort studies. Diabetes Care 37:2246–2252PubMedCrossRef

23.

Liao CC, Chou YC, Yeh CC, Hu CJ, Chiu WT, Chen TL (2014) Stroke risk and outcomes in patients with traumatic brain injury: 2 nationwide studies. Mayo Clin Proc 89:163–172PubMedCrossRef

24.

Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML (2011) Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf 20:236–242PubMedCrossRef

25.

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697PubMedCrossRef

26.

Guilley E, Herrmann F, Rapin CH, Hoffmeyer P, Rizzoli R, Chevalley T (2011) Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly. Osteoporos Int 22:647–653PubMedCrossRef

27.

Yang S, Nguyen ND, Center JR, Eisman JA, Nguyen TV (2014) Association between hypertension and fragility fracture: a longitudinal study. Osteoporos Int 25:97–103PubMedCrossRef

28.

Baker NL, Cook MN, Arrighi HM, Bullock R (2011) Hip fracture risk and subsequent mortality among Alzheimer’s disease patients in the United Kingdom, 1988–2007. Age Ageing 40:49–54PubMedCrossRef

29.

Dennison EM, Compston JE, Flahive J et al (2012) Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 50:1288–1293PubMedCrossRef

30.

Hippisley-Cox J, Coupland C (2012) Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ 344:e3427PubMedCrossRef

31.

Trimpou P, Odén A, Simonsson T, Wilhelmsen L, Landin-Wilhelmsen K (2011) High serum total cholesterol is a long-term cause of osteoporotic fracture. Osteoporos Int 22:1615–1620PubMedCrossRef

32.

Bhattacharjee S, Sambamoorthi U (2013) Co-occurring chronic conditions and healthcare expenditures associated with Parkinson’s disease: a propensity score matched analysis. Parkinsonism Relat Disord 19:746–750PubMedCrossRef

33.

Leibson CL, Maraganore DM, Bower JH, Ransom JE, O'brien PC, Rocca WA (2006) Comorbid conditions associated with Parkinson’s disease: a population-based study. Mov Disord 21:446–455PubMedCrossRef

34.

Kauppi M, Stenholm S, Impivaara O, Mäki J, Heliövaara M, Jula A (2014) Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample. Osteoporos Int 25:1685–1695PubMedCrossRef

35.

Gerlach OH, Broen MP, van Domburg PH, Vermeij AJ, Weber WE (2012) Deterioration of Parkinson’s disease during hospitalization: survey of 684 patients. BMC Neurol 12:13PubMedCentralPubMedCrossRef

36.

Gerlach OH, Winogrodzka A, Weber WE (2011) Clinical problems in the hospitalized Parkinson’s disease patient: systematic review. Mov Disord 26:197–208PubMedCentralPubMedCrossRef

37.

Chou KL, Zamudio J, Schmidt P et al (2011) Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers. Parkinsonism Relat Disord 17:440–445PubMedCentralPubMedCrossRef

38.

Sato Y, Kikuyama M, Oizumi K (1997) High prevalence of vitamin D deficiency and reduced bone mass in Parkinson’s disease. Neurology 49:1273–1278PubMedCrossRef

39.

Sato Y, Iwamoto J, Honda Y (2011) Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson’s disease. Parkinsonism Relat Disord 17:22–26PubMedCrossRef

40.

Invernizzi M, Carda S, Viscontini GS, Cisari C (2009) Osteoporosis in Parkinson’s disease. Parkinsonism Relat Disord 15:339–346PubMedCrossRef

41.

Gnädinger M, Mellinghoff HU, Kaelin-Lang A (2011) Parkinson’s disease and the bones. Swiss Med Wkly 141:w13154PubMed

42.

Dobson R, Yarnall A, Noyce AJ, Giovannoni G (2013) Bone health in chronic neurological diseases: a focus on multiple sclerosis and parkinsonian syndromes. Pract Neurol 13:70–79PubMedCrossRef

43.

Lees AJ, Hardy J, Revesz T (2009) Parkinson’s disease. Lancet 373:2055–2066PubMedCrossRef

44.

Pouwels S, van Staa TP, Egberts AC, Leufkens HG, Cooper C, de Vries F (2009) Antipsychotic use and the risk of hip/femur fracture: a population-based case-control study. Osteoporos Int 20:1499–1506PubMedCentralPubMedCrossRef

45.

Vestergaard P, Rejnmark L, Mosekilde L (2007) Fracture risk associated with parkinsonism and anti-Parkinson drugs. Calcif Tissue Int 81:153–161PubMedCrossRef

Title: Risk and adverse outcomes of fractures in patients with Parkinson’s disease: two nationwide studies
Authors: Y.-F. Huang
Y.-G. Cherng
S. P. C. Hsu
C.-C. Yeh
Y.-C. Chou
C.-H. Wu
T.-L. Chen
C.-C. Liao
Publication date: 01-06-2015
Publisher: Springer London
Published in: Osteoporosis International / Issue 6/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3052-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk and adverse outcomes of fractures in patients with Parkinson’s disease: two nationwide studies

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2015

Dietary patterns and risk of hip fractures in postmenopausal women and men over 50 years

The ABC of writing a grant proposal

A longitudinal study of bone area, content, density, and strength development at the radius and tibia in children 4–12 years of age exposed to recreational gymnastics

Peripheral quantitative computed tomography (pQCT) reveals low bone mineral density in adolescents with motor difficulties

Education, marital status, and risk of hip fractures in older men and women: the CHANCES project

The relationship between platelet indices and postmenopausal osteoporosis