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Osteoporosis and Type of Hip Fracture in Parkinson Disease

In this study from Italy, researchers examine the type of hip fractures that occur in Parkinson patients. They offer suggestions for hip fracture prevention in this particular group of patients. This is important because Parkinson disease leaves patients with poor balance, rigidity, loss of arm movements, and a tendency to fall backwards or sideways. All of those factors increase the risk of falling and hip fractures. Finding ways to reduce the risk of falls and fractures in Parkinson patients is the goal.

They started with a group of over 1,000 patients who suffered their first hip fracture ever. The patients with Parkinson disease (38 total) were pulled out and put in their own separate group. A second (control) group was made up of an equal number of patients from the main group with hip fractures. They were matched by age, sex, and type of fracture. No one in the control group had Parkinson disease. No one in either group was a smoker.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum.It forms a deep cup that surrounds the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck.

A bony bump on the outside of the femur just below the femoral neck is called the greater trochanter. A smaller bony bump on the femur called the lesser trochanter is located on a diagonal from the greater trochanter. These two bumps on the femur are where some of the hip muscles attach.

There were two main types of hip fractures investigated: trochanteric and cervical. All were caused by a fall. A trochanteric hip fracture occurs in or around the greater or lesser trochanter. This type of fracture is considered extracapsular (outside the actual hip joint).

A cervical hip fracture is intracapsular (inside the hip joint) affecting some part of the actual hip socket or the top of the femoral head. In the general population, trochanteric fractures are typically linked with more severe osteoporosis (poor or low bone mineral density). It appears that trochanteric fractures occur more often in patients who have lower bone thickness.

Everyone in the study had bone mineral density testing done of the uninvolved hip. Four areas were tested: the top of the femur, the femoral neck, the trochanteric area, and the intertrochanteric region (between the greater trochanter bony bump and the lesser trochanteric bump).

They found similar results between the Parkinson group and the control group. Remember, the control group represents patients with hip fractures who don't have Parkinson disease. Levels of bone mineral density leading to hip fractures were similar in both groups. Trochanteric hip fractures were more common than cervical hip fractures. Bone mineral density was much lower in all patients (both groups) with trochanteric fractures.

Based on this information, the authors suggest several preventive steps for hip fractures in Parkinson patients. First, bone mineral density testing is important. Anyone with Parkinson disease who has low bone mineral density should be taking medication (bisphosphonates) for this problem.

Second, vitamin D supplementation has been shown effective in reducing hip fractures (both in the general population and for Parkinson patients). Vitamin D deficiency is common in patients with Parkinson disease, so this recommendation is doubly important.

And third, medication to control the Parkinson symptoms and an exercise program to help with balance disturbances and falls prevention are important. People with Parkinson disease are twice as likely as others their same age to have a hip fracture. Increasing age is a risk factor in all people. These two variables added together are a bad recipe for falls and fractures. A little prevention could go a long way in reducing falls and injuries from falls.


Marco Di Monaco, MD, et al. Type of Hip Fracture in Patients with Parkinson Disease is Associated with Femoral Bone Mineral Density. In Archives of Physical Medicine and Rehabilitation. December 2008. Vol. 89. No. 12. Pp. 2297-2301.


12/22/2008

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