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Tue Jan 13, 5:14 pm ET
NEW YORK (Reuters Health) - People with Parkinson's disease have an elevated 
risk of developing fragile bones and fractures over time -- a problem that 
deserves more attention, according to a new report.
Parkinson's disease is a neurological disorder in which movement-regulating 
cells in the brain die off or become disabled, leading to symptoms like 
tremors, rigidity in the joints, slowed movement and balance problems.
What often gets lost is the fact that these symptoms can lead to reduced 
bone mass and a greater risk of falls -- which together put Parkinson's 
disease patients at risk of bone fractures and joint injuries.
What's more, Parkinson's makes it more difficult for people to recover from 
surgery to repair such injuries, according to the new report, published in 
the Journal of the American Academy of Orthopedic Surgeons.
A key reason that Parkinson's disease patients tend to lose bone mass is 
that they walk less than people their age without the disorder, explains Dr. 
Lee M. Zuckerman, an orthopedic surgeon at the State University of New York 
Downstate Medical Center in Brooklyn.
They also typically spend less time outdoors in the sunlight, which limits 
their bodies' natural synthesis of bone-maintaining vitamin D.
Lower bone mass, coupled with the disease-related movement and balance 
problems, puts them at particular risk of falls and injuries.
To help lower this risk, Zuckerman writes, people with Parkinson's disease 
should have their symptoms managed to the greatest degree possible with 
medication. They can also try physical therapy to improve their mobility 
problems, and, when necessary, take measures to maintain their bone 
density -- like taking calcium and vitamin D supplements or medications 
designed to protect bone mass.
Parkinson's disease patients should also get advice on simple ways to 
prevent falls, including how to get up from a seated position in the safest 
manner or how to use visual cues to stay steady on their feet.
Parkinson's disease patients also face challenges after surgery to repair 
orthopedic injuries, according to Zuckerman. Symptoms like tremors, he 
explains, can interfere with their rehabilitation after surgery. In one 
study, the patients' pain typically improves after surgery, but this their 
long-term mobility may not.
"Whether this is because the disease is progressing or because the 
rehabilitation was insufficient is unclear," Zuckerman said in a written 
statement.
He suggested that Parkinson's disease patients who have orthopedic surgery 
start physical therapy soon afterward, and that, when necessary, they see 
various specialists -- such as neurologists and physical rehabilitation 
specialists -- who can help them with recovery.
"I recommend patients and their families read up on Parkinson's disease so 
they can prepare themselves for the challenges that come with it," Zuckerman 
said. "This type of early education is important, because it can prevent 
these secondary problems from occurring."
SOURCE: Journal of the American Academy of Orthopedic Surgeons, December 
2008.

Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
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