Mind the Gap: Predictors of Osteoporosis Treatment Following Fragility Fracture in Parkinsonism

BACKGROUND: Fracture risk is increased in Parkinson's yet this risk is often not addressed. OBJECTIVES: Our objective was to study the extent to which osteoporosis was treated, and predictors of treatment in a large representative cohort with parkinsonism. METHODS: The clinical practice research datalink (CPRD) GOLD data contains anonymized UK primary care data. We identified fragility fractures (hip, vertebrae, wrist/distal radius, humerus, rib, pelvis and unspecified osteoporotic) amongst prevalent parkinsonism patients between 2010 and 2019, and ascertained whether bone protective medications and/or vitamin D/calcium supplements were prescribed in the pre-fracture period or in the 48-weeks post-fracture. Logistic regression was used to determine predictors of prescriptions. RESULTS: There were 21,581 people with parkinsonism (mean age 74.7 ± 9.8 years, 40% female), with a mean of 3.1 ± 2.5 years of available data. One thousand eight hundred twenty-three experienced at least one fragility fracture. Prior to a fragility fracture 12% had a prescription for bone protective medication. This increased to 38% and 53% in the 16 and 48-weeks post-fracture, respectively. 24% already had a prescription for vitamin D/calcium which increased to 73% at 48-weeks post-fracture. Female gender (OR = 2.06 [1.69-2.51], p < 0.001) and sustaining a vertebral fracture (OR = 2.06 [1.53-2.77], p < 0.001) increased the odds of bone protection prescriptions. However, sustaining a rib fracture (OR = 0.34 [0.19-0.60], p < 0.001) or residing in a care home (OR = 0.58 [0.38-0.88], p = 0.01) decreased the odds. CONCLUSIONS: There is an osteoporosis treatment gap in Parkinson's rendering an already high-risk population at further risk of fracture. Men and those with rib fractures are two groups who are least likely to receive potentially beneficial treatment.