Parkinson’s disease (PD) significantly influences mortality after fractures, primarily because it worsens the risks and complications associated with these injuries. People with PD face a higher likelihood of fractures due to motor symptoms like impaired balance, rigidity, and tremors, which increase fall risk. When fractures occur, especially hip fractures, the presence of PD complicates recovery and elevates the chance of death compared to individuals without PD.
The increased mortality after fractures in PD patients is linked to several interrelated factors. First, PD causes progressive motor decline, which impairs mobility and muscle strength. This leads to slower and more difficult rehabilitation after a fracture, making it harder for patients to regain independence. Reduced mobility also increases the risk of secondary complications such as blood clots, pneumonia, and pressure ulcers, all of which can be fatal in frail individuals.
Second, PD is often accompanied by cognitive impairments, including dementia and confusion. These neuropsychiatric symptoms can hinder a patient’s ability to follow medical advice, participate in physical therapy, and manage medications properly. Cognitive decline also raises the risk of postoperative complications and infections, further increasing mortality risk.
Third, the surgical treatment of fractures, such as total hip arthroplasty (THA) for femoral neck fractures, is more complex in PD patients. The disease’s characteristic muscle rigidity and impaired motor control contribute to higher rates of postoperative complications like joint instability and dislocation. These complications often necessitate revision surgeries, which carry additional risks and can worsen outcomes. Moreover, PD patients tend to have poorer bone quality and muscle weakness, which can affect surgical success and healing.
Another critical factor is the increased frequency of falls in PD, which not only causes initial fractures but also raises the risk of subsequent fractures. After an initial fracture, PD patients are more likely to experience additional fractures, compounding their health challenges and mortality risk.
Medication management in PD also plays a role. The fluctuating dopamine levels due to the progressive nature of PD and the challenges in adjusting treatment between clinic visits can lead to unstable motor symptoms. This instability increases the risk of falls and fractures, and complicates recovery after injury.
Overall, the combination of motor impairment, cognitive decline, surgical challenges, and increased fall risk creates a scenario where fractures in PD patients lead to higher mortality rates than in the general population. The progressive nature of PD means that each fracture can accelerate functional decline, reduce quality of life, and increase vulnerability to life-threatening complications.
Efforts to reduce mortality in PD patients after fractures focus on comprehensive care approaches. These include fall prevention strategies, optimized medical management of PD symptoms, tailored rehabilitation programs, and surgical techniques that account for the unique challenges posed by PD. Early intervention and close monitoring are essential to improve outcomes and reduce the risk of death following fractures in this vulnerable population.