title: Risk and adverse outcomes of fractures in patients with Parkinson's disease: two nationwide studies.
abstract: The association between Parkinson's disease and fracture was not completely understood. This nationwide study investigated increased risk of fracture in patients with Parkinson's disease. In the nested cohort study, Parkinson's disease was associated with pneumonia, septicemia, stroke, urinary tract infection, and mortality after fracture admission.
  
  
  BACKGROUND
  Falls are a common complication in people with Parkinson's disease (PD). This study evaluated fracture risk and post-fracture outcomes in patients with PD.
  
  
  METHODS
  We identified 1,423 adults aged 40 years and older newly diagnosed with PD using the Taiwan National Health Insurance Research Database from 2000 to 2003. Comparison cohort consisted of 5,692 adults without PD randomly selected from the same dataset, frequency matched in age and sex. Followed-up events of fracture from January 1, 2000, until December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HR) and 95 % confidence interval (CI) of fracture associated with PD were evaluated. Another nested cohort study of 397,766 hospitalized fracture patients analyzed for adjusted odds ratios (ORs) and 95 % CIs of adverse events after fracture among patients with and without PD between 2004 and 2010.
  
  
  RESULTS
  The incidences of fracture for people with and without PD were 39.5 and 23.9 per 1,000 person-years, respectively (p < 0.0001). Compared with control, the adjusted HR of fracture was 2.25 (95 % CI 1.97-2.58) for PD patients. Previous PD was associated with risks of pneumonia (OR 1.44, 95 % CI 1.36-1.52), septicemia (OR 1.41, 95 % CI 1.33-1.49), stroke (OR 1.40, 95 % CI 1.32-1.50), urinary tract infection (OR 1.53, 95 % CI 1.46-1.61), and mortality (OR 1.25, 95 % CI 1.15-1.35) after fracture.
  
  
  CONCLUSIONS
  PD was associated with higher risk of fracture. Patients with PD had more complications and mortality after fracture. Fracture prevention and attention to post-fracture adverse events are needed for this susceptible population.
authors: Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors: Y-F
authors: YF
authors: Huang
authors: Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.|School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Y-G
authors: YG
authors: Cherng
authors: Neurosurgery Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Visiting Professor, Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
authors: S P C
authors: SP
authors: Hsu
authors: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Department of Surgery, University of Illinois, Chicago, IL, USA.
authors: C-C
authors: CC
authors: Yeh
authors: Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
authors: Y-C
authors: YC
authors: Chou
authors: Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: C-H
authors: CH
authors: Wu
authors: School of Medicine, Taipei Medical University, Taipei, Taiwan.|Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, Taiwan, 110.|Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
authors: T-L
authors: TL
authors: Chen
authors: School of Medicine, Taipei Medical University, Taipei, Taiwan. ccliao@tmu.edu.tw.|Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, Taiwan, 110. ccliao@tmu.edu.tw.|Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan. ccliao@tmu.edu.tw.|School of Chinese Medicine, China Medical University, Taichung, Taiwan. ccliao@tmu.edu.tw.
authors: C-C
authors: CC
authors: Liao
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000453:epidemiology*; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Fracture; Mortality; Parkinson’s disease