People with Parkinson’s (a brain disorder that causes slowness of movements and tremor) are more likely to have falls and thinning of their bones. Weak bones are more likely to fracture. There are treatments that improve bone strength and reduce the number of fractures, but not all people who could benefit from them are currently prescribed these treatments. We want to find out how many people with Parkinson’s have bone fractures, how many are investigated with a scan that measures bone thickness, and how many are prescribed the preventive bone health treatments. We will compare the findings between people with Parkinson’s and people without Parkinson’s. We will use this information to highlight the need for early bone health assessment in everyone with Parkinson’s, to get people on the right treatment, and reduce the number of bone fractures.
We will determine the incidence rates of osteoporosis, and major fragility fractures in people with Parkinson’s, and compare this to age, sex, and GP practice controls in a matched cohort design. Hospital Episode Statistics (HES) admission data and CPRD data will be used to determine fractures (limb, pelvic, shoulder, and vertebral). HES Diagnostic imaging data will be used to determine DXA use and the radiological diagnosis of fractures, and GOLD and Aurum treatment data for cases prescribed bone health preventive treatment. The probability of experiencing fragility fractures during follow-up will be plotted using the Kaplan–Meier method and differences between Parkinson's and matched controls examined using the log-rank test. The association between PD and a diagnosis of osteoporosis, and the occurrence of fragility fracture, will be examined using a matched cohort approach by fitting Cox regression models adjusted for known confounders. Modelling results will be expressed as adjusted hazard rate ratios (95% confidence intervals). Interactions between sex/gender x (age group, IMD, urbanicity) and age group x (IMD, urbanicity) will be explored. The incidence rates for cases of Parkinson's undergoing DXA scans and being prescribed bone health preventive therapy will also be analysed, compared to matched controls. Two sensitivity analyses will be conducted to evaluate whether the rates of osteoporosis and fragility fracture are similar across different patient populations: firstly, including cases with osteoporosis before the Parkinson's diagnosis, and, secondly, by excluding cases with fragility fractures before the Parkinson's diagnosis. The findings will be used to inform the ongoing national service improvement project in the UK Parkinson’s Excellence network, and to reinforce the messages about the incorporation of bone health assessment into routine care with the wider healthcare professional community, and people with Parkinson’s and their families.
Primary outcome in bone health in Parkinson’s: Diagnosis of major osteoporotic fracture (limb, shoulder, vertebral)
Secondary outcomes in bone health in Parkinson’s: Diagnosis of osteoporosis; Performance of bone densitometry scan; Prescription of anti-resorptive bone treatment
Donald Grosset - Chief Investigator - Parkinson's UK
Donald Grosset - Corresponding Applicant - Parkinson's UK
Cathal Doyle - Collaborator - Parkinson's UK
Katherine Grosset - Collaborator - Parkinson's UK
Lance Lee - Collaborator - Parkinson's UK
Prasanth Anand Iruthayaraj - Collaborator - Parkinson's UK
Romel Gravesande - Collaborator - Parkinson's UK
Syed Jaker Hussain - Collaborator - Parkinson's UK
Sacha Gandhi - Collaborator - GREATER GLASGOW AND CLYDE
HES Admitted Patient Care;HES Diagnostic Imaging Dataset;Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification