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Dr. Okun

Should I be worried about an increased risk for osteoporosis and osteopenia with Parkinson’s Disease?

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There are now over a dozen published studies in the Parkinson’s disease literature and all point to an increased risk of osteopenia (thin bones), and to an increased risk of osteoporosis (brittle and fragile bones). A sobering issue recently raised by Daniel et. al. is that men with Parkinson’s disease are also at risk for having thin bones. Our thinking on bone loss has been evolving and we now believe that the degenerative process in Parkinson’s disease affects the signals that trigger bone growth, thereby putting both genders at risk. We now recommend that both men and women have regular bone health checkups. Having thin bones sets up an increased risk for fractures, and because Parkinson’s patients are at risk for falling it is critically important to keep healthy bones. There are several factors that can help to strengthen your bones including exercise, calcium supplementation, and vitamin D. In more severe cases osteoporosis drugs can also be prescribed. Additionally, some mild exposure to sunlight can be helpful, however remember to wear sunscreen, as Parkinson’s disease patients are at a higher risk for melanoma.

 

Selected References:

 

1: Levin RM, Tucci JR. Parkinson's Disease and Metabolic Bone Disorders: A Common Connection That Needs More Attention. Endocr Pract. 2012 May 1:1-9. [Epub ahead of print] PubMed PMID: 22548948.

 

2: Daniel SK, Lansang MC, Okun MS. Bone mineral density (BMD) in male patients with Parkinson's disease. Int J Neurosci. 2012 Apr 18. [Epub ahead of print] PubMed PMID: 22510054.

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Hi Dr. Okun,

 

I am bother by pain at the bottom of my feet, and it's painful to stand. I had an appointment with a rheumatoligist who requested an exray of my feet and prescribe pain medication. I also made an appointment to see my Neurologist to see if this have any thing to do with my PD. Have you seen patients who have experience similiar problems with their feet who's diagnosed with PD?

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Be careful that this is not plantar fasciitis. This is a condition when the bottoms of the feet are painful to walk on and it can occur even in one foot. An orthopedic practice, a physiatrist, or a podiatrist can make the diagnosis. If that is the diagnosis we discourage surgery, and advocate stretching, and sometimes boots to sleep in. There are many ways to address, but we also don't advocate injections of steroids into the foot as they may cause long-term damage.

 

Also, see the neurologist to be sure it isn't dystonia.

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Thank you so much. This truly does help ease my mind some. However, now when I stand up for more than 5 minutes I jerk back and forth. The spasms come all the way up my body, and my toes and fingers are twitching and it is visible. It feels as though I can feel the blood flowing (tingling) throughout my body. My family has witnessed me almost fall over. I have to stand withy legs apart and one foot slightly above the other to keep from falling over. I read about brain stem ischemia, is it possible that I have Horton a touch of that from my iron being so low for so long. These symptoms are prodomently on my left side but now I can feel them all over. Oddly enough if my left thumb twitches then my right twitches. Whatever happens on one side then happens on the other.

 

My first PCP did suggest that I had restless leg but since my arms were involved I though he was wrong. I had never heard of restless arm. So I will follow up with that suggestion. While I would like not to have anything I can live with those two alot better than the others.

 

Once again thanks for your time.

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These are tough symptoms to interpret by internet. I would suggest you see a specialist and hopefully he/she can shed some light. Hope you feel better soon.

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Hi Dr. Okun,

My partner is 32 and has YOPD (diagnosed 1.5 yrs ago). The last time we were at his MDS, I suggested a bone density scan to get a base-level reading, but his dr didn't think it was necessary.

 

Do you think this is something we should push for? Or wait a handful of years and check it out then?

 

Thanks for your advice!!

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Osteoporosis and osteopenia occur at a higher frequency in both women and men with PD. I ask the primary care docs to follow this every year or two with a bone scan and to treat early and aggressively, especially considering the fall risk. This is of course the preference of our clinic, but I do recommend it.

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