Media portrayal:
Scientific interpretation:

Falls and hip fractures may precede Parkinson’s diagnosis by decades

Original article: Risk of injurious fall and hip fracture up to 26 y before the diagnosis of Parkinson disease: nested case-control studies in a nationwide cohort, PLoS Medicine: February 2, 2016

The takeaway

Falls and hip fractures early in life may be indicative of Parkinson’s disease later in life.

Why is it important?

Increasing evidence indicates that subtle signs of Parkinson’s disease may crop up many years before diagnosis. Although therapies that slow or stop Parkinson’s do not currently exist, identification of the disease in its earliest stages may one day allow physicians to intervene, once disease-modifying drugs are available


“This is a surprising finding that suggests falls and hip fractures occur in people before they know they have Parkinson’s disease. It could indicate that people experience subtle motor symptoms leading to the falls long before diagnosis.” Dr. Patrik Brundin



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The details

Using the Swedish National Patient Register, the scientists identified 24,412 people who had been diagnosed with Parkinson’s between 1988 and 2012. The average study period started about 20 years prior to diagnosis. During this time, 18 percent of people with Parkinson’s and 11.5 percent of healthy controls had a fall that required emergency treatment. Taking into account other factors that could be related to falls, people who went on to be diagnosed with Parkinson’s still had a higher risk of falls and hip fractures, the incidence of which increased closer to diagnosis.

It is important to note that the information for this study came from patient registers and not from direct examination of patients. Although additional work is needed to confirm the link, these findings provide insight into potential neurodegenerative problems many years before onset of traditional symptoms and diagnosis.

Related work

It has been shown that falls are related in part to a reduction in the neurotransmitter acetylecholine and this can contribute to walking (gait) and cognitive issues. Such gait dysfunction can also lead to an increased likelihood of falls. The ReSPonD trial tested a drug known as rivastigmine which ameliorates this reduction in acetylcholine in to see if it could reduce gait variability in people with Parkinson’s.


The results published in 2016 showed that rivastigmine can improve gait stability of people with Parkinson’s and therefore may reduce the frequency of falls. A phase 3 study is currently being designed.

Original article: Nyström H, Nordström A, Nordström P. February 2, 2016. Risk of injurious fall and hip fracture up to 26 y before the diagnosis of Parkinson disease: nested case-control studies in a nationwide cohort. PLoS Med.

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