Abstract
Despite growing evidence on prodromal symptoms of Parkinson's disease, it remains unknown whether they culminated in clinically significant events. We found elevated risks of hip fractures from 3 years before until up to 10 years after diagnosis of Parkinson's disease, underscoring the need for early and continuous fracture risk management. PURPOSE: Parkinson's disease (PD) is associated with a higher risk of hip fracture. However, the risk of hip fracture at the prodromal stage of PD is unknown. Our study aimed to investigate the incidence of hip fractures in persons with and without PD in Finland from 5 years before to 10 years after the diagnosis of PD. METHODS: We included persons diagnosed with PD between 2000 and 2009 in Finland and 1:2 matched comparison cohort. Hazard ratio [HR] was computed to assess overall risk of incident hip fracture. The annual incidence rate per 1000 person-year [IR/1000PY] and incidence rate ratios [IRR] were calculated for each year of follow-up from 5 years before to 10 years after PD diagnosis. RESULTS: During the follow-up among 33,153 eligible persons, 13.4% persons with and 5.3% persons without PD had an incident hip fracture (HR 1.82, 95% confidence interval [CI] 1.47-2.26). Persons with PD had higher annual incidence rates of hip fracture starting from 3 years before diagnosis (with PD: IR/1000PY 2.83, 95% CI 1.93-4.02; without PD: IR/1000PY 1.64, 95% CI 1.15-2.28). The higher annual incidence rates continued until 10 years after diagnosis (with PD: IR/1000PY 15.7, 95% CI 11.7-20.5; without PD: IR/1000PY 4.53, 95% CI 3.08-6.44). Prevalence of fall-risk-increasing medications but not anti-osteoporosis medications was higher at hip fractures among persons with PD than without PD. CONCLUSION: As the risk of hip fracture is elevated already years before the diagnosis of PD, it is important to manage fall risks concomitantly while applying the diagnostic procedures for PD.