Skip to main content

Advertisement

SpringerLink
Log in

Bone mineral density and vitamin D status in Parkinson’s disease patients

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Bone loss is more common in Parkinson’s disease (PD) than in the general population. Several factors may be involved in the development of bone loss, including malnutrition, immobilization, low body mass index, decreased muscle strength, vitamin D deficiency and medication use. This study investigates the prevalence of osteoporosis and possible risk factors associated with bone loss in early stage PD. In 186 PD patients (Hoehn and Yahr stage 1–2.5, mean age 64.1 years, 71 % men) bone mineral density (BMD) measurements were performed with DEXA. T- and Z-scores were calculated. Univariate linear regression analysis was performed to identify variables that contributed to BMD. 25-OH-vitamin D status of PD patients was compared with 802 controls (mean age 63.3 years, 50 % men) using linear regression analysis. Osteoporosis (11.8 %) and osteopenia (41.4 %) were common in PD patients. Mean Z-score for the hip was 0.24 (SD 0.93), and for the lumbar spine 0.72 (SD 1.91). Female gender, low weight, and low 25-OH-vitamin D were significantly correlated with BMD of the hip and lumbar spine. PD patients had lower 25(OH)D serum levels than controls (B = −10, p = 0.000). More than half of the patients with early stage PD had an abnormal BMD. Female gender, low weight, and low vitamin D concentration were associated with bone loss. Furthermore, vitamin D concentrations were reduced in PD patients. These results underscore the importance of proactive screening for bone loss and vitamin D deficiency, even in early stages of PD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abou-Raya S, Helmii M, Abou-Raya A (2009) Bone and mineral metabolism in older adults with Parkinson’s disease. Age Ageing 38:675–680

    Article  PubMed  Google Scholar 

  2. Allen NE, Sherrington C, Paul SS, Canning CG (2011) Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 26:1605–1615

    Article  PubMed  Google Scholar 

  3. Ashburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C (2007) A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 78:678–684

    Article  PubMed  Google Scholar 

  4. Bachmann CG, Trenkwalder C (2006) Body weight in patients with Parkinson’s disease. Mov Disord 21:1824–1830

    Article  PubMed  Google Scholar 

  5. Bezza A, Ouzzif Z, Naji H, Achemlal L, Mounach A, Nouijai M, Bourazza A, Mossadeq R, El MA (2008) Prevalence and risk factors of osteoporosis in patients with Parkinson’s disease. RheumatolInt 28:1205–1209

    Article  CAS  Google Scholar 

  6. Bloem BR, Geurts AC, Hassin-Baer S, Giladi N (2008) Treatment of gait and balance disorders. In: Hallett M, Poewe W (eds) Therapeutics of Parkinson’s disease and other movement disorders. Wiley, Chichester, pp 417–443

    Chapter  Google Scholar 

  7. Canning CG, Allen NE, Dean CM, Goh L, Fung VS (2012) Home-based treadmill training for individuals with Parkinson’s disease: a randomized controlled pilot trial. Clin Rehabil 26(9):817–826

    Google Scholar 

  8. Cruise KE, Bucks RS, Loftus AM, Newton RU, Pegoraro R, Thomas MG (2010) Exercise and Parkinson’s: benefits for cognition and quality of life. Acta NeurolScand 123(1):13–19

    Google Scholar 

  9. Evatt ML, Delong MR, Khazai N, Rosen A, Triche S, Tangpricha V (2008) Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease. Arch Neurol 65:1348–1352

    Article  PubMed  Google Scholar 

  10. Evatt ML, DeLong MR, Kumari M, Auinger P, McDermott MP, Tangpricha V (2011) High prevalence of hypovitaminosis D status in patients with early Parkinson disease. Arch Neurol 68:314–319

    Article  PubMed  Google Scholar 

  11. Fink HA, Kuskowski MA, Orwoll ES, Cauley JA, Ensrud KE (2005) Association between Parkinson’s disease and low bone density and falls in older men: the osteoporotic fractures in men study. J Am Geriatr Soc 53:1559–1564

    Article  PubMed  Google Scholar 

  12. Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56:33–39

    Article  PubMed  CAS  Google Scholar 

  13. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD, Seidl L (2004) Movement disorder society task force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 19:1020–1028

    Article  PubMed  Google Scholar 

  14. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170

    Article  PubMed  Google Scholar 

  15. Hyattsville M (2007) Dual-energy X-ray absorptiometry (DXA) procedure manual. In: US Department of Health and Human Services CfDCaP (ed) Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey

  16. Idjadi JA, Aharonoff GB, Su H, Richmond J, Egol KA, Zuckerman JD, Koval KJ (2005) Hip fracture outcomes in patients with Parkinson’s disease. Am J Orthop (Belle Mead, NJ) 34:341–346

    Google Scholar 

  17. Invernizzi M, Carda S, Viscontini GS, Cisari C (2009) Osteoporosis in Parkinson’s disease. Parkinsonism Relat Disord 15:339–346

    Article  PubMed  Google Scholar 

  18. Lam K, Li M, Mok V, Hui A, Woo J (2010) A case control study on bone mineral density in Chinese patients with Parkinson’s disease. Parkinsonism Relat Disord 16:471–474

    Article  PubMed  Google Scholar 

  19. Lebrun CE, van der Schouw YT, de Jong FH, Pols HA, Grobbee DE, Lamberts SW (2005) Endogenous oestrogens are related to cognition in healthy elderly women. Clin Endocrinol (Oxf) 63:50–55

