Men's Osteoporosis Support GroupVery-low-birth-weight and bone density, nano forms of calcium, and Parkinson's Disease and BMD PLoS Med. 2009 Aug;6(8):e1000135. Epub 2009 Aug 25. Decreased bone mineral density in adults born with very low birth weight: a cohort study. Hovi P and others. PMID: 19707270. This article demonstrates another apparent risk factor for osteoporosis: very-low-birth-weight (VLBW, < 1,500 g). The free full article is available online. The study was based upon the Helsinki Study of Very Low Birth Weight Adults, a multidisciplinary cohort study representative of all VLBW births within the larger Helsinki area from 1978 to 1985 which included 144 preterm children. The authors compared the skeletal health of those born preterm to matched controls who were term-born by dual-energy X-ray absorptiometry (DXA) when each group reached age 18.5 and 27.1 years. In the free full article the authors note, "These findings show that, when studied close to the age of peak bone mass, young adults born with VLBW have a significantly lower BMD than their term-born peers and a 2-fold greater risk of having a lumbar spine Z score of below −1.0; a unit decrease in Z score approximately doubles the risk of bone fractures." [Emphasis added]. Be sure to check Figure 2 in the full article. The side-by-side comparison of individuals' lumbar bone mineral density (BMD) is very informative. Most of the VLBW individuals are in the lower half of the chart and most of the term-born individuals are in the upper half of the chart. The authors note, "Bone mass accrues with age, with at least 90% of peak bone mass acquired by age 18 y, and with bone loss beginning at ages 35 to 45 y. Peak bone mass is regarded as the most important determinant of osteoporosis and fractures in later adulthood." They note, "We conclude that healthy young adults born preterm with VLBW, as compared with their term-born counterparts, show signs of significantly compromised skeletal health in adulthood, including a 2-fold risk for having a lumbar spine BMD Z score below −1.0. This finding may predict symptomatic osteoporosis and increased fracture rates. Promotion of adequate nutrition with sufficient calcium and vitamin D, and an increase in weight-bearing exercise are thus important for former VLBW infants at all ages." [Emphasis added] Editor's comments. This is the first article I'm aware of that has noted the lower peak BMD in VLBW individuals. There is no direct finding regarding osteoporosis in these individuals, but the low Z-score is suggestive that as they age they will be at higher risk for osteoporosis. Thus if you are a VLBW individual it would be prudent to take whatever steps you can to maximize peak BMD. This might include adequate vitamin D through sunshine or supplements, a healthy diet, weight-bearing exercise, etc. Additionally it would be wise to monitor your height carefully as any loss thereof might be suggestive of osteoporosis. As well other tests such as DXA or heal bone densitometry after midlife might be helpful in picking up early bone loss. Nanotechnology. 2009 Sep 16;20(37):375102. Epub 2009 Aug 26. Effects of nano calcium carbonate and nano calcium citrate on toxicity in ICR mice and on bone mineral density in an ovariectomized mice model. Huang S and others. PMID: 19706952. I don't highlight much of the animal research, but this article is interesting so I wanted to mention it. It involves giving lab mice two nano forms of calcium: the carbonate and the citrate salts. The authors conclude, "The results of our in vivo studies indicate that administering nano calcium carbonate and nano calcium citrate can enhance the serum calcium concentration and maintain the whole-body bone mineral density in ovariectomized mice. These data suggest that nano calcium carbonate and nano calcium citrate are more bioavailable than micro calcium carbonate and micro calcium citrate, respectively." Editor's comments. Although the authors state that, "Taking calcium supplements can reduce the risk of developing osteoporosis . . .", the literature is mixed on this topic. But their findings that nano calcium forms prevented the loss of BMD in ovariectomized mice might produce future significant research in humans. Standard calcium supplements have little or no effect on BMD in ovariectomized humans. They generally require some form of hormone replacement or FDA-approved osteoporosis medication. Future studies could be very enlightening. Age Ageing. 2009 Aug 15. [Epub ahead of print]. Bone and mineral metabolism in older adults with Parkinson's disease. Abou-Raya S, Helmii M, Abou-Raya A. PMID: 19684354. This study comparing 82 Parkinson's Disease (PD) patients to controls found, ". . .that the bone mineral density (BMD) of all PD patients was significantly lower compared to controls. PD patients had significantly decreased vitamin D levels, significantly increased BALP and NTx levels, reduced physical and mental performance and more falls and/or fractures in comparison to healthy controls." They also noted, "PD is associated with an increased incidence of osteoporosis, falls and fractures. PD is thus a risk factor for osteoporosis and appropriate therapeutic interventions should be initiated to slow or prevent disability." Editor's comments. It stands to reason that if PD individuals have difficulty walking and doing outdoor activity their BMD levels will decrease, both because of less sunshine-induced vitamin D and weight-bearing exercise. Since they have stability issues, they are more likely to fall, thus increasing the chance of fractures. It is reasonable that all those who can should engage in fall-prevention exercise and take steps to eliminate fall risk, such as eliminating throw rugs, steps, etc. Additionally they should have an osteoporosis evaluation to see if they would benefit from an FDA-approved medication, either as a preventive or for treatment. In keeping with my repetitive suggestions to take charge of your own health, I want to mention a friend of mine who did that, one who has Parkinson's. About two years ago he was obviously failing badly, shuffling, extremely slow and I felt we would lose him pretty soon. This year when I saw him again after about six months, I was amazed at the improvement in his health. He was taking long walks, no longer shuffling, and said he felt better than he had in years. He still had strong tremors in his hands and legs, but had energy and drive like I'd never seen. I asked what happened and he said he got on the Internet, found a specialist in "motor disabilities" in his area, read the positive reviews on her efforts to help PD patients, wrote her with a summary of his issues, then called for an appointment and was taken as a new patient. She changed his medications, got him on a serious exercise routine, and changed his life, at least for the last year or so. I have no idea if a similar approach would help others with PD, perhaps my friend's case is unusual. But I know that giving up and not trying dooms you to failure. So I strongly suggest getting the facts, searching for help and educating yourself about your condition, whatever it is, to empower you. Good luck.
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