Hip Fracture in Patients with Parkinson’s Disease and Related Mortality: A Population-Based Study in Korea

Abstract

Introduction: Patients with Parkinson’s disease (PD) are prone to falls, thereby increasing the risk of fractures and mortality. This population-based study investigated the risk of hip fractures and their effect on mortality in patients with PD in Korea. Methods: National Health Insurance Service-National Sample Cohort data were used. Patients newly diagnosed with PD between 2006 and 2015 and age- and sex-matched individuals were classified into the PD group and the comparison group, respectively, with a 1:9 ratio. The Cox proportional hazards model was used to calculate hazard ratios (HRs), and the Kaplan-Meier method to identify survivorship. Results: In total, 26,570 individuals were enrolled in the study: 2,657 in the PD cohort and 23,913 in the matched comparison cohort. The PD group had about a 2 times higher risk of hip fracture than the comparison group (3.95 vs. 1.94%, p < 0.001). According to sex, the difference between the PD and comparison groups for the risk of hip fracture was greater in males than in females. The highest difference in HR for hip fracture between the PD and comparison groups was found in individuals aged between 60 and 69 years. Regarding post-fracture mortality in patients with PD, the mortality risk was twice as high in the patients with hip fracture than in those without. The effect of hip fracture on mortality between these 2 groups was also the highest in individuals aged between 60 and 69 years. Conclusion: The PD group showed an approximately 2 times higher risk of hip fracture compared with the comparison group, and the post-fracture mortality rate was 2 times higher in the patients with PD with hip fracture than in those without. Those aged 60–69 years were associated with the highest risk of hip fracture and post-hip fracture mortality among patients with PD.

Development and validation of a predictive nomogram for subsequent contralateral hip fracture in elderly patients within 2 years after hip fracture surgery

“…Most hip fractures occur following a fall and that impaired balance and postural instability in patients with PD contribute to the increased risk of falls ( 36 ). Nam JS et al revealed that the risk of hip fracture was about approximately 2-fold higher in people with PD than in the control group, which bolstered our research results ( 37 ). AD was a degenerative change in the central nervous system, characterized by progressive loss of memory and cognition.…”

Hip Fracture Care in Parkinson Disease: A Retrospective Analysis of 1,239 Patients

“…Although we did not evaluate the effect of these variables on hip fracture risk or outcomes, it is important to note that a diagnosis of PD in and of itself serves as a risk factor for hip fracture. 1 , 2 , 4 - 8 …”

“…Although we did not evaluate the effect of these variables on hip fracture risk or outcomes, it is important to note that a diagnosis of PD in and of itself serves as a risk factor for hip fracture. 1,2,[4][5][6][7][8] PD is additionally associated with lower BMD, risk of vitamin D deficiency, and osteoporosis. 3,9,10 The prevalence of osteopenia and osteoporosis in all PD patients, including those without a hip fracture, has been found to be 41.4% and 11.8%, respectively.…”

“…Parkinson disease (PD) patients are susceptible to recurrent falls 1 - 3 and subsequent hip fractures. 1 , 2 , 4 - 8 They exhibit a 3-fold risk of falls compared to the general population, 3 with more than 50% sustaining repeated falls. 1 , 2 Of those that fall, approximately 1/3 sustain 1 or more fractures, with 28-50% of such fractures involving the hip.…”

“…1,2 Of those that fall, approximately 1/3 sustain 1 or more fractures, with 28-50% of such fractures involving the hip. 1,2 PD patients have been found to carry 2-3 times the risk of hip fracture compared to the general population, [4][5][6] with 27% of patients experiencing hip fracture within 10 years of diagnosis. 8 In addition, PD has been found to be associated with lower bone mineral density (BMD) 3,9 and higher risk of vitamin D deficiency and osteoporosis, 10 increasing the likelihood of subsequent hip fracture.…”