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My brother has just been diagnosed with Parkinson's disease. We've suspected it for a long time. We are most concerned about him falling and breaking his head open. He's already taken a few spills at home. What can we do to help prevent this from happening?

The risk of falls increases in anyone with Parkinson's disease as the disease progresses (or when the symptoms are poorly controlled by medication). Balance disturbances and a sudden drop in blood pressure when standing up (called postural hypotension) are symptoms that increase the risk of falls. Parkinson patients also suffer from a tendency to fall backwards or to the side. With a rigid body and an inability to move the arms quickly to catch themselves, falls can be a major problem. On top of that, most Parkinson patients are older adults who are also at risk for osteoporosis (brittle bones). They have twice the risk of hip fracture compared with adults their same age who don't have Parkinson's disease. There are several steps that can be taken. First, consult with his primary care physician. Ask about getting a baseline bone density test done. This will give the doctor, patient, and family an idea of how serious the problem is at this time. If bone density levels are low, medications called bisphosphonates can be prescribed. Taking a calcium supplement with vitamin D is also recommended. Taking calcium with vitamin D has been proven effective in lowering the risk of bone fracture. And in patients with Parkinson's disease, vitamin D deficiency is common, making supplementation all the more important. Exercise is also important. Strength training, balance training, improving proprioception (joint sense of position), and kinesthesia (sense of boy movement through space) are all key factors in maintaining balance. Parkinson’s patients tend to be rigid and unable to move the arms and legs quickly in order to regain balance once the equilibrium has been challenged. A physical therapist can help you with this part of the program. The therapist can also offer many suggestions for ways to modify the home to prevent falls. This is one time where Ben Franklin's admonition: an ounce of prevention is worth a pound of cure is especially appropriate. Hip fractures can be disabling enough in a healthy adult. But in someone with a neurologic problem like Parkinson's disease, a hip fracture can be devastating. Prevention is extremely important.

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