Studies have found that osteoporosis (weak bones) and osteopenia (weaker than normal bones) affect up to 91% of women and 61% of men living with Parkinson’s. Studies that have examined bone mineral density in people with Parkinson's show lower bone mineral density compared to people of the same age but without PD. Parkinson's disease can greatly impact one's balance. In fact, between 45% and 68% of people with Parkinson's disease fall each year, and falls account for 90% of hip and wrist fractures in older adults.
What is bone mineral density and bone health?
Bone mineral density is how much calcium and other minerals are in our bone. It is correlated with how strong and healthy our bones are. As we age we naturally lose bone mineral density, but this can occur faster in others depending on medical history and lifestyle. When we have poor bone health, meaning low amounts of calcium and minerals, we are at a greater risk of breaking a bone.
Why is it more common in people with Parkinson's?
Immobility/reduced mobility is a major symptom of Parkinson's and is also a major cause of weakened bones.
Decreased muscle strength is common in people with Parkinson's. The weaker our muscles are, the less force being placed on our bones, and the weaker our bones become.
Low body weight. People with Parkinson's tend to have a lower body weight compared to those without PD. Higher body weight increases the demand on our bones which makes them adapt and become stronger. The lower the body weight, the less positive adaptations occurring.
Hyperhomocysteinaemia. This means high levels of certain amino acids in your blood that negatively impacts bone health. Unfortunately, levodopa use has been shown to lead to these changes.
What can I do to improve my bone health?
There are two main ways (other than medication) we can improve bone health: Nutrition and Exercise.
Nutrition tips:
Foods high in calcium are very important for bone health. Often, foods like spinach, almonds, beets, and rhubarb are recommended when people are lactose intolerant. However, those specific foods are high in a compound called oxalate. Oxalate will limit how much calcium our body absorbs. Cheese, yogurt, canned sardines, salmon, and fortified orange juice are great options. We generally need 1,000 mg for women less than 50 years old and all men, and 1,200mg for women over 50 years old.
Vitamin D intake is crucial. 15-20 minutes in mid day sun will give you all the vitamin D you need. You can also get vitamin D in salmon, tuna, swordfish, and fortified orange juice. Supplements are often recommended for those with low bone density. We generally need 800 – 1,000 IUD per day.
Drinking alcohol can lead to bone mineral loss. 1-2 drinks per week have very little effect on your bone density.
Caffeine has a negative effect on our bone health. Drinking more than 3 cups of coffee is not recommended.
Diets high in salt can cause your body to lose calcium. Do your best to limit how much processed foods, canned foods, and added salt you eat per day. Try to limit to 140 mg/serving.
Have you heard of the compound phytates? Phytates can inhibit our body’s ability to absorb calcium. Beans/legumes have a high quantity of calcium, but they also have a high quantity of phytates. Lower the phytate level by soaking the beans in water for several hours, then cook them in fresh water.
Protein helps our muscles grow, which in turn has a huge impact on our bones. It is recommended that older adults have 1-1.3g/kg of body weight of protein every day. 0.8g/kg of body weight is the bare minimum that the general population should be getting, although this will not help you gain muscle, only maintain it. It is important to note that protein negatively impacts the effectiveness of levodopa, so make sure you are spacing out your meals and medication time. Talk with your neurologist if you have questions about this.
Magnesium and potassium have also been found to be helpful. Talk with your Doctor before trying to add these nutrients into your diet.
Talk with your Neurologist and Primary Care Physician about a referral to a Registered Dietician who can help you make the right diet choices for you.
Exercise tips:
Weight bearing exercises are crucial. The effects of gravity on our bones help them adapt and grow back stronger. However, just our body weight isn't enough. There are several studies that look at programs where the participants either did body weight exercises, very light weight exercises, or even just walking, and the results were not promising.
In 2017, a trial looking at women over the age of 58 with moderate to severe osteoporosis studied the effects of 4 specific exercises. It showed by doing the exercises in this study, you can significantly improve your bone health which will reduce your risk of breaking a bone. It also showed improvements in balance, which help lower your risk of falls. This study was then repeated with men and showed similar results.
The exercises performed:
What makes this study different from the other studies? The intensity.
The intensity was prescribed as 80-85% 1 rep max (RM). 1RM is the maximum weight you can lift in a single movement. To calculate your 1RM, you can use this website: https://strengthlevel.com/one-rep-max-calculator. Another way to determine in intensity is to use Reps in Reserve (RIR). Reps in Reserve means the number of repetitions you could do until failure (or until you lose your technique). 80-85% 1RM is equivalent to 1-2 RIR. You might have also heard this being referred to as “left in the tank.” For example, “do a set of squats with 5 reps left in the tank.”
Exercises were completed in two 30 minute sessions a week. Each exercise was performed at a scheme of 5 sets of 5 reps.
Not sure how to perform these movements safely? Visit your favorite Physical Therapist! Click below to see a listing in your area.
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