Abstract
Introduction
Patients with Parkinson’s Disease (PD) are at an increased risk of developing osteoporosis. Vertebral fractures (VFs) are the commonest type of osteoporotic fracture and are frequently underdiagnosed, up to 70% going unreported. Individuals with VFs are at a significantly higher risk of experiencing subsequent fractures (relative risk increase of 2.8 for hip fractures and 5.4 for additional VFs). The presence of VFs are often not formally reported. VFs are also associated with an eightfold increase in morbidity. These complications could result in reduced independence and confidence.
Methods
Data were collected from two University Health Boards (UHBs): Betsi Cadwaladr and Cardiff & Vale. Inclusion criteria consisted of individuals with diagnosed PD, prescribed ≥5 doses of levodopa per day (indicative of advanced PD) and who regularly attended a movement disorder clinic. Patients who had undergone any CT scan of the abdomen, thorax, or pelvis within the past five years were identified. The CT images were re-evaluated using the Genant Classification, and Grade 2/3 VFs identified, including if they were reported.
Results
In Cardiff & Vale UHB, 31 % (n=8/26) of patients had a VF, 87.5% were unreported by radiologists (n=7/8) and 12.5% (n=1/8) reported. In Betsi Cadwaladr UHB, 27% (n=7/26) had a VF, 85.7% (n=6/7) of VFs were unreported and 14.3% (n=1/7) reported. Overall, 86.7% of VFs were unreported and untreated. Statistical analysis was run and there was no statistical difference in the prevalence of VFs between the 2 health boards.
Conclusion
Our review highlights the widespread underdiagnosis of VFs and the role of opportunistic identification on pre-existing CT scans which can improve outcomes in advanced Parkinson's. Currently, no pathways exist for auditing VF prevalence and management in high-risk PD patients. Future work includes expanding the audit to collect data on larger cohorts for further statistical analysis.