Keeping bones healthy is important for everyone and especially important for people with Parkinson’s. We share some top tips for keeping your bones in tip top condition.
Key points
Bone health is important for everyone, but especially if you have Parkinson’s.
You are at more risk of getting osteoporosis when you have Parkinson’s, which can weaken bones and make them more likely to break.
Your healthcare team can assess you and may prescribe medication to help improve your bone health.
Strength exercises and maintaining a good diet can also help.
What is bone health?
Bone health really means having ‘healthy bones’. Healthy bones are strong enough to prevent fractures, for example when we have a fall. Our bones are more healthy when we have enough calcium in our diet (from milk, and dairy products like cheese) and when we use our arms and legs (such as with exercise).
Bones are living organisms that build and break down, but when the body loses more bone than it makes, problems can arise. Early detection and treatment can help those with bone loss maintain active lifestyles. Dr. Ejigayehu Abate, a Mayo Clinic endocrinologist, explains what women should know about osteoporosis.
Older people are more susceptible to kyphosis. Osteoporosis is a risk factor, so it is no surprise that women are affected more frequently. This rounding tendency of the thoracic spine can be measured on a lateral x-ray of the spine in terms of degrees; 20 to 40° is considered normal. The angle increases with age, and almost half of older people have an angle more than 40°.
Children can also get kyphosis-Scheuermann’s disease-during the rapidly growing years. Kyphosis occurs when the normally block-like vertebrae become wedge shaped, with the narrow part towards the front.
Causes of kyphosis include fractures, with or without osteoporosis, disc degeneration, cancer and cancer treatment. Tuberculosis of the bone used to be a common cause of hunchbacks, but this is no longer a problem.
Kyphosis can produce breathing problems by putting pressure on the lungs, increase digestive problems such as GERD, or compress spinal nerves causing pain.
At the age of 89, I have a problem with kyphosis. At the age of 30, one of my thoracic vertebrae sustained a wedge compression fracture, probably from jumping off a wall or something similarly stupid.
I continually have to fight foreword slouching when I walk, and remind myself to stand up straight, and throw my shoulders back. My neck arthritis makes it difficult to look up when I walk.
I also do angle push-ups to strengthen my back muscles. I have a friend who has severe kyphosis, and recently had an orthopedic operation to correct it. I am hopeful that this operation will relieve his sense of shortness of breath and reduce his GERD.
Treatment includes taking vitamin D and calcium, or other medicines for osteoporosis. Smoking should be avoided, and alcohol limited. There are a number of exercises that are recommended, some of which I have mentioned.
Please refer to the following Mayo clinic article for more information.
As part of the Conservation of Hearing Study (CHEARS), researchers from Brigham and Women’s Hospital analyzed data from nearly 144,000 women who were followed for up to 34 years. They found that risk of subsequent moderate or worse hearing loss was up to 40 percent higher in study participants with osteoporosis or LBD. The study, published in the Journal of the American Geriatric Society, also found that bisphosphonates did not alter risk of hearing loss.
The researchers found that a history of vertebral fracture was associated with up to a 40 percent higher risk of hearing loss, but the same did not hold true for hip fractures, the two most common osteoporosis-related fractures. “The differing findings between these skeletal sites may reflect differences in the composition and metabolism of the bones in the spine and in the hip,” Curhan said. “These findings could provide new insight into the changes in the bone that surrounds the middle and inner ear that may contribute to hearing loss.”
Hip fracture is an iconic bugaboo of old age. It is a chronic condition in the sense that its complications, such as Depression, blood clots and pneumonia often extend long beyond the healing process.
Predisposing factors include old age and associated risk factors like osteoporosis, sarcopenia (loss of muscle mass and strength), poor vision, poor balance and hazards in the home.
FALLING is the usual agency that produces the fracture. At the risk of being ostracized, I will point out that thousands of injuries sustained by walking or tripping over dogs (and cats) occur every year.
In my small “hilltop” group of friends, there was 1 fatality, 1 shoulder fracture-dislocation, 1 hip fracture, and 0 acknowledgements of animal causation. Members of the family are immune to blame.
