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Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study
  1. D R Williams1,2,3,
  2. H C Watt2,3,4,
  3. A J Lees1,2,3
  1. 1Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
  2. 2Queen Square Brain Bank for Neurological Disorders, London, UK
  3. 3Institute of Neurology, University College London, London, UK
  4. 4Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to:
 Professor A J Lees
 Reta Lila Weston Institute of Neurological Studies, 46 Cleveland Street, London W1T 4JF, UK; alees{at}


Background: Falls and fractures contribute to morbidity and mortality in bradykinetic rigid syndromes.

Methods: The authors performed a retrospective case notes review at the Queen Square Brain Bank for Neurological Disorders and systematically explored the relation between clinical features and falls and fractures in 782 pathologically diagnosed cases (474 with Parkinson’s disease (PD); 127 progressive supranuclear palsy (PSP); 91 multiple system atrophy (MSA); 46 dementia with Lewy bodies (DLB); 27 vascular parkinsonism; nine Alzheimer’s disease; eight corticobasal degeneration).

Results: Falls were recorded in 606 (77.5%) and fractures in 134 (17.1%). In PD, female gender, symmetrical onset, postural instability, and autonomic instability all independently predicted time to first fall. In PD, PSP, and MSA latency to first fall was shortest in those with older age of onset of disease. Median latency from disease onset to first fall was shortest in Richardson’s syndrome (12 months), MSA (42), and PSP-parkinsonism (47), and longest in PD (108). In all patients fractures of the hip were more than twice as common as wrist and forearm fractures. Fractures of the skull, ribs, and vertebrae occurred more frequently in PSP than in other diseases.

Conclusion: Measures to prevent the morbidity associated with falls and fractures in bradykinetic rigid syndromes may be best directed at patients with the risk factors identified in this study.

  • AD, Alzheimer’s disease
  • CBD, corticobasal degeneration
  • DLB, dementia with Lewy bodies
  • MSA, multiple system atrophy
  • PD, Parkinson’s disease
  • PSP, progressive supranuclear palsy
  • PSP-P, PSP-parkinsonism
  • RS, Richardson’s syndrome
  • VP, vascular parkinsonism
  • Parkinson’s disease
  • bradykinetic rigid syndromes
  • falls
  • fractures

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  • Competing interests: none declared

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