Falls can be difficult for people with Parkinson's disease (PD), leading to fractures and other injuries. People with PD are at increased risk of fracture, with a four times higher risk of hip fracture than the general population. A person with PD will often return to their baseline after recovery from a fracture. However, for some, a fracture and its resultant immobility and the effects of a potential surgery and hospitalization will lead to a permanent decline in their condition. Therefore, steps to prevent falls are a crucial goal of PD management.
But not every fall can be prevented, so an often-overlooked part of managing someone who tends to fall is assessing bone density and treating low bone density if possible. A fall that could result in a fracture in someone with low bone density could be much less of a problem in someone with average bone density.
Bone density is assessed using a simple test called dual-energy X-ray absorptiometry (DEXA), also known as bone densitometry. X-ray technology is used to measure the thickness of the hip and spine bones. Depending on the bones' mineralization level, the test can diagnose osteoporosis, "porous bones."
People with PD need to have their bone mineral density assessed because they are at increased risk of falls and because studies show that people with PD have lower bone mineral density than age-matched controls.
There are several research to suggest why people with PD have bones that are less dense than the general population:
In addition, low bone density can be a direct consequence of PD symptoms. A person with PD may:
Weak bone density can be successfully treated – including in people with PD.
Besides the apparent importance of Vitamin D in maintaining bone health in people with PD, there have also been numerous studies investigating other associations between Vitamin D and PD. There are conflicting results as to whether low levels of Vitamin D are associated with an increased risk of developing PD. In addition, some studies demonstrate an increased rate of Vitamin D deficiency in people with PD compared to age-matched controls and even link low Vitamin D levels to increased severity of PD symptoms. Conclusion: there are conflicting results as to whether Vitamin D supplementation can reduce PD symptoms. More studies are necessary to clarify these associations.
Vitamin D is a critical nutrient derived from two sources – your diet and exposure to sunlight. Not many foods contain Vitamin D, so about 70-80% of our Vitamin D needs to be obtained from sunlight (Ultraviolet B from sunlight converts a steroid precursor in the skin to Vitamin D.) Vitamin D plays many roles in the body, including helping with calcium absorption from food and supporting the mineralization of bone. (To get some Vitamin D from your diet, try salmon, canned tuna, and mushrooms that naturally contain Vitamin D. There are also many kinds of milk, yogurt, and orange juice options fortified with Vitamin D.)
Because people tend to spend a lot of time inside, especially in the winter, Vitamin D deficiency is a widespread problem in the general population. Vitamin D deficiency can be more pronounced for those with PD, who might have an even harder time getting outside.
Vitamin D levels can be tested in blood. If it is low, over-the-counter supplements are readily available.
Despite optimizing fall prevention and bone strength, people with PD may still experience fractures. The hip is a common site of injury which typically requires surgical intervention. It is reassuring to note that should this be necessary, immediate post-op complications of hip fracture surgery are the same in people with PD compared to age-matched controls.
However, more long-standing complications after hip fracture do occur in people with PD, including:
Prevention of falls and fractures should be a priority for people with PD.