Falls, fractures may precede Parkinson’s disease by decades

By Eleanor McDermid, Senior medwireNews Reporter

People who later develop Parkinson’s disease (PD) have an increased tendency to fall and injure themselves, being at particular risk of hip fracture, a study shows.

“These findings suggest that clinically relevant neurodegenerative impairment could be present many years before the clinical onset of the disease”, say the researchers.

Using data from Swedish national registries, the team found that 18.0% of 24,412 patients with PD versus 11.5% of 243,363 age- and gender-matched controls had at least one fall resulting in injury prior to the date of PD diagnosis.

The fall resulted in a fracture in 10.7% of PD patients versus 6.9% of controls. In addition, 7.1% and 3.2%, respectively, had sustained a hip fracture prior to the date of PD diagnosis. All differences between the patients and controls were statistically significant.

After accounting for confounders, PD patients had a significantly increased risk of injurious falls and hip fractures throughout the decade before diagnosis, and the risk increased further as they neared the date of PD diagnosis. The association was even stronger for hip fracture, and it extended back for more than 15 years.

“The time-dependent patterns indicate a direct link between injurious falls and subsequent PD, and may be explained by subtle neurodegenerative impairment many years before the diagnosis of this disease”, write Peter Nordström (Umeå University, Sweden) and study co-authors in PLOS Medicine.

The team also identified 622,333 people with an injurious fall and 622,333 without, and found that rates of subsequent PD diagnosis were significantly higher in the former than the latter, at 0.7% versus 0.5%.

Previous studies have identified reduced handgrip and elbow-flexion strength in patients 3 decades before PD diagnosis, the researchers note. “The involvement of the upper extremity is of particular interest in relation to the increased risk of hip fracture in the present study, as dysfunctional arm movements when falling are thought to play an important role in the high incidence of hip fracture in patients with PD”, they say.

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