title: Assessment and management of fracture risk in patients with Parkinson's disease.
abstract: Parkinson's disease (PD) is associated with substantially increased fracture risk, particularly hip fracture, which can occur relatively early in the course of PD. Despite this, current national clinical guidelines for PD fail to adequately address fracture risk assessment or the management of bone health. We appraise the evidence supporting bone health management in PD and propose a PD-specific algorithm for the fracture risk assessment and the management of bone health in patients with PD and related movement disorders. The algorithm considers (i) calcium and vitamin D replacement and maintenance, (ii) quantification of prior falls and fractures, (iii) calculation of 10-year major osteoporotic and hip fracture risks using Qfracture, (iv) application of fracture risk thresholds, which if fracture risk is high (v) prompts anti-resorptive treatment, with or without dual X-ray absorptiometry, and if low (vi) prompts re-assessment with FRAX and application of National Osteoporosis Guidelines Group (NOGG) guidance. A range of anti-resorptive agents are now available to treat osteoporosis; we review their use from the specific perspective of a clinician managing a patient population with PD. In conclusion, our current evidence base supports updating of guidelines globally concerning the management of PD, which presently fail to adequately address bone health.
authors.affiliation: Older People's Unit, Royal United Hospital Bath NHS Trust, Combe Park, Bath BA1 3NG, UK.
authors.forename: Veronica
authors.initials: V
authors.lastname: Lyell
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Henderson
authors.affiliation: Older People's Unit, Royal United Hospital Bath NHS Trust, Combe Park, Bath BA1 3NG, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Devine
authors.affiliation: Older People's Unit, Royal United Hospital Bath NHS Trust, Combe Park, Bath BA1 3NG, UK Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Celia
authors.initials: C
authors.lastname: Gregson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D019091:Critical Pathways; D019587:Dietary Supplements; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium
keywords: FRAX; Qfracture; fracture; movement disorder; older people; osteoporosis