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  1. I am 75 and have had Parkinson’s for 14 years and had Beep Brain Stimulation (DBS) in 2012 but am still on high doses of medication being Madopar 125 mg (one and a quarter tablets) 6 times per day, Sifrol ER (pramipexole) 3.75mg once per day, Amantadine 100 mg twice per day to control dyskinesia. Also Mirtazapine 15 mg per day for depression. I have some osteoporosis of left forearm so I take Fosamax 70mg/70 mcg (1 tablet) per week and Caltrate (1500mg calcium carbonate) once per day and Vitamin D 1000 IU liquid once per month. Is it necessary to take all 3 (Fosamax, Caltrate, Vitamin D)? I have been advised to take Fosamax for the rest of my life. When I go to the dentist I take an antibiotic Amoxycillin 500mg 4 capsules (total 2000mg) 1 hour before the appointment and 2 capsules after the appointment to minimize bacteria settling on DBS hardware . For hayfever I occasonally take Claratyne (Loratadine) 10mg. Do all these medications agree with each other is there any contraindication? Am I over-medicated either for Parkinson’s or for osteoporosis?
  2. 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.