Sex Differences in Fall Frequency, Risk Factors, and Outcomes in Parkinson's Disease: A Cross-Sectional Analysis

Joaquin A Vizcarra; Kat Hefter; David-Erick Lafontant; Michael Tran Duong; Ashkan Ertefaie; Brian Litt; Dani S Bassett; Andrew Siderowf; Parkinson's Progression Markers Initiative

doi:10.1002/mdc3.70664

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Sex Differences in Fall Frequency, Risk Factors, and Outcomes in Parkinson's Disease: A Cross-Sectional Analysis

Journal article

Open access

Peer reviewed

Sex Differences in Fall Frequency, Risk Factors, and Outcomes in Parkinson's Disease: A Cross-Sectional Analysis

Joaquin A Vizcarra, Kat Hefter, David-Erick Lafontant, Michael Tran Duong, Ashkan Ertefaie, Brian Litt, Dani S Bassett, Andrew Siderowf and Parkinson's Progression Markers Initiative

Movement disorders clinical practice (Hoboken, N.J.)

05/07/2026

DOI: 10.1002/mdc3.70664

PMID: 42093339

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Abstract

Female sex is an independent fall risk factor in Parkinson's disease (PD), yet sex-specific fall patterns remain unclear. To compare sex-specific fall risk and outcomes across PD, prodromal alpha-synucleinopathy (PAS), and healthy controls (HC); estimate fall frequency across PD progression; and assess how sex modifies fall risk and outcomes. Fall outcomes were analyzed in the Parkinson's Progression Markers Initiative. Yearly rates of rare and frequent falls were estimated by time since diagnosis. PD participants were classified as never, rare, or frequent fallers. Clinical measures included motor, cognitive, behavioral, sleep, and autonomic domains. Outcomes included injuries and healthcare utilization. Regression models adjusted for age, sex, and disease duration with Benjamini-Hochberg correction. Among 3100 participants (937 PD, 1926 PAS, 237 HC; 6977 visits), PD participants had higher odds of falling than PAS (OR 1.66, 95% CI 1.46-1.87) and HC (OR 4.03, 95% CI 3.14-5.23). In PD and PAS, females had higher odds of injuries (OR 1.50, 95% CI 1.20-1.88) and fractures (OR 1.62, 95% CI 1.15-2.29), including hip (OR 2.30, 95% CI 1.09-4.91) and upper-extremity fractures (OR 2.67, 95% CI 1.51-4.85). Within PD, falls increased with disease duration and were higher in females (7 years: 42% vs. 32%; 14 years: 88% vs. 61%) despite milder clinical profiles. Across the Neuronal Synuclein Disease-Integrated Staging System (NSD-ISS) stages, fall occurrence was higher in females. Falls increase with disease duration and NSD-ISS stage. Female PD participants are at greater risk despite milder symptoms, supporting sex-specific prevention strategies.

Parkinson's

NSD‐ISS

risk factors

fall

Details

Title: Subtitle: Sex Differences in Fall Frequency, Risk Factors, and Outcomes in Parkinson's Disease: A Cross-Sectional Analysis
Creators: Joaquin A Vizcarra - University of Pennsylvania
Kat Hefter - University of Pennsylvania
David-Erick Lafontant - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
Michael Tran Duong - University of Pennsylvania
Ashkan Ertefaie - University of Pennsylvania
Brian Litt - University of Pennsylvania
Dani S Bassett - University of Pennsylvania
Andrew Siderowf - University of Pennsylvania
Parkinson's Progression Markers Initiative
Resource Type: Journal article
Publication Details: Movement disorders clinical practice (Hoboken, N.J.)
DOI: 10.1002/mdc3.70664
PMID: 42093339
NLM abbreviation: Mov Disord Clin Pract
ISSN: 2330-1619
eISSN: 2330-1619
Publisher: Wiley
Grant note: Michael J. Fox Foundation for Parkinson's Research 1T32NS091006-10 / NIH HHS 5T32NS091006-10 / NIH HHS
Language: English
Electronic publication date: 05/07/2026
Academic Unit: Biostatistics
Record Identifier: 9985161445002771

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