Bone health and Parkinson's

Healthy bones are important for everyone, but people with Parkinson’s are more likely to have bone problems.

Find out more about how to keep your bones healthy and reduce your risk of breaking a bone.

Key points

People with Parkinson’s are at a higher risk of bone problems, including osteoporosis (brittle bones) and bone fractures (broken bones). There are lots of things you can do to keep your bones strong and reduce your chance of bone problems.
If you’re worried about your bone health, it’s important to reach out and ask your Parkinson’s nurse or doctor about it. They can assess your bone health through questions about risk factors and a DEXA scan, a quick and painless X-ray.
Weight-bearing and resistance exercise, and getting enough calcium and vitamin D, is key for keeping bones healthy.
If staying active and getting the right vitamins and minerals aren’t enough, medication may help.
Health professionals can give you advice about bone health and treatment if you need it.

people with Parkinson’s
women
people with rheumatoid arthritis
people taking steroid medication
older people, as our bones get weaker as we age
people who’ve had a fragility fracture before. A fragility fracture is a broken bone caused by a minor fall, such as tripping while walking or falling out of a chair. A broken wrist or hip are examples of fragility fractures
people with lower levels of oestrogen, such as women going through menopause
people with lower testosterone levels, such as men having some types of prostate cancer treatment
people with chronic liver or kidney disease
people who drink alcohol
smokers.

These are called risk factors. Having one or more risk factors doesn’t mean you will definitely have osteoporosis. But you can have osteoporosis when you only have one risk factor, including having Parkinson’s.

Osteoporosis and Parkinson’s

People with Parkinson’s are more likely to have osteoporosis than people without Parkinson’s. But there are things you can do to help prevent it developing.

Around 4 in 10 women with Parkinson’s over 50 will develop osteoporosis. For men with Parkinson’s over 50, the figure is 2 in 10.

Some research studies suggest that the damage to the cells that produce dopamine in Parkinson’s might cause bones to get weaker. People with Parkinson's can also find it more difficult to get enough vitamin D and calcium. But more research is needed to tell us why people with Parkinson’s are more likely to get osteoporosis.

Physical activity is very important for helping to prevent osteoporosis and keep bones strong. And exercise where you lift or move some type of weight is especially important.

If your Parkinson’s makes it difficult to move around, this can increase the risk of osteoporosis.

Osteopenia

Osteopenia means that your bones are less dense than they should be. But, in osteopenia, your bone density isn't low enough to be diagnosed with osteoporosis.

Both osteopenia and osteoporosis make you more likely to break a bone, but osteoporosis carries a higher risk.

Having osteopenia doesn’t mean you will definitely get osteoporosis. Taking steps to keep your bones healthy helps either condition and can sometimes reverse osteopenia.

Most people diagnosed with osteopenia will not be prescribed medication for their bones.

If you see a chiropractor (a practitioner who uses alternative medicine to treat muscle and bone problems), then it's important you let them know if you have osteoporosis or osteopenia.

Breaking a bone

People with Parkinson’s are twice as likely to break a bone compared to someone without the condition.

This is because people with Parkinson’s are more likely to:

have osteoporosis
experience falls.

Parkinson’s symptoms, bone fractures and falls

Some Parkinson’s symptoms can make a fall more likely which can lead to a broken bone.

Balance problems. Getting more unsteady when standing up is common in Parkinson’s.
Stiffness (rigidity). In Parkinson’s, your muscles may become more stiff. This can increase your risk of falling. You may also be less able to break or soften your fall, so are more likely to injure yourself. Help from a physiotherapist or occupational therapist can make you safer and more confident.
Low body weight or general muscle weakness (sarcopenia). Sarcopenia is when your muscles become weaker and lose some of their mass. Parkinson's symptoms may make it more difficult to get active, which can cause muscles to get weaker. This could contribute to a fall.
Low blood pressure. People with Parkinson’s can experience a drop in blood pressure when they stand up. This can cause dizziness or fainting.
Freezing. Some people with Parkinson’s have problems starting to move, or suddenly "freeze" while moving.
Feet and eye problems. Parkinson’s, and some Parkinson’s medication, can cause stiffness (dystonia) or swelling in your feet and make walking more difficult. Parkinson’s can also cause difficulty moving your eyes. This can mean you don’t always see obstacles around you in time.

