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Preventing Fractures in Parkinson’s Disease by Identifying Barriers to Care and Social Determinants of Health

Study Rationale: Compared with the general population, people with Parkinson’s disease (PD) are more likely to fall and break a bone as a result of disease-related motor issues, such as difficulty walking or poor balance. Although medications and therapies can help, many of these individuals remain undertreated, perhaps because they lack access to health care or are unable to pay for therapy. By studying patterns in Medicare data and surveying doctors and patients, we will assess the factors that make some individuals with PD more vulnerable to fractures, information that can be used to help them obtain proper care.

Hypothesis: We anticipate that fractures will be more common in individuals who are often underrepresented in health-related research—such as minorities, people of color and the poor—and in people with PD who do not get care from a neurologist or seek medication or physical therapy.

Study Design: We will identify Medicare recipients who were diagnosed with PD in 2018 and review several years’ worth of their medical records to determine which of these individuals fractures a bone. We will assess whether fracture in these individuals can be related to education, inability to pay for treatments, living conditions or limited transportation options. We also will explore whether obtaining care and treatment from a neurologist helps prevent fractures in people with PD. Using this information, we will work with local communities to survey doctors and patients to gain their perspective on the challenges to getting medical care.

Impact on Diagnosis/Treatment of Parkinson’s disease: By providing doctors who do not specialize in PD with information on the medications and therapies available to treat problems with movement, we hope to decrease the number of fractures in people with PD.

Next Steps for Development: Understanding how the risk for fracture can be affected by differences in health care access, living environment, transportation and the ability to pay for or receive treatments for PD will facilitate the development of public health strategies to reduce these inequities and improve quality of life in people with PD.


  • Alejandra Camacho-Soto, MD, MPHS

    St. Louis, MO United States

  • Brad A. Racette, MD

    St. Louis, MO United States

  • Susan Searles Nielsen, PhD

    St. Louis, MO United States

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