Hye Yeon Koo1, Eun Bin Cho2, Sung Hye Kong3, Kyungdo Han4, Kyu Na Lee5, Jung Eun Yoo6, Ju-Hong Min7,8,9, Sohyun Chun10, Dong Wook Shin11,12,13. 1. Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 2. Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea. 3. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 4. Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea. 5. Department of Biomedicine and Health Science, Catholic University of Korea, Seoul, Republic of Korea. 6. Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea. 7. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 8. Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea. 9. Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea. 10. International Health Center, Samsung Medical Center, 81 Irwon-Ro, Gangnam-gu, Seoul, Republic of Korea. sohyun.chun@gmail.com. 11. Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea. dwshin.md@gmail.com. 12. Department of Clinical Research Design and Evaluation/Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea. dwshin.md@gmail.com. 13. Center for Wireless and Population Health Systems, University of California, La Jolla, San Diego, CA, USA. dwshin.md@gmail.com.
Abstract
Fracture risk was elevated in Parkinson's disease (PD) patients compared with controls in this nationwide study. Among PD patients, the risk of fracture increased linearly with PD severity, whereas no difference in fracture risk was observed according to PD duration. INTRODUCTION: Parkinson's disease (PD) is reported to be associated with a high risk of fractures. Several studies found an association between severity and duration of PD and falls or bone mineral density, but those factors have not been considered in most previous research. The aim of this study was to determine the fracture risk in PD patients according to their disease severity and duration. METHODS: This population-based, retrospective cohort study used data from the Korean National Health Insurance Service database. The study population included 10,333 patients with prevalent PD and 6,501,464 comparison cohort. Fracture risks according to the prevalence, severity, and duration of PD were evaluated using Cox proportional hazard methods. RESULTS: Fracture risk was elevated in PD patients at all sites compared with controls (adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.44-1.56 for any fracture). When comparing fracture sites, hip fractures showed the largest risk increase in PD patients (aHR 2.16, 95% CI 1.95-2.38). Among PD patients, the risk of any fracture increased linearly with PD severity and was highest in patients with severe disease (aHR 1.65, 95% CI 1.53-1.79 compared with controls). Meanwhile, no significant association was observed between PD duration and fracture risk. CONCLUSIONS: The prevalence of PD was related to an increased risk of fractures in this nationwide study, and PD severity was linearly associated with fracture risk. PD prevalence and severity should be considered when evaluating the risk factors of fracture in clinical practice.
Fracture risk was elevated in Parkinson's disease (PD) patients compared with controls in this nationwide study. Among PD patients, the risk of fracture increased linearly with PD severity, whereas no difference in fracture risk was observed according to PD duration. INTRODUCTION: Parkinson's disease (PD) is reported to be associated with a high risk of fractures. Several studies found an association between severity and duration of PD and falls or bone mineral density, but those factors have not been considered in most previous research. The aim of this study was to determine the fracture risk in PD patients according to their disease severity and duration. METHODS: This population-based, retrospective cohort study used data from the Korean National Health Insurance Service database. The study population included 10,333 patients with prevalent PD and 6,501,464 comparison cohort. Fracture risks according to the prevalence, severity, and duration of PD were evaluated using Cox proportional hazard methods. RESULTS: Fracture risk was elevated in PD patients at all sites compared with controls (adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.44-1.56 for any fracture). When comparing fracture sites, hip fractures showed the largest risk increase in PD patients (aHR 2.16, 95% CI 1.95-2.38). Among PD patients, the risk of any fracture increased linearly with PD severity and was highest in patients with severe disease (aHR 1.65, 95% CI 1.53-1.79 compared with controls). Meanwhile, no significant association was observed between PD duration and fracture risk. CONCLUSIONS: The prevalence of PD was related to an increased risk of fractures in this nationwide study, and PD severity was linearly associated with fracture risk. PD prevalence and severity should be considered when evaluating the risk factors of fracture in clinical practice.
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