Improving Bone‑Health Assessment in Parkinson’s Disease: A Completed Audit Cycle and Quality‑Improvement Project

Background

Parkinson’s disease (PD) results in a 2-to-4-fold higher risk of hip and fragility fractures due to osteoporosis, falls, and motor dysfunction. Fractures in this group often cause loss of mobility, extended admissions, and higher mortality. Despite these consequences, bone-health assessment is inconsistently incorporated into routine PD care.

Introduction

The local analysis of 100 patients at York Hospital during the 2025 Parkinson’s UK audit, revealed bone health was considered in 10% of cases, compared with a national figure of 63% (2022 data for comparable services; p < 0.001). This deficit represents missed opportunities for fracture prevention and prompted a quality-improvement initiative with the aim of enhancing clinician adherence to gold-standard BONE-PARK algorithm.

Methods

A “bone-health sticker” was introduced into outpatient PD clinics. Stickers were affixed to clinic sheets before consultations. Each sticker prompted documentation of: (1) current treatment, (2) > 1 fall in past month, (3) FRAX/QFracture calculation, and (4) DEXA requirement. Data were collected and analysed using Excel. Implementation began in December 2025 across consultant and PD nurse specialist clinics.

Results

31 patients from clinic in December 2025 were re-audited (mean age ~80 years; 55% male). Documented bone-health assessment increased from 10% to 26% (p = 0.026). FRAX scores were recorded in 5 (16%) people, and treatment or investigation was initiated in 6 (19%), including DEXA referrals and zoledronate treatment. Clinicians reported greater awareness and consistent prompting of bone-health discussions, though limited clinic time occasionally constrained completion.

Conclusions

There is early evidence that introducing a sticker prompt into PD clinics increased documentation and clinical action relating to bone-health assessment. This low-cost, reproducible intervention improved alignment with the BONE-PARK algorithm within a high-risk cohort. The service plans to continue optimising the sticker, by analysing; human factors, outcomes and balancing measures, with future integration into electronic records to sustain practice change.