Parkinson's: Managing bone health and fracture risk
1 Falls in Parkinson’s
The following video provides you with a brief overview of this course about managing bone health and fracture risk in Parkinson’s, and the content of the course.
In section 1, you will gain:
- an overview of the epidemiology of falls in Parkinson’s
- an understanding of why people with Parkinson’s fall
- an awareness of the potential sequelae of falls
Throughout this course we will return to this case study to inform learning
Mr Smith is a 74 year old man, diagnosed with idiopathic Parkinson’s, who has been seen in clinic for the last 8 years. He is taking sinemet 125mg four times a day. He was diagnosed with prostate cancer last year and is now on anti-androgen hormone treatment. He had polymyalgia rheumatica 3 years ago and had steroid treatment for 18 months. He has some back pain. He drinks 3 units of red wine daily. He suffers with constipation which is easily managed with aperients. He is hypothyroid on monitored replacement therapy. He takes bendroflumethiazide for hypertension, zopiclone to aid sleep as well as aspirin 75mg for secondary cardiovascular disease prevention. He comes to clinic and it is noted that he is shuffling more than he used to and now uses a stick to walk. Coming through the door he gets ‘stuck’ and freezes. There is no ‘wearing off’ phenomenon. On examination he is wearing bifocal glasses, but his eye movements are normal. He has Hoehn and Yahr stage 3 Parkinson’s and has a moderately stooped posture. He has moderate bradykinesia and rigidity of his upper and lower limbs, more evident on the left than the right and no red flags to suggest an alternative diagnosis to idiopathic Parkinson’s. He weighs 57kg and is 1.59m tall. He reports his main problem as feeling ‘really unsteady’ and as a result he is less confident leaving the house to do his weekly shop. He has not fallen.
1.1 Who falls with Parkinson’s?