TY - JOUR
T1 - Fractures in the prodromal period of Parkinson disease
AU - Camacho-Soto, Alejandra
AU - Gross, Anat
AU - Searles Nielsen, Susan
AU - Miller, Anna N.
AU - Warden, Mark N.
AU - Salter, Amber
AU - Racette, Brad A.
N1 - Funding Information:
This work was supported by the WUSM Faculty Diversity Scholar Award (A.C.-S.), RMSTP NCMRR K12HD00109719 (A.C.-S.), NIEHS K24ES017765 (B.A.R.), Michael J. Fox Foundation (B.A.R., S.S.N.), and American Parkinson Disease Association (B.A.R.).
Funding Information:
A. Camacho-Soto reports a WUSM Faculty Diversity Scholar Award, RMSTP NCMRR: K12HD00109719, NIEHS K24ES017765, Michael J. Fox Foundation, and American Parkinson Disease Association support. A. Gross reports no disclosures relevant to the manuscript. S. Searles Nielsen reports government research support from the NIH (R21 ES024120 [co-I], R01ES021488 [co-I], R01 ES025991 [co-I]). A. Miller reports honoraria from Depuy Synthes, Stryker, Smith, and Nephew. M. Warden and A. Salter report no disclosures relevant to the manuscript. B. Racette receives research support from the following grants: NIEHS R01ES026891, R01ES026891-S1, R01ES025991, R01ES025991-02S1, K24ES017765, Grant 10289-01 Michael J. Fox Foundation, American Parkinson Disease Association, and Hope Center for Neurologic Disorders. Dr. Racette has received honoraria (personal compensation) for lectures from the University of Texas and the American Academy of Neurology and personal compensation for peer review from the Parkinson Study Group and for service on the National Advisory Environmental Health Sciences Council for NIEHS. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
© American Academy of Neurology.
PY - 2020/6/9
Y1 - 2020/6/9
N2 - ObjectiveTo examine the association between fractures and Parkinson disease (PD) during the 5-year prodromal phase as compared to controls.MethodsWe performed a population-based case-control study of Medicare beneficiaries in the United States from 2004 to 2009. We identified 89,632 incident PD cases and 117,760 comparable controls 66-90 years of age in 2009. PD case status was the outcome, and noncranial fracture the independent variable. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association between fracture and PD in yearly time intervals prior to PD diagnosis/control reference date, after adjusting for covariates.ResultsThere were 39,606 total fractures (25.4% cases, 14.3% controls) over the 5 years prior to the PD diagnosis/control reference date. PD was positively associated with fractures even after adjusting for age, sex, race/ethnicity, Charlson comorbidity index, alcohol use, tobacco use, and osteoporosis. The association between PD and fracture was evident at yearly time windows prior to PD diagnosis/control reference date. The association between PD and each type of fracture strengthened as the PD diagnosis/control reference date approached (all time interaction p values ≤0.02). Among beneficiaries with a mechanism of injury, the majority were attributed to falls (74.6% cases, 72.8% controls).ConclusionFractures occur more commonly during the prodromal period of PD compared to controls, especially as diagnosis date approached, suggesting that patients with PD may experience unrecognized motor and nonmotor symptoms.
AB - ObjectiveTo examine the association between fractures and Parkinson disease (PD) during the 5-year prodromal phase as compared to controls.MethodsWe performed a population-based case-control study of Medicare beneficiaries in the United States from 2004 to 2009. We identified 89,632 incident PD cases and 117,760 comparable controls 66-90 years of age in 2009. PD case status was the outcome, and noncranial fracture the independent variable. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association between fracture and PD in yearly time intervals prior to PD diagnosis/control reference date, after adjusting for covariates.ResultsThere were 39,606 total fractures (25.4% cases, 14.3% controls) over the 5 years prior to the PD diagnosis/control reference date. PD was positively associated with fractures even after adjusting for age, sex, race/ethnicity, Charlson comorbidity index, alcohol use, tobacco use, and osteoporosis. The association between PD and fracture was evident at yearly time windows prior to PD diagnosis/control reference date. The association between PD and each type of fracture strengthened as the PD diagnosis/control reference date approached (all time interaction p values ≤0.02). Among beneficiaries with a mechanism of injury, the majority were attributed to falls (74.6% cases, 72.8% controls).ConclusionFractures occur more commonly during the prodromal period of PD compared to controls, especially as diagnosis date approached, suggesting that patients with PD may experience unrecognized motor and nonmotor symptoms.
UR - http://www.scopus.com/inward/record.url?scp=85086298723&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000009452
DO - 10.1212/WNL.0000000000009452
M3 - Article
C2 - 32345729
AN - SCOPUS:85086298723
SN - 0028-3878
VL - 94
SP - E2448-E2456
JO - Neurology
JF - Neurology
IS - 23
ER -