Title : An audit on the assessment and management of osteoporosis in a Parkinson’s and related diseases clinic in Australia
Abstract:
Osteoporosis is characterised by low bone mineral density and is associated with minimal trauma fractures. Patients with Parkinson’s disease (PD) and atypical parkinsonian syndromes are at increased risk of falls and should be actively screened and treated for osteoporosis. In 2024, the Royal Australian College of General Practitioners (RACGP) revised their practice guidelines for diagnosing and managing osteoporosis in postmenopausal women and men aged over 50 years. Here we conduct the first Australian study to audit the use of these guidelines in patients with PD and atypical parkinsonian syndromes.
We audited all PD, Dementia with Lewy Bodies, Progressive Supranuclear Palsy and Multiple System Atrophy cases attending our neurology service between January and March 2024 against the RACGP osteoporosis guidelines. We identified patients at risk of osteoporosis or minimal trauma fractures and assessed if they had been referred to their general practitioner (GP) for appropriate management or were already receiving appropriate osteoporosis treatment.
This audit evaluated 230 patients, the majority of which had PD (n=199). We identified 78 patients over the age of 50 years with risk factors that should trigger a GP bone health assessment as per the guidelines. Twenty-six of these patients were already being managed appropriately for their bone health. However only 12 of the remaining 52 ‘at risk’ patients (23%) were directed to seek screening for osteoporosis by their GP, leaving 77% (40/52) without appropriate guidance.
Specialists reviewing PD patients are well placed to assess osteoporosis and fracture risk, but this audit highlighted that this is currently not frequently done. Our major recommendations include following the guidelines and referring patients for a bone health screen with their GP if they have risk factors for osteoporosis. Considering the detrimental impact of poor bone health on morbidity and mortality, awareness amongst specialists needs to be improved.
