The effects of anti-Parkinsonian medications on bone mineral density: A systematic review
Abstract
INTRODUCTION
Parkinson'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.
OBJECTIVE
Investigate whether antiparkinsonian medications influence BMD.
METHODS
A 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.
RESULTS
A 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…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Erratum to: The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations
- Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis
- Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis
- Association of obesity with bone mineral density and osteoporosis in adults: a systematic review and meta-analysis
- Falls, fractures, and areal bone mineral density in older adults with sarcopenic obesity: A systematic review and meta‐analysis
- Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.