Co-occurrence patterns and related risk factors of fractures and Parkinson’s disease across 204 countries and territories

The epidemiology of fractures and Parkinson's disease (PD) has not been systematically characterized at the global level. This study aimed to estimate the global co-occurrence patterns and related risk factors. The Global Burden of Disease Study 2021 data were analyzed, and the population aged 50 years and over was selected. Pearson correlation was used to evaluate the association between age-standardized rate (ASRs) of fractures and PD. Geographical co-distribution of disease burden was visualized in univariate and bivariate choropleth maps, which were also used to display the burden attributable to specific risk factors. The shared and disease-specific risk factors were identified and classified by a random forest model with SHapley Additive exPlanations and stepwise linear regression. Finally, we simulated the possible decrease in ASR for hypothetical intervention scenarios. A significant positive association between the ASRs of fractures and PD was found (Pearson R = 0.35-0.57, all P < .001). The geographical analysis revealed highly concurrent disease patterns in high-income regions, including North America, Western Europe, and East Asia. The burden ratio analysis indicated a U-shaped relationship between the relative burden of fractures and age, with the highest relative burden observed in the youngest and oldest demographics. The burden attributed to shared risk factors, such as lead exposure, also showed a clear geographic pattern, with high concentrations in Eastern Europe and parts of Asia. Four shared risk factors were found for both sexes combined: "lead exposure," "smoking," "diet high in processed meat," and "diet high in sugar sweetened beverages." The elimination of fracture-specific risk factors provided the greatest potential burden reduction; targeting shared risk factors also had a significant effect. Significant co-occurrence patterns of fractures and PD and were identified, alongside multiple shared and condition-specific risk factors, highlighting the importance of combined public health measures that target shared risk factors.