TABLE OF CONTENTS

Volume 21, Issue 2

ACNR is a UK-based, international, open access, peer reviewed neurology journal which aims to keep busy practicing specialists up-to-date with the latest advances in their fields.

ISSN 1473-9348


Clinical Review Articles
  • Confidence College – an online education tool for neurology patients
  • Heather Angus-Leppan, Alice Caulfield, Melika M Moghim, Jennifer Nightingale, Rob Sloan, Tom Stables, Michael Oates, Bernadette Porter, Anette Schrag
Movement Disorders
  • Physical activity and exercise for people with Parkinson’s
  • Julie Jones, Katherine Baker, Bhanu Ramaswamy
Epilepsy Series
  • The Comorbidities of Epilepsy: Introduction
  • Marco Mula
  • Seizures and sleep: Not such strange bedfellows
  • Guy Leschziner
Sleep Series
  • Psychostimulants as cognitive enhancers – the evidence for the use and abuse of smart drugs
  • Poppy Goldsmith and Kirstie Anderson
Headache Series
  • Vestibular migraine
  • Nitesh Patel, Kulvinder Talewar, Anish Bahra, Diego Kaski
Special Features
  • Rehabilitating Romberg
  • Mark R Baker, Timothy L Williams, Andrew Larner
  • Arnold’s Nerve
  • JMS Pearce

Related

  • HOME
  • ISSUES
  • EXPLORE CONTENT
    • Introduction
    • Articles
    • Book Reviews
    • Case Reports
    • News
    • Sponsored Editorial
  • EVENTS
    • Introduction
    • Event News
    • Conference Reports
    • Submit your event to ACNR
  • AUTHORS
    • Introduction
    • Author Guidelines
    • Author Disclosure
  • RESOURCES
  • ABOUT
    • Introduction
    • How is ACNR funded?
    • Editorial Board
    • Peer Reviewers
    • Policies and Forms
    • Ethics and Malpractice
    • Email Newsletter
    • Mail Signup
    • ACNR Privacy Policy
This website is intended for healthcare professionals
ACNR
  • HOME
  • ISSUES
  • EXPLORE CONTENT
    • Introduction
    • Articles
    • Book Reviews
    • Case Reports
    • News
    • Sponsored Editorial
  • EVENTS
    • Introduction
    • Event News
    • Conference Reports
    • Submit your Event to ACNR
  • AUTHORS
    • Introduction
    • Author Guidelines
    • Author Disclosure
  • RESOURCES
  • ABOUT
    • Introduction
    • How is ACNR Funded?
    • Editorial Board
    • Peer Reviewers
    • Policies and Forms
    • Ethics and Malpractice
    • Email Newsletter
    • Mail Signup
    • ACNR Privacy Policy
  • Menu

ACNR ARTICLES

Bone health in patients with Parkinson’s disease

Authors

  • Aishling Murray
  • Consultant Geriatrician

Dr Aishling Murray is a Consultant Geriatrician at Royal Liverpool Hospital, UK with a special interest in Movement Disorders and Orthogeriatrics.

  • Thea Jones

Dr Thea Jones is ST6, Royal Liverpool Hospital, UK

  • Correspondence Email:
  • maishling@hotmail.com

Conflict of Interest Statement:
None declared

Publication Dates:

Publication Date:
30 Jan 2017

Acknowledgements

This paper was a runner up in the Parkinson’s Academy MasterClass Project 2016. The Parkinson’s Academy intermodule project is an integral part of the Advanced MasterClass. Course participants choose an area of interest which might be around service delivery, patient or drug management and present their findings at Module 2 to the faculty and other participants who select the winner.


Article Categories

  • ABN (5)
  • ABNT (7)
  • Alzheimer's Disease (3)
  • Australia/NewZealand (32)
  • Clinical Review (124)
  • COVID-19 (15)
  • Dementia (7)
  • Epilepsy (9)
  • Headache (4)
  • History (29)
  • Movement Disorders (3)
  • Multiple Sclerosis (16)
  • Neurological Literature (3)
  • Neurological Signs (2)
  • Neurosurgery (18)
  • Nutrition (5)
  • Pain (3)
  • Parkinson's Disease (28)
  • Personal Perspectives (2)
  • Rehabilitation (35)
  • Sleep (14)
  • Special Feature (45)
  • Stroke (11)
  • Supplements (1)

After attending the MasterClass and being tasked with producing a project encompassing aspects of Parkinons patient care, we endeavoured to create a project relevant to our particular patient cohort. As a newly appointed Consultant Geriatrician, and SpR with a specialist interest in orthogeriatrics and movement disorders, we found a lot of scope for quality improvement in management of bone health.

