Fractures in Parkinson's Disease: Pathophysiology, Prevention, and Orthopedic Outcomes

Abstract

Fractures are an important comorbidity in Parkinson's disease (PD), which can result in disability, mortality, and high healthcare costs. Impaired mobility, postural instability, bradykinesia, muscle rigidity, and decreased bone mineral density (BMD) contribute to the increased risk of falls, which often result in hip and upper extremity fractures. Hip fractures in patients with PD are associated with an increased hospital length of stay and a decline in functional independence. Multimodal fall prevention in PD is well established, but prevention of fractures is often underutilized, despite evidence-based interventions. Information on fall-related fracture outcomes after exercise interventions is an area warranting further investigation. Several new strategies, such as home-based telerehabilitation (TR) and pharmacologic agents, show promise but are not yet widely implemented in care. While screening tools and risk stratification methods are available, most patients with PD are not screened for skeletal fragility or entered into a structured prevention program. This review proposes a reframing of skeletal fragility in PD from a problem of secondary complications, amenable to treatment only after the fact, to a primary and expected consequence of neuromotor dysfunction in this disease. When fracture risk is considered a core and predictable outcome of PD progression, the integration of new models of care may be accelerated that combine movement therapy, bone-protective interventions, and proactive surgical planning to improve long-term outcomes.