Background Postural instability and resultant fractures are common in parkinsonism but no studies have analysed fracture rates in prospective incident cohorts of parkinsonian patients and controls.

Methods Data from the PINE study (326 incident parkinsonian patients, 261 age-gender matched controls) were used. The study database included prospectively collected data on falls and fractures from annual reviews supplemented by hospital and GP records. Major fractures were defined as skull, long bone or pelvis. Kaplan-Meier curves for time-to-first fracture from diagnosis were analysed by diagnostic groups. Multivariate Cox regression analysis was used to identify factors that independently predicted fractures.

Results The fracture rates in patients with PD, Parkinson's plus syndromes, dementia with Lewy Bodies and vascular parkinsonism were similar (log rank p value=0.89) and so these groups were combined. The percentage of frequent fallers among the patients (24.2%) was higher than the controls (1.3%). The incidence of any fractures and major fractures was about three times higher in patients (5.51 and 4.25 per 100 patient-years respectively) than in controls (1.96 and 1.42 respectively). Parkinsonism, female gender, frequent fallers and development of dementia were independent predictors of major fractures.

Conclusion Patients with parkinsonism have a much higher risk of falls and fractures.