2025-04-09
Parkinson’s disease: bone health shouldn’t be overlooked
Geriatrics Neurology
#ParkinsonsDisease #Osteoporosis #FractureRisk
#FRAX #Prevention
In patients with Parkinson’s disease (PD), the risk of fracture is significantly higher than in the general population, particularly among the elderly. This heightened vulnerability stems from a combination of motor and metabolic factors. Frequent falls—linked to bradykinesia and postural instability—occur alongside reduced bone strength, often due to osteopenia or osteoporosis. These fractures—especially hip fractures—can lead to serious consequences such as prolonged hospitalizations, loss of independence, and increased mortality. Yet, despite their frequency and impact, bone health disorders remain underdiagnosed and undertreated in the care pathways of patients with Parkinson’s disease.
Aware of this issue, the latest UK guidelines from the National Osteoporosis Guideline Group (NOGG, 2021) call for systematic fracture risk assessment in this population. They recommend combining validated tools such as the FRAX® (Fracture Risk Assessment Tool) score and DXA (dual-energy X-ray absorptiometry) scanning to guide therapeutic decisions.
However, in routine clinical practice, such assessments are still seldom performed. Preventive treatments (e.g., bisphosphonates, calcium and vitamin D supplementation) are underprescribed—even in patients identified as high-risk. This underassessment represents a missed opportunity for early intervention to prevent severe, yet avoidable, complications.
The BONE-PARK 2 study—a randomized controlled trial—evaluated the feasibility and relevance of a targeted bone risk assessment algorithm in patients with parkinsonism. The objective was to refine treatment decisions by integrating often-overlooked variables such as DXA results and fall history, alongside the FRAX score. Among the 213 participants enrolled (mean age: 74.5 years), more than 40% had experienced at least two falls in the previous year, and nearly 30% had already suffered a fragility fracture. Yet only 11.5% were receiving preventive treatment for osteoporosis.
The analysis showed that adding DXA measurements to the FRAX score led to risk reclassification in approximately 40% of patients. Some had their risk level downgraded, while others crossed the threshold warranting therapeutic intervention.
Additionally, factoring in fall frequency led to reclassification in 18.7% of cases, with 5% more patients becoming eligible for osteoporosis treatment. These findings underscore the importance of including these parameters in fracture risk assessments—failing to do so may leave vulnerable patients unprotected.
Parkinson’s disease is a neurodegenerative condition that significantly increases the risk of fractures—particularly hip fractures—due to a combination of balance disorders, frequent falls, and bone fragility associated with osteopenia or osteoporosis. Despite current recommendations for a more proactive approach, bone health is still rarely assessed or integrated into the care pathway.
This study evaluates the benefits of a personalized bone risk assessment algorithm (BONE-PARK 2), which incorporates bone mineral density and fall history into the FRAX calculation to better estimate fracture risk and optimize treatment decisions. The results show that a large proportion of PD patients at risk of fracture still do not receive preventive treatment. By integrating bone density and fall history into the FRAX score, the BONE-PARK 2 algorithm improves the identification of at-risk patients and enhances clinical decision-making. This straightforward approach strengthens fracture prevention in Parkinson’s disease by enabling more accurate risk stratification.
Although the BONE-PARK 2 algorithm is simple, accessible, and effective for improving bone health management, it is only a first step. Further progress will require adapting the FRAX tool to the specific features of Parkinson’s disease and implementing systematic screening protocols within neurological care pathways to optimize fracture prevention.
In patients with Parkinson’s disease (PD), the risk of fracture is significantly higher than in the general population, particularly among the elderly. This heightened vulnerability stems from a combination of motor and metabolic factors. Frequent falls—linked to bradykinesia and postural instability—occur alongside reduced bone strength, often due to osteopenia or osteoporosis. These fractures—especially hip fractures—can lead to serious consequences such as prolonged hospitalizations, loss of independence, and increased mortality. Yet, despite their frequency and impact, bone health disorders remain underdiagnosed and undertreated in the care pathways of patients with Parkinson’s disease.
Aware of this issue, the latest UK guidelines from the National Osteoporosis Guideline Group (NOGG, 2021) call for systematic fracture risk assessment in this population. They recommend combining validated tools such as the FRAX® (Fracture Risk Assessment Tool) score and DXA (dual-energy X-ray absorptiometry) scanning to guide therapeutic decisions.
However, in routine clinical practice, such assessments are still seldom performed. Preventive treatments (e.g., bisphosphonates, calcium and vitamin D supplementation) are underprescribed—even in patients identified as high-risk. This underassessment represents a missed opportunity for early intervention to prevent severe, yet avoidable, complications.
FRAX + DXA: a winning combo against fractures?
The BONE-PARK 2 study—a randomized controlled trial—evaluated the feasibility and relevance of a targeted bone risk assessment algorithm in patients with parkinsonism. The objective was to refine treatment decisions by integrating often-overlooked variables such as DXA results and fall history, alongside the FRAX score. Among the 213 participants enrolled (mean age: 74.5 years), more than 40% had experienced at least two falls in the previous year, and nearly 30% had already suffered a fragility fracture. Yet only 11.5% were receiving preventive treatment for osteoporosis.
The analysis showed that adding DXA measurements to the FRAX score led to risk reclassification in approximately 40% of patients. Some had their risk level downgraded, while others crossed the threshold warranting therapeutic intervention.
Additionally, factoring in fall frequency led to reclassification in 18.7% of cases, with 5% more patients becoming eligible for osteoporosis treatment. These findings underscore the importance of including these parameters in fracture risk assessments—failing to do so may leave vulnerable patients unprotected.
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Think bones... think parkinson’s too
Parkinson’s disease is a neurodegenerative condition that significantly increases the risk of fractures—particularly hip fractures—due to a combination of balance disorders, frequent falls, and bone fragility associated with osteopenia or osteoporosis. Despite current recommendations for a more proactive approach, bone health is still rarely assessed or integrated into the care pathway.
This study evaluates the benefits of a personalized bone risk assessment algorithm (BONE-PARK 2), which incorporates bone mineral density and fall history into the FRAX calculation to better estimate fracture risk and optimize treatment decisions. The results show that a large proportion of PD patients at risk of fracture still do not receive preventive treatment. By integrating bone density and fall history into the FRAX score, the BONE-PARK 2 algorithm improves the identification of at-risk patients and enhances clinical decision-making. This straightforward approach strengthens fracture prevention in Parkinson’s disease by enabling more accurate risk stratification.
Although the BONE-PARK 2 algorithm is simple, accessible, and effective for improving bone health management, it is only a first step. Further progress will require adapting the FRAX tool to the specific features of Parkinson’s disease and implementing systematic screening protocols within neurological care pathways to optimize fracture prevention.
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