Treatment of hip fracture involves surgery with pins, or the more cost-effective Hip replacement. PREVENTION is critical. Osteoporosis must be prevented by exercise, Calcium, vitamin D, and avoidance of certain medication like Corticosteroids.
Balance should be developed by exercises. Vision problems, such as cataracts,should be corrected. Muscle mass should be preserved by diet and exercise, and the home cleared of throw-rugs and obstacles removed.
Just yesterday, a friend wearing socks (reducing friction?) fell down some stairs after stepping over a dog-gate. She is scheduled to have her elbow pinned. Have I mentioned SLEEP, DIET and EXERCISE RECENTLY?
Falling down is common on both ends of the Human lifespan. Little kids are always falling down, but there isn’t much energy to dissipate, since their mass is small and they don’t have far to fall. Moreover, their bones are pliable.
The Elderly also fall, increasingly, as they age. They have a lot further to fall, and their bones are often brittle and osteoporotic. Injury is quite common, they often break a hip, and may slide into a peogressive deterioration leading to their demise..
Ordinary walking, a “normal gait”, is a very complex activity and requires a lot of information and coordination by the nervous system.
VISION is critical, as you are often navigating through a minefield of stairs, rug edges, slippery objects, lamp cords, tubes and pets. Cataracts may be a problem to be corrected. Multifocal glasses can be a factor.
HEARING can warn of certain hazards or warnings and is important. A FINE SENSE OF TOUCH is required to give you cues as you are walking. Peripheral neuropathy can make walking difficult.
PROPRIOCEPTION, the positional sense of where your extremities are located in space, is a sense we take for granted, but which may deteriorate in time. Proprioception is very important for a normal Gait. The inner ear, with it’s semicircular canals and vestibular apparatus is necessary for proper BALANCE.
Balance can be PRACTICED in a number of ways, like standing on one leg, or merely WALKING a lot. These MULTIPLE SENSES must be COORDINATED by the Thalamus, Corpus Striatum, medulla, Cerebellum, and Cerebral Cortex and instructions sent to the muscles of your Legs, Arms, back and abdomen.
It is mandatory to keep these muscles, your Heart and your body, STRONG and FIT. Factors that make you more likely to have a fall are mostly the reverse of the above, and are called RISK FACTORS.
–Previous Falls are the best predictor. More than 2 or 3 in a year is worrisome.
–Balance Impairment is best treated by practice.
–Decreased Muscle strength. –Visual impairment.
–Polypharmacy (more than 4 prescription Meds), or a Psychoactive drug (look up)
–Gait impairment, Walking difficulty.
–Depression, which is often treated by antidepressants or sleeping pills- Psychoactive drugs.
–Dizziness or orthostatic hypotension, which causes a drop in blood pressure on standing. and a number of other problems, often a function of age.
PREVENTION of falls is of course better than treatment of the resulting INJURY. Working on your HEALTH will help the INTRINSIC causes of falls, and that is what we have been discussing.
Preventing the EXTRINSIC causes of falls means working on: –Improving the household safety by putting in railings, getting rid of throw rugs, clutter, and maybe pets( a good friend went into a downward spiral after tripping over his Dog.
Adjusting or eliminating psychoactive drugs and antihypertensive drugs (which often include the beta blockers which worsen orthostatic hypotension.
Interestingly, VITAMIN D supplements were mentioned in 2 references I saw. Apparently Vitamin D reduces falls by increasing MUSCLE STRENGTH.
Please refer to the following Canadian article for a more complete discussion.
I have been having Heartburn for more than 40 years. The cause of Heartburn is leakage of acid from the stomach, where tissues have evolved to tolerate the highly acidic conditions, into the esophagus, where they haven’t.
The young body has an efficient, functional gate, or sphincter, keeping the food, once swallowed into the stomach, from coming back up. As you eat, you chew your food well to aid digestion. Your taste buds, sensing chemicals in the delicious food, activate saliva.
The salivary enzymes start the digestion of the carbohydrates in the food. If you eat slowly enough, you may be able to appreciate the digestion of tasteless starch, like in bread, into sweet sugar, right in your mouth.
