Author Identifier (ORCID)
Marc Sim: https://orcid.org/0000-0001-5166-0605
Abstract
IntroductionParkinson's disease (PD) is associated with elevated fracture risk, particularly at the hip. Antiparkinsonian medications have also been associated with increased fracture risk; although their direct effects on bone mineral density (BMD) remains unclear.ObjectiveInvestigate whether antiparkinsonian medications influence BMD.MethodsA systematic search of four databases (Embase, MEDLINE, APA PsycINFO, Web of Science) was conducted up to 24/11/2025 using terms related to PD, antiparkinsonian medications and bone.ResultsA total of 748 records were identified, with 543 screened following deduplication. Fourteen studies underwent full-text review, of which seven met inclusion criteria. Three studies assessed bone mineral content or surrogate measures at non-standard sites (hand radiographs or skull Hounsfield Units) and reported no associations with L-Dopa therapy. Four studies reported areal BMD (aBMD) from dual energy x-ray absorptiometry (DXA). One study showed negative correlations between L-Dopa dosage with aBMD at the hip and spine. Two studies (RCT and cross-sectional) implicated elevated serum homocysteine (Hcy) levels induced by L-Dopa as a potential mechanism for osteoporosis risk in PD. In the cross-sectional study, although L-Dopa therapy was associated with higher Hcy and lower aBMD, there were no causal associations between L-Dopa and hip aBMD. In the RCT, lower Hcy was associated with reduced annual aBMD loss with L-Dopa therapy. One further study found no associations between L-Dopa therapy and aBMD at any site.ConclusionsThe contribution of antiparkinsonian medication to low BMD in PD remains unclear. Despite plausible mechanisms of action, evidence of causal associations is lacking.
Keywords
BMD, bone mineral density, L-dopa, osteoporosis, Parkinson's disease
Document Type
Journal Article
Date of Publication
7-1-2026
Volume
208
PubMed ID
41921715
Publication Title
Bone
Publisher
Elsevier
School
Nutrition and Health Innovation Research Institute
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Breasail, M. Ó., El-Leissy, M. B., Singh, K. P., Smith, M., Mesinovic, J., Sim, M., Evans, A., Blacker, D., Heshmat, S., Mahant, N., Girgis, C., Ebeling, P. R., & Zengin, A. (2026). The effects of anti-Parkinsonian medications on bone mineral density: A systematic review. Bone, 208, 117873. https://doi.org/10.1016/j.bone.2026.117873