Strong and Healthy Bones
Strong healthy bones are important for good posture and to reduce your risk of fracture from falls. This is especially true if you have Parkinson’s, since balance problems and changes in posture can be a part of the disease. In addition, our bones and skeletal system change as we get older or if we are less physically active. As a result, changes seen with aging and Parkinson’s are flexed posture, reduced joint range of motion, spine and joint arthritis, and pain.
What is osteoporosis and osteopenia?
In osteoporosis which means ‘porous bones’ there is loss of bone density and bone strength. Osteopenia or bone thinning is a milder form of bone thinning. Both of these problems can cause a fracture- most common in the hips, spine or wrist. Fractures can occur after a fall but even after simple tasks that put strain on your skeletal system such as leaning over to pick up a heavy object. Symptoms of osteoporosis are bone pain, loss of height with stooped posture and fractures.
How does osteoporosis develop?
Bone is continuously changing or remodeling- old bone breaks down and new bone forming. Bone mass is at its peak in our mid-30s and declines thereafter. Bone loss increases after menopause when estrogen is reduced. Therefore the risk of developing osteoporosis increases with age. Women are at greater risk than men, however, men over the age of 75y.o. and with low testosterone levels are at risk. In PD, declining physical activity and vitamin D deficiency may further increase your risk. Calcium deficiency, certain intestinal malabsorption syndromes such as Celiac disease, hormone deficiencies, and vegetarians are also at risk.
Risk Factors for Osteoporosis (Adapted from the Mayoclinic.org)
- Women- fractures are twice as common in women than men.
- Age- the older you are the greater the risk.
- Reduced physical activity- a risk for many with Parkinson’s.
- Low calcium- This can be due to low intake, interference with medicines or reduced absorption such as with gastrointestinal disorders.
- Reduced exposure to sunshine- Due to low vitamin D levels. Especially important to people in Northern climates. Increasing factor with increased use of sunscreen to prevent skin cancer.
- Family history- Increased risk if parent or sibling has osteoporosis. People of white and Southeast Asian descent have higher risk.
- Body build- slender people may have les bone mass to begin with.
- Excessive alcohol use is the leading cause in men.
- Corticosteroid use- treatments for asthma, inflammatory diseases.
- Thyroid medicine- too much can be a risk.
- Women with breast cancer treated with certain chemotherapeutic medicines that block estrogen.
- Aluminum containing antacids
- Soda (carbonated beverages) - It is not known why drinking a lot of soda increases your risk. Caffeine, phosphorous, and lack of calcium (if you substitute soda for milk).
- Depression- How this is a rsk is not known. One study showed people on SSRI antidepressants were also at risk. The risk could be related to other factors such as changes in diet and physical activity in depressed people.
How is osteoporosis diagnosed?
Osteoporosis can be diagnosed by simple radiograph procedures such as CT scanning, ultrasound and dual energy X-ray absorptiometry (DEXA). DEXA, measures bone density in your hip, wrist and spine. It is a simple, painless X-ray procedure requiring no invasive procedures or injections.
What can I do to improve my bone health?
There are many things you can do to improve your bone health and prevent bone loss!
- Exercise. Just like our muscles, our bones are stronger when they are used to bear weight. Jumping, walking, stair climbing, and dancing, are examples of weight bearing exercise. One study showed that a simple exercise of jumpig up and down, led to improved bone density in older patients.
- Talk to your PCP about screening tests. Radiology tests can measure bone density to identify if you are at risk or have osteoporosis or osteopenia. Ask your doctor about screening with a DEXA scan if you are over 65y.o or if you have any risk factors. Check a vitamin D level. In a recent a study, Vitamin D levels were lower in PD compared to people with Alzheimer’s disease and the general population even if they received the same amount of sunshine. Your healthcare provider can check your level by ordering a simple blood test.
- Obtain adequate amounts of calcium and vitamin D in your diet. Calcium is a necessary mineral for bone growth and development. Vitamin D regulates our body’s calcium by increasing calcium absorption from the intestines and into bone. You can still be deficient of calcium even if you eat adequate amounts if your vitamin D level is low. The nutrition section includes more information about calcium, vitamin D and bone health.
- Get outdoors! Vitamin D is called the sunshine vitamin since it is produced when your skin is exposed to ultraviolet rays from the sun. People that live in northern climates, get little sun exposure or use sunscreen will make less vitamin D. ‘Getting out doors’ may help in many ways such as increasing your level of exercise and even reducing depression. Exposure to sun increases your risk for skin cancer (see Skin Health) so talk to your healthcare provider about how much is right for you.
- Medications are available to treat osteoporosis. Your healthcare provider can help you determine if this is right for you.
For more information on osteoporosis log onto the National Osteoporosis Foundation at www.nof.org.
Author: Monique Giroux, MD Medical Director NWPF and Booth Gardner Parkinson’s Care Center, Kirkland, WA.