Parkinson’s disease (PD) is being increasingly recognised as an independent risk factor for osteoporosis and fragility fractures. There is a two-fold risk of hip fracture for men with PD and three-fold for women. Those with Parkinson’s present earlier in morbidity trajectory, with hip fracture than non-PD counterparts. The median time to hip fracture calculated as four years from diagnosis. Vitamin D deficiency is common in these patients1. Osteoporosis pathophysiology is proposed to be multifactorial in nature, contributory factors being reduced activity, sarcopenia, malnutrition, vitamin D deficiency and factors related to L-Dopa metabolism2.

There is a universal lack of clear guidelines in management of bone health in patients with Parkinson’s disease, and no reference to PD-specific peri-operative guidance in standardised fracture neck of femur pathways. On that basis and from anecdotal evidence of poor management and outcomes of Parkinson’s patients who suffer a hip fracture, lack of consistent review of bone health in the outpatient setting, we embarked on a quality improvement project.  We divided the project into an inpatient and an outpatient arm.

Aims/Objectives

To review inpatient care and outcomes for patients with Parkinon’s disease who experience a fractured neck of femur.

Method

A retrospective review of 18 months of data from our trust’s national hip fracture database was reviewed. This covered the period January 2015 to June 2016. This data includes information on: length of stay (LOS), discharge destination, time to surgery, performance status (ASA) and cognition (pre- and post-operative AMT [abbreviated mental test]). A sample of case notes of patients with Parkinson’s was also reviewed in more depth.

Following review of this data, a review of available Parkinson’s medications was also undertaken.

Results

659 patients were admitted with a fractured neck of femur over the 18 months. Fifteen patients (2.25%) had a working diagnosis of idiopathic PD. The patients with PD had a total of 296 bed days with a 2.46 days longer average LOS; 19.73 (10–46) days, compared to the patients without PD average of 17.27 (1–120) days.

The patients with Parkinson’s were more likely to be residing in their own home pre-op, however had a higher rate of discharge to 24 hour care.

Patients with PD did have a shorter time to theatre.

The table below summarises the results:

The review of case notes showed high rates of delirium, constipation, urinary catheter insertion and delay in physio review. One patient was inappropriately prescribed a rotigotine patch. Another patient was given intravenous haloperidol in theatre recovery, when they were in urinary retention and settled following a catheter.

Parkinson’s disease medications were not routinely stocked on the orthopaedic wards. They are currently only available in the emergency medication cupboard or on the geriatric medicine wards.

Discussion and future plans

Results reflect the ethos that patients with Parkinson’s are pre-morbidly higher functioning at time of hip fracture; however, have increased peri-operative morbidity and poorer outcomes, including admission to 24 hour care. Having reviewed outcomes and patient journeys following hip fracture, and outpatient bone health management, we are implementing practice change at trust level. During our current transition to a paperless system, we are opportunistically augmenting our Fracture Neck of Femur Pathway, to include a PD subsection. This peri-operative guidance will include medication management, NBM status, common complications, a directive section on rehab and prominently placed contact details for our PD Nurse specialist. We also have an IV Bisphosphonate pathway as a once-off therapeutic opportunity for selected patients. In terms of in-building systematic bone health review to out-patient assessments, we have proposed 2-yearly review. We are also engaging nursing staff in out-patients to ask the question of “any falls or fractures” since last review, as well as planning the addition of an e-prompt on our proforma.


References

  1. Lyell, V et al (2015)  Assessment and management of fracture risk in patients with Parkinson’s disease Age Ageing 44 (1): 34-41
  2. Van den bos, F et al (2013) Parkinson’s disease and osteoporosis Age Ageing 42: 156–162.

Related

  • Published by Whitehouse Publishing
  • The Lynch, Mere, Wiltshire BA12 6DQ, United Kingdom
  • info@acnr.co.uk
  • +44 1747 860168

FOLLOW US

  • Facebook
  • Instagram
  • Twitter
  • Linkedin

ACNR SIGNUPS

Join our email list to be notified when there is new content or upcoming events. For UK-based specialists join our mailing list for the journal.

© 2022 ACNR. Published by Whitehouse Publishing. Read our Privacy and Cookie Policy. Website by Sugar Web.

SIGN UP FOR OUR EMAILING LIST

Sign up to receive our email newsletter with links to the latest content. ACNR is free, thanks to the support of advertisers. The editorial content is peer reviewed and remains completely independent unless clearly specified.

For UK-based specialists, sign up for our journal mailing list.