You then swallow the food, which slips past another gate, called the epiglottis, diverting the bolus of food past your windpipe. This gate sometimes does not shut tight, and you choke on the food or drink. The food is then conducted into the highly acidic environment of the stomach.
The stomach evolved to be an acidic, “fiery pit”, inhospitable to any bacteria that came in with the food, thus protecting the stomach from infection. In the old days, there were a lot of bacteria, and the acidity of the stomach was useful, and evolutionarily conserved.
These days, the “fiery pit” tends to be a problem. As you get older, the gate that keeps food in the stomach gets more floppy and relaxed, and allows food to come back up into the esophagus, and sometimes, most often at night when you would rather be sleeping, all the way up to your throat, and is inhaled into your windpipe and lungs in what is called “gastroesophageal reflux”, or GERD.
Even if the food, and acid, doesn’t make it all the way up, and stops at the esophagus, which has not evolved to tolerate acid, you will have “heart burn”. Of course it is not the heart that is burning, but the esophagus, which runs right past the back of the heart as it goes all the way from the throat to the stomach.
When I first developed Heartburn, all that was available was the flavored chalk, Calcium Carbonate, sold as Tums. It works right away, and is a source of Calcium, but can cause trouble, like kidney stones, if you take too much. The relief didn’t last long enough for me, and I had to take more in the middle of the night.
My next medicine was Xantac, a medication that blocks histamine from stimulating acid production in the stomach. The H2 blockers have recently been recalled because of NDMA contamination. I sometimes used H2 blockers like Xantac when my patients would get a bad allergic reaction. In such cases BOTH an H1 blocker like Benadryl, and an H2 blocker are called for.
Zantac was not strong enough for me, and I soon graduated to Prilosec,which directly blocks the secretion of acid in the stomach.
Prilosec was then very expensive, but now is available as the inexpensive GENERIC Medication, Omeprazole. It seems that no medication is without side effects.
Omeprazole, by reducing stomach acid, makes stomach and GI infections more likely, and interferes with the absorption of B12, and Calcium.
If you have had a lot of heartburn over a long period of time, you should check with a Gastroenterologist, who may scope you to rule out Barritt’s esophagus, which can lead to Cancer.
It is interesting that the antacid Tums in excess can cause too MUCH Calcium in the body, and can cause kidney stones and other kidney problems like MAS, and Omeprazole, by interfering with absorption can cause too LITTLE absorption of Calcium, leading to OSTEOPOROSIS.
The best rule is to take as low a dose of ANY medication as possible, preferably none, to understand the possible side effects, and compensate for them if you can.
I have heard the same story over and over. You get older, you trip over your dog or on the edge of a rug, you fall and break your hip, and in treatment or convalescence, you get a pneumonia and die, or at least you get weaker, setting you up for the next fall. Your course is downhill.
The culprit is often OSTEOPOROSIS. Osteoporosis is a disease characterized by loss of bone mass, as opposed to Osteomalacia, discussed in a recent podcast on this site, which is softening of bone The word itself is a MEMONIC for the RISK FACTORS; Then comes WHAT TO DO.
The RISK FACTORS and Prevention Strategies can be remembered in the following mnemonic:
Osteoporosis prevention begins when you are a child, with healthy diet rich in Calcium, and lots of exercise. Your bone mass peaks in the early 20s. While you are young, in your reproductive years, your reproductive hormones, Estrogen and Testosterone protect you.
Women should develop a Preventative strategy during menopause. Being THIN, like i am, is generally a marker of good health, much better than being Fat.
But especially as you get older and Lose muscle mass, Osteoporosis can become a problem, maybe because your bones don’t get the stress required to keep them strong.
BONE DENSITY DECLINES WITH AGE. I get a DEXASCAN as often as my insurance allows, about every 2 years, and am due this summer.
More and more treatments for Osteoporosis are emerging, if your bone loss becomes severe enough.
KEEP IN CONTACT WITH YOUR DOCTOR.
–Dr. C
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