Assessing and managing bone health and fracture risk in Parkinson's disease: the BONE PARK 2 protocol.

Background: In Parkinson's disease (PD), the propensity to fall and the higher risk of osteoporosis converge yielding a high fracture risk. Updated National Osteoporosis Guideline Group (NOGG) guidance recommends that PD should trigger a risk assessment, for example using the FRAX tool, yet clinical pathways remain sub-optimal. To address this, we generated an algorithm for the assessment and management of bone health specifically in PD.

Methods: Within the Proactive and Integrated Management and Empowerment in Parkinson's Disease randomised controlled trial (PRIME-UK RCT), bone-health metrics were collected, and all participants were offered a dual X-ray absorptiometry scan. The FRAX tool was used to obtain the 10-year probability of hip and major osteoporotic fracture (MOF), and the resulting NOGG risk-category recorded. Probabilities were recalculated including femoral-neck bone mineral density (FN-BMD) and/or with numeric adjustment for recurrent falls, and results compared.

Results: Among 182 people with parkinsonism (mean age 73.8 years, 65% male, median disease duration 5 years), 28% reported a prior fragility fracture, and 40.7% recurrent falls over the previous year. 28.6% had MOF above NOGG intervention thresholds (IT); whilst 12.1% had a FN-BMD T-Score ≤ -2.5. Recalculation of FRAX with FN-BMD (n = 182) reduced fracture MOF and hip fracture probabilities; 12 (6.6%) deescalated below the IT, and 16 (8.8%) moved above the IT.

Conclusions: This 2024 BONE-PARK algorithm is informed by both the latest NOGG Guidelines and novel findings in a 'real-world' population. The algorithm will aid bone health assessment for people with PD.