Ask the MD: Broken Bones (Fractures) and Parkinson’s Disease

Monday, 4th December 2023

This article was originally published by The Michael J. Fox Foundation for Parkinson’s Research

This blog was written by Caroline (Carlie) Tanner, MD, PhD, a movement disorder specialist and professor of neurology at the Weill Institute for Neurosciences, University of California, San Francisco. Dr. Tanner shared this information to help you and your loved ones learn more about how and why bones might break (fracture) when living with Parkinson’s and how you can lessen risk.

Do people with Parkinson’s break bones more often? If so, why?

Broken bones are more common in people with Parkinson’s disease compared to other people the same age and sex. About one in 10 people with Parkinson’s have a fracture each year, and people who have fallen in the past year are at higher risk.

There are two major factors contributing to fractures in people with Parkinson’s. The first is an increased risk of falling. People with Parkinson’s are more likely to fall for many reasons. Balance and walking are often impaired, and some people have freezing of gait, a temporary inability to move the feet forward. Muscle strength, especially in the lower body, may also be reduced. And some medications (for Parkinson’s or other conditions) can reduce alertness or cause low blood pressure, which can cause dizziness or passing out. The second major factor is having weaker bones (osteopenia or osteoporosis), possibly due to reduced physical activity or lower levels of vitamin D.

What should people with Parkinson’s and their loved ones know about fractures?

People with Parkinson’s should do what they can to avoid fractures. They can be painful and can reduce the ability to perform certain actions or movements. Some bone breaks, like hip fractures, can also reduce a person’s independence. (And people with PD are four times more likely than others the same age and sex to experience a hip fracture.)

Not everyone will break a bone. But if you do, it’s best to follow a rehabilitation program, which often includes physical, occupational and other therapy and guidance, under expert supervision.

Are there any ways to avoid falls and/or prevent fractures?

There are many things you can do to avoid falls and fractures:

Exercise!
This is important to maintain strength and balance. Exercise can reduce the risk of falls and may also help reduce potential injuries due to a fall, including fractures. Strength and aerobic (cardio) training as well as activities like tai chi that improve balance are all useful and necessary — remember that strength training strengthens bones!
Maintain bone health.
Stronger bones are less prone to fractures. People should ask their doctors whether, when and how often they need tests of bone density or vitamin D levels, and if they should take vitamin D or prescription medication for bone health.
Review all your medications with your doctor regularly.
See if any increase the risk of falls. Sometimes people receive medicines from several different doctors, and it can be helpful to take a second look. And ask your Parkinson’s doctor whether medication or other treatment adjustments (such as adding physical therapy) may help reduce your risk of falls.
Consider a home safety evaluation.
Occupational therapists or other home health professionals can review your home environment for safety and fall risks. They can also advise on ways to reduce the risk of falls and recommend equipment to help. Simple changes like improved lighting, decluttering, adjusting furniture or removing throw rugs can reduce fall risk. Certain areas, like bathrooms, are common locations for falls. Adding grab bars, shower seats or similar modifications can reduce falls.
Be extra careful in situations that might make a fall more likely.
For example, walking on uneven ground or in a poorly lit or crowded area, or when fatigued or after a drink of alcohol may increase the risk of tripping or losing balance.
See a physical therapist, if possible.
They can do a detailed evaluation of your walking and risk of falling. And they can help develop a plan for your care and a personalized exercise program.

What can care partners do to help?

Care partners can provide essential support as exercise partners. They can help to facilitate home safety changes and medical visits. If a fracture does occur, they can help with rehabilitation and support.

What treatments are available?

There are several treatments to strengthen bones. Although many people with Parkinson’s would qualify for treatment with a bone-strengthening drug, fewer than five percent are actually treated. To address this gap, I joined with other Parkinson’s experts and experts in bone health to test whether a single dose of zoledronate (an FDA-approved drug for osteoporosis) can reduce fractures in people with Parkinson’s or other forms of parkinsonism. This home-based study, called TOPAZ (Trial of Parkinson’s with Zoledronic Acid) is enrolling people with Parkinson’s across the U.S. If the zoledronate treatment does reduce fractures in people with Parkinson’s disease, we hope this home-based approach will reduce barriers and make it easier for people to receive fracture-prevention treatment.

The medical information contained in this blog is for general information purposes only. The Michael J. Fox Foundation for Parkinson’s Research has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson’s disease and any other medical condition be made in consultation with a physician or other qualified medical professional.