#ParkinsonsDisease #Osteoporosis #FractureRisk
#FRAX #Prevention
In patients with
Parkinson’s disease (PD), the
risk of fracture is significantly higher than in the general population,
particularly among the elderly. This heightened vulnerability stems from a
combination of motor and metabolic factors. Frequent falls—linked to
bradykinesia and postural instability—occur alongside reduced bone strength,
often due to osteopenia or osteoporosis. These fractures—especially hip
fractures—can lead to serious consequences such as prolonged hospitalizations,
loss of independence, and increased mortality. Yet, despite their frequency and
impact, bone health disorders remain underdiagnosed and undertreated in the
care pathways of patients with Parkinson’s disease.
Aware of this issue, the latest
UK guidelines
from the National Osteoporosis Guideline Group (NOGG, 2021) call for systematic
fracture risk assessment in this population. They recommend combining validated
tools such as the
FRAX® (
Fracture Risk Assessment Tool) score and
DXA
(
dual-energy X-ray absorptiometry)
scanning to guide therapeutic decisions.
However, in routine clinical practice, such assessments are still seldom
performed.
Preventive treatments (e.g., bisphosphonates, calcium and vitamin D
supplementation) are underprescribed—even in patients identified as high-risk.
This underassessment represents a missed opportunity for early intervention to
prevent severe, yet avoidable, complications.
FRAX + DXA: a winning combo against fractures?
The BONE-PARK 2 study—a randomized controlled trial—evaluated the feasibility
and relevance of a targeted bone risk assessment algorithm in patients with
parkinsonism. The objective was to refine treatment decisions by integrating
often-overlooked variables such as DXA results and fall history, alongside the
FRAX score.
Among the 213 participants enrolled (mean age:
74.5 years), more than 40% had experienced at least two falls in the previous
year, and nearly 30% had already suffered a fragility fracture. Yet only 11.5%
were receiving preventive treatment for osteoporosis.
The analysis showed that adding DXA measurements to the FRAX score led to risk
reclassification in approximately 40% of patients. Some had their risk level
downgraded, while others crossed the threshold warranting therapeutic
intervention.
Additionally, factoring in fall frequency led to reclassification
in 18.7% of cases, with 5% more patients becoming eligible for osteoporosis
treatment. These findings underscore the importance of including these
parameters in fracture risk assessments—failing to do so may leave vulnerable
patients unprotected.
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Think bones... think parkinson’s too
Parkinson’s disease is a neurodegenerative condition that significantly
increases the risk of fractures—particularly hip fractures—due to a combination
of balance disorders, frequent falls, and bone fragility associated with
osteopenia or osteoporosis. Despite current recommendations for a more
proactive approach, bone health is still rarely assessed or integrated into the
care pathway.
This study evaluates the benefits of a
personalized bone risk assessment algorithm (BONE-PARK 2), which incorporates
bone mineral density and fall history into the FRAX calculation to better
estimate fracture risk and optimize treatment decisions. The results show that
a large proportion of PD patients at risk of fracture still do not receive
preventive treatment. By integrating bone density and fall history into the
FRAX score, the BONE-PARK 2 algorithm improves the
identification of at-risk
patients and
enhances clinical decision-making. This straightforward approach
strengthens fracture prevention in Parkinson’s disease by enabling more
accurate risk stratification.
Although the BONE-PARK 2 algorithm is simple,
accessible, and effective for improving bone health management, it is only a
first step. Further progress will require adapting the FRAX tool to the
specific features of Parkinson’s disease and implementing systematic screening
protocols within neurological care pathways to optimize fracture prevention.
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