Bone Health

Kathrynne Holden, M.S., R.D.

Osteoporosis is serious. It can cause fractures of the hip, spine, or wrist, and affects many women over age 60. However, though it’s not as widely known, men – especially men with PD – are also at risk for osteoporosis and fractures. Studies have shown that both men and women with Parkinson’s disease are likely to have lower bone mineral density, and greater incidence of osteoporosis, falls and bonefractures. Recovery from hip fracture takes longer with PD, and many people require long-term care before returning to their own home.

What is osteoporosis?

Osteoporosis is a disease that causes weakened bones. Calcium is removed from bones, leaving tiny holes. The early stage of such bone thinning is called osteopenia; when it progresses too far, it is called osteoporosis, and the risk for fracture is greatly increased.

What are the common risk factors for osteoporosis?

• Age. Bone loss increases with age.

• Post menopausal estrogen loss in women

• Heredity and race: white and Asian women are at greatest risk.

• Long-term use of medications, such as the steroids used to treat asthma and arthritis; some cancer treatments; anticonvulsants; and antacids that contain aluminum

• Diseases that affect hormone levels, such as diabetes, kidney disease, and hyperthyroidism.

• Smoking.

• Excessive alcohol use.

• Low calcium intake.

• Too little physical activity.

An ounce of prevention is worth a pound of cure

Strong, dense bones can withstand the impact of a sudden fall, while weak, brittle bones will fracture. Men and women with PD can do a number of things to prevent osteoporosis. Although we can’t do anything about age and heredity, there are other risk factors that we can control.

• Avoid unplanned weight loss – stay at a healthy weight. Losing too much weight raises the risk for bone fractures. Unplanned weight loss is accompaniedby loss of bone mass as well as muscle and fat. Let your doctor or registered dietitian help determine the best weight for you, and maintain that weight.

• Talk to your doctor:

• If you are a man or woman over age 50• If you are a post menopausal woman

• If you have a family history of osteoporosis

• If you use medications that increase the risk for osteoporosis

• If you believe you have low levels of testosterone (men)

• If you have diabetes, kidney disease, or hyperthyroidism.

Change any unhealthy habits that cause bone thinning, like smoking, excessive alcohol use, and inactivity. Get enough calcium, magnesium, and vitamins D and K.

Calcium — the bone mineral

The latest recommendation for adults age 50 and older is 1200 mg calcium per day.That amount can be found in four glasses of fortified milk or four to six ounces of cheese. But, since these foods are high in protein, they may not be helpful for those using levodopa. In fact, some people have found that dairy foods are more apt than other protein foods to inhibit levodopa absorption.Getting enough calcium can be difficult when you have PD. Here are some recommendations that will help to meet calcium requirements.

• Calcium-fortified orange juice

• Calcium-fortified rice- and soy- milk alternatives for use on cereal, in smoothies, and in many cooked dishes

• Breakfast cereals and other foods fortified with calcium

It may also be necessary to use a calcium supplement. Calcium carbonate is the richest source of calcium, but some people cannot tolerate it. Calcium citrate is often a better choice. Chewable calcium tablets are better absorbed, because they are already broken down when they reach the stomach.

Vitamin D -- for calcium absorption.

Without adequate amounts of vitamin D, calcium cannot be absorbed by the body. If you live in a sunny area, vitamin D is easy to get through about one hour per week outdoors in the sunshine with the face, hands, and arms exposed. Because vitamin D is stored, our bodies can conserve enough D during the summer to last us through the winter.

However, if you live in northern areas or if you mostly stay indoors, you may not get enough vitamin D from sunlight.The current recommendation for vitamin D is 400 IUs daily (ten mcg) for people age fifty and older; and 600 IUs daily (15 mcg) for those over age 70.

Food Sources of Vitamin D:

Fortified foods, such as milk and milk substitutes, milk products, margarine, and cereals

Fatty fish, such as salmon, and fish liver oils

Liver

Eggs

If you think you’re not getting enough vitamin D, check with your doctor or registered dietitian about a vitamin D supplement. Be careful not to take too much, since it’s stored in the tissues and can be toxic in large amounts.

Magnesium is just as important as calcium.

It helps rebuild and strengthen bone. Magnesium also has some effect as a muscle relaxant, so may be beneficial to people with PD who experience muscle rigidity as a primarysymptom.

Broccoli and other dark green vegetables, dried beans and peas, and whole grains are all rich in bone-building magnesium. For adults, the RDA is 420mg per day for men, 320 mg per day for women. Magnesium and calcium are often combined in over-the-counter nutritional supplements.

Don’t forget vitamin K. This nutrient is also important, however, it is not as difficult to get from foods as calcium and vitamin D. The adult requirement for vitamin K is 120 mcg for men and 90 mcg for women. Dark green leafy vegetables such as collards, spinach, and chard; Brussels sprouts, broccoli, cabbage, and lettuce, all provide generous amounts of vitamin K.