Risk of fracture amongst patients with Parkinson's disease and other forms of parkinsonism

Isobel Sleeman, Zhu Chung Che, Carl Counsell

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Postural instability, a core feature of parkinsonism, leads to an increased risk of falls and fractures. However, the risk of fracture has not been assessed in an incident cohort of Parkinson's disease and atypical parkinsonism.


We determined the absolute and relative fracture risk and predictive variables in a prospective incident cohort of parkinsonian patients and controls.


Fracture data for 326 incident parkinsonian cases (198 Parkinson's disease, 128 atypical parkinsonism) and 261 controls was recorded annually in the Parkinsonism Incidence in North-East Scotland study. Incidence rates were determined for all fractures and major fractures. Kaplan-Meier curves were used to determine time to first fracture for each group. Stepwise, multivariate Cox regression analysis was used to identify risk factors for fracture in parkinsonian patients.


Mean age at recruitment was 74.5 years in all parkinsonian patients (age at diagnosis) and 75 years in controls. The incidence of any fracture was 5.5 (95% CI 4.3–7.0) and 2.0 (1.3–2.9)/100 participant-years for the parkinsonian and control groups respectively, whilst for major fractures due to falls it was 4.2 (3.2–5.5) and 1.4 (0.9–2.2)/100 participant-years respectively. Independent predictors for fractures in parkinsonian patients were osteoporosis, female gender and falling during the follow up period. There was no difference in fracture rates between those with Parkinson's disease and atypical parkinsonism.


The fracture rate in parkinsonism from the time of diagnosis (about 5% per year) is over three times greater than controls. Fracture risk should be routinely assessed in all parkinsonian patients.
Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalParkinsonism & Related Disorders
Early online date26 May 2016
Publication statusPublished - Aug 2016

Bibliographical note

We thank all the participants who took part, the research fellows (Kate Taylor, Robert Caslake, David McGhee, Angus Macleod) and nurses (Clare Harris, Joanna Gordon, Anne Hayman, Hazel Forbes) who helped assess the participants, and the study secretaries (Susan Kilpatrick, Pam Rebecca) and data management team (Katie Wilde, David Ritchie). The PINE study was funded by the BMA Doris Hillier award, Parkinson's UK, the RS McDonald Trust, NHS Grampian Endowments, SPRING and the BUPA Foundation. None of the funders had any influence in the study design, the collection, analysis and interpretation of the data, the writing of the report or the decision to submit the article for publication.


  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Fractures, Bone/epidemiology
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Parkinson Disease/epidemiology
  • Parkinsonian Disorders/epidemiology
  • Risk Factors
  • Statistics, Nonparametric


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