Body Mass Index Changes and Femur Fracture Risk in Parkinson's Disease: National Cohort Study

Abstract

Background: Parkinson's disease (PD) increases fracture risk owing to postural instability and bone fragility, with femur fractures being the most frequent and clinically significant. Many patients with PD experience weight loss as the disease progresses, and low body mass index (BMI) is a well-established fracture risk factor. However, the relationship between longitudinal BMI changes and femur fracture risk in PD remains unclear. We investigated this association using nationwide cohort data.

Methods: This retrospective cohort study used data from the Korean National Health Insurance Service (2009-2014). Overall, 19 422 patients newly diagnosed with PD who underwent three consecutive biennial health screenings were included in the analysis. Based on BMI measurements collected over a median exposure period of 4.01 years (2009-2014), changes were identified using Gaussian finite mixture modelling, classifying participants into two groups: stable BMI (n = 16 839) and decreasing BMI (n = 2583). The primary outcome was new-onset femur fracture, defined as hospitalization with the International Classification of Diseases (Tenth Revision) code S72, identified between 2015 and 2022. Multivariable Cox proportional hazard regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for new-onset femur fracture in the decreasing BMI group compared to the stable group.

Results: The mean age of participants was 65.6 ± 8.8 years, 57.0% were women, and the average baseline BMI was 24.2 ± 3.0 kg/m². Compared with the stable group, the decreasing BMI group was older, had a higher baseline BMI, and a lower proportion of current drinkers and regular exercisers. The proportion of women and the prevalence of obesity, hypertension, type 2 diabetes, dyslipidaemia and osteoporosis were also higher in the decreasing group. During a median follow-up of 8.46 years, 1156 femur fractures occurred. The incidence rate was higher in the decreasing BMI group than in the stable group (10.50 vs. 7.58 per 1000 person-years). In the unadjusted analysis, the decreasing BMI group exhibited a significantly increased risk of femur fractures (HR 1.41, 95% CI: 1.21-1.65, p < 0.001). The association remained significant after multivariable adjustment, with an HR of 1.20 (95% CI: 1.02-1.41, p = 0.027).

Conclusions: Patients with PD who experience a decline in BMI over time have a higher risk of femur fracture than those with a stable BMI. Monitoring longitudinal changes in BMI among patients with PD may serve as a practical tool for the early identification of fracture risk and the implementation of preventive strategies.

Keywords: BMI; Parkinson's disease; cohort; femur fracture; trajectory.

FIGURE 1

Flowchart of the study population selection. BMI, body mass index.

FIGURE 2

BMI trajectory groups during the exposure period. BMI, body mass index.

FIGURE 3

Cumulative incidence plots showing the rates of femur fracture incidence. BMI, body mass index.

FIGURE 4

Subgroup analysis for the association between the different BMI trajectory groups (decreasing vs. stable) and the risk of new‐onset femur fracture among individuals with PD stratified by sex, age, obesity, regular exercise and osteoporosis. BMI, body mass index; CI, confidence interval; HR, hazard ratio; PD, Parkinson's disease.