    Article  CAS  Google Scholar 

  20. Lorefalt B, Ganowiak W, Palhagen S, Toss G, Unosson M, Granerus AK (2004) Factors of importance for weight loss in elderly patients with Parkinson’s disease. Acta Neurol Scand 110:180–187

    Article  PubMed  CAS  Google Scholar 

  21. Muller M, Aleman A, Grobbee DE, de Haan EH, van der Schouw YT (2005) Endogenous sex hormone levels and cognitive function in aging men: is there an optimal level? Neurology 64:866–871

    Article  PubMed  CAS  Google Scholar 

  22. Pang MY, Mak MK (2009) Muscle strength is significantly associated with hip bone mineral density in women with Parkinson’s disease: a cross-sectional study. J Rehabil Med 41:223–230

    Article  PubMed  Google Scholar 

  23. Pang MY, Mak MK (2009) Trunk muscle strength, but not trunk rigidity, is independently associated with bone mineral density of the lumbar spine in patients with Parkinson’s disease. Mov Disord 24:1176–1182

    Article  PubMed  Google Scholar 

  24. Pickering RM, Grimbergen YA, Rigney U, Ashburn A, Mazibrada G, Wood B, Gray P, Kerr G, Bloem BR (2007) A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord 22:1892–1900

    Article  PubMed  Google Scholar 

  25. Sato Y, Iwamoto J, Honda Y (2011) Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson’s disease. Parkinsonism Relat Disord 17:22–26

    Article  PubMed  Google Scholar 

  26. Schneider JL, Fink HA, Ewing SK, Ensrud KE, Cummings SR (2008) The association of Parkinson’s disease with bone mineral density and fracture in older women. Osteoporos Int 19:1093–1097

    Article  PubMed  CAS  Google Scholar 

  27. Song IU, Kim JS, Lee SB, Ryu SY, An JY, Jeong DS, Kim YI, Lee KS (2009) The relationship between low bone mineral density and Parkinson’s disease in a Korean population. J Clin Neurosci 16:807–809

    Article  PubMed  Google Scholar 

  28. Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P (2004) Comparison of the LASA physical activity questionnaire with a 7-day diary and pedometer. J Clin Epidemiol 57:252–258

    Article  PubMed  Google Scholar 

  29. Taggart H, Crawford V (1995) Reduced bone density of the hip in elderly patients with Parkinson’s disease. Age Ageing 24:326–328

    Article  PubMed  CAS  Google Scholar 

  30. van der Marck MA, Dicke HC, Uc EY, Kentin ZH, Borm GF, Bloem BR, Overeem S, Munneke M (2012) Body mass index in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord 18:263–267

    Article  PubMed  Google Scholar 

  31. van Nimwegen M, Speelman AD, Hofman-van Rossum EJ, Overeem S, Deeg DJ, Borm GF, van der Horst MH, Bloem BR, Munneke M (2011) Physical inactivity in Parkinson’s disease. J Neurol 258:2214–2221

    Article  PubMed  Google Scholar 

  32. van Nimwegen M, Speelman AD, Smulders K, Overeem S, Borm GF, Backx FJ, Bloem BR, Munneke M (2010) Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients. BMC Neurol 10:70–79

    PubMed  Google Scholar 

  33. Vaserman N (2005) Parkinson’s disease and osteoporosis. Joint Bone Spine 72:484–488

    Article  PubMed  Google Scholar 

  34. Wood B, Walker R (2005) Osteoporosis in Parkinson’s disease. Mov Disord 20:1636–1640

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study is funded by ZonMw (The Netherlands Organization for Health Research and Development (75020012)); The Michael J Fox Foundation for Parkinson’s research; VGZ; Glaxo Smith Kline; the Dutch Parkinson’s disease society; and the National Parkinson Foundation.

Conflicts of interest

FB, ADS, MvN, YTvdS and HJJV reported no conflicts of interest. FJGB received grants from ZonMw and the Dutch Diabetes Fund. BRB has served as an editorial board member of Movement Disorders, currently serves as an editorial board member of Physiotherapy Canada, and is Associate Editor for the Journal of Parkinson’s disease. He received honoraria from serving on the scientific advisory board for Boehringer Ingelheim, Teva, Glaxo-Smith-Kline and Novartis and research support from the Netherlands Organization for Scientific Research (016.076.352), the Michael J Fox Foundation, the Prinses Beatrix Foundation, the Stichting Internationaal Parkinson Fonds and the Alkemade Keuls fonds. MM received grants from ZonMw, the Michael J Fox Foundation, the National Parkinson Foundation, the Dutch Parkinson’s Disease Society, and the Prinses Beatrix Fonds.

Ethical standard

All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in 1964 Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands

    F. van den Bos

  2. Department of Neurology, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    A. D. Speelman, M. van Nimwegen & M. Munneke

  3. Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    F. van den Bos & H. J. J. Verhaar

  4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Y. T. van der Schouw

  5. Department of Rehabilitation, Nursing Science and Sport, University Medical Center Utrecht, Utrecht, The Netherlands

    F. J. G. Backx

  6. Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    B. R. Bloem

  7. Scientific Institute for Quality of Healthcare, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    M. Munneke

Authors
  1. F. van den Bos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. D. Speelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. van Nimwegen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. T. van der Schouw
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. J. G. Backx
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. R. Bloem
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Munneke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. J. J. Verhaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. R. Bloem.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van den Bos, F., Speelman, A.D., van Nimwegen, M. et al. Bone mineral density and vitamin D status in Parkinson’s disease patients. J Neurol 260, 754–760 (2013). https://doi.org/10.1007/s00415-012-6697-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-012-6697-x

Keywords

Search

Navigation