Risk for femoral fractures in Parkinson's disease patients with and without severe functional impairment.
BACKGROUND
Impaired balance is a major problem in patients with idiopathic Parkinson's disease (PD) resulting in an increased risk of falls and fall-related fractures. Most studies which analyzed the risk of femoral fractures in patients with idiopathic PD were performed either in specialized centers or excluded very frail patients. The current study used a large population-based dataset in order to analyze the risk of femoral fractures in patients with idiopathic PD.


METHODS
Data from more than 880.000 individuals aged 65 years or older and insured between 2004 and 2009 at a large German health insurance company were used for the analyses. Persons with idiopathic PD were identified by the dispensing of Parkinson-specific medication and by hospital diagnoses, if available. People without PD served as the reference group. Incident femoral fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment (care need) as provided by reimbursement claims.


RESULTS
Compared with the reference group, persons with idiopathic PD had a more than doubled risk to sustain a femoral fracture. The risk was higher in men (HR = 2.61; 95%-CI: 2.28-2.98) than in women (HR = 1.79; 95%-CI: 1.66-1.94). The increased risk was only observed in people without severe functional impairment. The sensitivity analysis using a refined definition of idiopathic PD patients yielded similar results.


CONCLUSIONS
The findings confirm the increased risk of femoral fractures in patients with idiopathic PD. The relative risk is particularly high in male PD patients and in patients without severe functional impairment.
Department of Clinical Gerontology and Rehabilitation, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany.
Petra
P
Benzinger
Department of Clinical Gerontology and Rehabilitation, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Kilian
K
Rapp
Hertie-Institute for Clinical Brain Research, University Hospital Tuebingen, Tuebingen, Germany; DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany.
Walter
W
Maetzler
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Hans-Helmut
HH
König
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Andrea
A
Jaensch
Department of Clinical Gerontology and Rehabilitation, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Jochen
J
Klenk
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Gisela
G
Büchele
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology* / Q000209:etiology; D005858:Germany; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications*; D012044:Regression Analysis; D018570:Risk Assessment; D012737:Sex Factors