Objective: To explore the clinical characteristics and risk factors of fracture injury by falling in Parkinson’s disease (PD) based on a longitudinal prospective hospital cohort.

Background: Fracture injury by falling in PD normally brings up a devastating clinical prognosis for the patients and their caregivers. Although a couple of studies have investigated the clinical features of fractures in PD so far, sufficient epidemiologic evidence from prospective cohorts is limited.

Method:

All patients were recruited from the movement disorder clinics at Bundang Jesaeng Hospital and Ilsan Paik Hospital from 2016 to 2025. This prospective cohort study included PD patients who underwent comprehensive evaluation for diagnosis and followed by standard medical treatment.

Results: We analyzed total 936 PD patients consecutively registered, of whom 65 patients were identified to be suffered facture by falling (65/936, 6.9%) of which was stratified as injury on hip 63.1% (41/65), spine 43.1% (28/65), knee 20% (13/65), ankle 10.8% (7/65), foot 7.7% (5/65), shoulder 7.7% (5/65), upper arm 4.6% (3/65), wrist 13.8% (9/65), and hand 4.6% (3/65). The mean time to fracture from PD diagnosis was 5.4 ± 3.6 years. Fracture group demonstrated higher incidence of freezing of gait (FOG) over non-fracture group (17/65 (26.2 %) vs 95/871 (10.9 %); p < 0.001).

Increased risk of all types of fracture was 1.87 (adjusted hazard ratio; 95% CI 1.684 – 2.149; p < 0.001), hip 2.84 (95% CI 2.568 – 3.174; p < 0.001), spine 2.68 (95% CI 2.152 – 3.130; p < 0.001), and knee 1.54 (95% CI 1.154 – 1.932; p < 0.001), respectively, and rest of body were unremarkable. Surgery rate was 95.4% (62/65) with a mean hospitalization day of 10.7 ± 5.8. Patients whose BMI was < 18.5 kg/m² were greater in the fracture group (18/65 (27.7%) vs 124/684 (18.1 %); p < 0.05). In the fracture group, the incidence of underlying osteoporosis was higher in the subgroup of hip (27/41, 65.6%) and vertebrae (13/28, 46.4%).

Conclusion: Our data demonstrated that falling could bring up a higher incidence with greater future risk of fracture in PD, in the body parts of the hip and vertebrae in particular, which are supposed to be related to the presence of underlying osteoporosis. FOG may play a significant role in fractures caused by falls in PD. Early attention with management for osteoporosis and FOG is required to prevent facture injury in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characteristics-of-fracture-injury-by-falling-in-parkinsons-disease-a-prospective-cohort-study/