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.
Hello and welcome to the Parkinson's bone course. I'm Dr Veronica Lyell. I’m a consultant geriatrician with a specialist interest in Parkinson’s and Bone Health. My consultant colleagues, Dr Emily Henderson and Dr Celia Gregson, and I, here in the Royal United Hospital Bath, have developed this course in conjunction with Parkinson's UK and the Open University.
You will be very familiar with falls in Parkinson's. Falls can have many serious consequences, including injuries, hospital admission, and loss of confidence, and one particular fear is that of hip fracture.
Hip fractures cause great pain and loss of function. They’re compounded with complications such as pneumonia, delirium, and pressure sores. People with Parkinson’s are more likely to suffer these complications. Not only that, but people with Parkinson’s are more likely to sustain a hip fracture in the first place; indeed, a man with Parkinson’s has three times the chance of breaking his hip compared with another man of the same age.
There are real opportunities to intervene for our patients with Parkinson’s to reduce the burdens of fractures and we hope that this course will empower you to take these opportunities.
It is designed to provide an overview of falls assessment, to explain bone metabolism and osteoporosis, to introduce concepts of fracture risk assessment and to give management options, from lifestyle interventions through to drug therapies. There are modules to work through, each with interactive features that we hope will aid your understanding and learning.
By the end of the course we hope you will have developed the confidence to tackle bone health assessment and management in Parkinson’s. People with Parkinson’s have enough to contend with without fractures, and we are passionate about helping them reduce the risk of broken bones.
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?