Fractures in the prodromal period of Parkinson disease

Alejandra Camacho-Soto, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
Anat Gross, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
Susan Searles Nielsen, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
Anna N. Miller, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
Mark N. Warden, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
Amber Salter, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa.
Brad A. Racette, From the Departments of Neurology (A.C.-S., A.G., S.S.N., M.N.W., B.A.R.) and Orthopedic Surgery (A.N.M.) and Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; and School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa. racetteb@neuro.wustl.edu.

Document Type

Article

Abstract

OBJECTIVE: To examine the association between fractures and Parkinson disease (PD) during the 5-year prodromal phase as compared to controls. METHODS: We performed a population-based case-control study of Medicare beneficiaries in the United States from 2004 to 2009. We identified 89,632 incident PD cases and 117,760 comparable controls 66-90 years of age in 2009. PD case status was the outcome, and noncranial fracture the independent variable. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association between fracture and PD in yearly time intervals prior to PD diagnosis/control reference date, after adjusting for covariates. RESULTS: There were 39,606 total fractures (25.4% cases, 14.3% controls) over the 5 years prior to the PD diagnosis/control reference date. PD was positively associated with fractures even after adjusting for age, sex, race/ethnicity, Charlson comorbidity index, alcohol use, tobacco use, and osteoporosis. The association between PD and fracture was evident at yearly time windows prior to PD diagnosis/control reference date. The association between PD and each type of fracture strengthened as the PD diagnosis/control reference date approached (all time interaction values ≤0.02). Among beneficiaries with a mechanism of injury, the majority were attributed to falls (74.6% cases, 72.8% controls). CONCLUSION: Fractures occur more commonly during the prodromal period of PD compared to controls, especially as diagnosis date approached, suggesting that patients with PD may experience unrecognized motor and nonmotor symptoms.

Medical Subject Headings

Accidental Falls; Accidents, Traffic; Age Factors; Aged; Aged, 80 and over; Alcoholism (epidemiology); Case-Control Studies; Comorbidity; Confidence Intervals; Ethnicity (statistics & numerical data); Female; Fractures, Bone (epidemiology, etiology); Humans; Logistic Models; Male; Medicare (statistics & numerical data); Models, Theoretical; Odds Ratio; Organ Specificity; Osteoporosis (epidemiology); Parkinson Disease (complications); Prodromal Symptoms; Retrospective Studies; Risk Factors; Smoking (epidemiology); United States (epidemiology); Violence

Publication Date

6-9-2020

Publication Title

Neurology

E-ISSN

1526-632X

Volume

94

Issue

23

First Page

e2448

Last Page

e2456

PubMed ID

32345729

Digital Object Identifier (DOI)

10.1212/WNL.0000000000009452

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