Abstract
Title: Improving Bone Health in Patients with Parkinson’s Disease: A Retrospective Study in a DGH
Background:
Parkinson’s disease (PD) is a neurodegenerative disorder primarily affecting movement, but its impact on bone health is often overlooked. Over 40% of individuals with PD experience recurrent falls, with more than a two-fold increased risk of hip fractures and nearly double the risk of non-vertebral fractures—largely influenced by mobility impairments, vitamin D deficiency, and long-term effects of medication. The aim of this study was to evaluate local compliance with bone health assessments in patients with PD.
Methods:
A retrospective analysis was conducted on 55 patients who attended PD clinics between January 2024 and September 2024, all with confirmed PD and ongoing treatment. The cohort ranged in age from 55 to 87 years (35 males, 20 females). Patients who had passed away were excluded in the study. The Clinical Frailty Scale (CFS) scores ranged from 2 to 7, with a median CFS of 4.
Among the study population:
- 29 patients (52.7%) experienced falls
- 12 patients (41.4% of those who fell) sustained fractures
- 38 patients (69.1%) had vitamin D levels checked
- 29 patients (52.7%) received bone protection treatment
- 6 patients who experienced falls did not receive any bone protection afterwards
Conclusion:
Findings from this retrospective study indicate that the assessment and management of bone health in PD patients remain suboptimal. While vitamin D monitoring and bone protection treatments are implemented, there is room for improvement in compliance, early screening, and preventive care strategies.
References
Royal Osteoporosis Society | 2019.12.18 - Patients with Parkinson’s disease at greater risk of fragility fractures
The risk of hip and non-vertebral fractures in patients with Parkinson's disease and parkinsonism: A systematic review and meta-analysis - ScienceDirect
Better bone health resources | Parkinson's UK
Comments
Hello. Thank you for your…
Hello. Thank you for your poster regarding your work. What did bone protection comprise of? Was receiving vitamin D deemed bone protection or did individuals need to be on bisphosphonate treatment? What thoughts were made to using FRAX / Q-fracture as part of the bone health assessment? What proportion of patients had Vitamin D deficiency and was there a correlation between Vitamin D levels and the Clinical Frailty Scores?
thank you for your questions…
thank you for your questions .
In our study, bone protection was defined as patients being prescribed Vitamin D, Calcium, or both, and/or bisphosphonates. However, bone health assessments using validated tools such as FRAX or QFracture are not routinely performed in Parkinson’s Disease (PD) clinics—a key gap this QIP aims to address.
We reviewed prescribing patterns and recorded the number of patients who had Vitamin D levels checked, but did not assess the prevalence of deficiency or its association with frailty. One of the main objectives of this project is to encourage routine use of bone health assessment tools in PD clinics to support more comprehensive and preventative care.
Thank you for your poster,…
Thank you for your poster, in additional to pharmaceutical bone health intervention was there also discussion/education around non-pharmaceutical interventions?
thank you for your question…
thank you for your question.
We aim to raise awareness of both pharmacological and non-pharmacological aspects of fall prevention; however, this was not assessed in the current project.
Intervention plan?
This is a great project, and I’m keen to understand proposed intervention plan. Parkinson’s disease patients has complex motor and non-motor symptoms, often leaving little time to address bone health in PD clinics. If FRAX is used, many patients will likely require BMD assessment or specialist referral. I'd like to know who is responsible for initiating investigation or preventive treatment—GPs, PD team, or another service? Given the high prevalence of swallowing difficulties in PD, oral bisphosphonates may not be suitable, so referral to orthogeriatric services? As all services have high workload, I'd like to know your view?
Thank you for taking the…
Thank you for taking the time to view the poster and asking the question. As you rightly pointed out, this will be the main challenge in making improvements.
At the moment, we are focusing on increasing awareness among PD practitioners (PD consultants, registrars, and PD nurses). Our current focus is on ensuring routine bone health assessments in PD patients and timely referral to the appropriate services (Bone Health Unit/Ortho-Geriatrics) for ongoing care.