If you’re worried about these or other Parkinson’s symptoms affecting your bones, speak to your doctor or Parkinson’s nurse.

Everyone’s Parkinson’s is different and not everyone will have all of the symptoms above.

Preventing falls

Preventing falls is important to protect your bones.

You can help prevent falls by:

asking for help from others
avoiding distractions while you walk
taking your time and slowing down when you turn
walking to the tick of a metronome can help you maintain a rhythm, or help you restart walking if you freeze
choosing shoes with low heels or flat soles
reducing trip hazards at home.

Read more about falls and Parkinson’s.

Diagnosing bone problems

Assessing bone health risk

If you have Parkinson’s, your Parkinson’s nurse or your doctor should assess your risk of bone problems by carrying out a risk assessment.

You may not always be offered a bone health risk assessment. If your Parkinson’s team hasn't assessed your bone health in the last year, you should ask them to.

Don’t be worried about asking for an assessment. It’s what clinical guidelines advise.

Your bone health will usually be assessed by a scoring system using the Fracture Risk Assessment (FRAX) tool. FRAX measures your risk of having a broken bone over the next 10 years. It does this by using your bone health risk factors and your bone mineral density, if known.

FRAX does not take into account the higher risk of falls in Parkinson’s, but your doctor will be aware of this when advising you about your bone health and explaining your FRAX results.

Bone density scans (DEXA scans)

A DEXA (or DXA) scan can check your bone density. DEXA scans are quick and painless X-ray scans. It involves lying on an X-ray table, while a scanner is passed over your body. You can usually wear your clothes as normal during a DEXA scan, but you’ll be asked to remove any metal, like jewellery, bras that contain metal or clothes with zips.

DEXA scans are safe and use less radiation than regular X-rays.

If your Parkinson’s symptoms make it difficult to lie flat or still for a scan, let the hospital department know before your appointment. The hospital may be able to adapt the scanning process, such as by scanning your arm instead of your whole body. Sometimes, it may not be possible to have a DEXA scan if your symptoms are very severe.

The letter inviting you to your scan appointment will have a contact number. You can phone this number to discuss any concerns you have before your appointment.

If a DEXA scan isn’t right for you, or if your area does not have DEXA scanning available, your doctor may still be able to recommend treatment without the scan.

If you have had deep brain stimulation (DBS), let the healthcare team arranging your DEXA scan know. They may tell you to switch your DBS device off during your scan, to protect the battery.

Keeping your bones healthy

Looking after your bones

There are lots of things you can do to keep your bones healthy and reduce your risk of osteopenia and osteoporosis.

If you’ve already been diagnosed with osteoporosis, these strategies can help you to keep bones as strong as possible, alongside any medication your doctor recommends.

Should I speak to my doctor or Parkinson’s nurse about looking after my bones?

Clinical guidelines say that health professionals should talk to people about ways to keep their bones healthy. But some people find that this doesn’t always happen.

It’s a good idea to talk to your doctor or Parkinson’s nurse about looking after your bones as soon as you can after you’re diagnosed.

But you can discuss this with them at any time. It doesn’t matter when you were diagnosed with Parkinson’s, or whether you’ve had a bone problem.

Physical activity

Physical activity is essential for keeping bones healthy and reducing the risk of osteoporosis. It’s also good for managing your Parkinson’s symptoms.

Weight-bearing and resistance exercises are both important for bone health. For most people with Parkinson's, they're a safe way to help manage it.

However, people with a diagnosis of osteoporosis are more likely to have a bone fracture from doing high-impact exercises, like jumping, running or lifting heavy weights. Avoid exercises which could lead to a fall or bumping into something.

If you’ve been diagnosed with osteopenia or osteoporosis, speak to a health professional such as your physiotherapist before you start doing exercises like these.

Weight-bearing exercise

This is any activity where you support your weight with your feet or legs, such as:

walking
running
dancing
exercise classes
sports like tennis.

Resistance exercise

This means using your muscles to push or pull against resistance. That might be:

lifting weights
using a resistance band
using weight machines at the gym
carrying shopping bags
exercises which use the weight of your body, like squats, lunges or push-ups.

Going to the gym

Most gyms offer inductions where they can explain their equipment to you. Some offer introductory sessions with a personal trainer.

It may help to tell the trainer about your Parkinson’s before your induction. You could let them know about your symptoms and your exercise goals. Then they can show how you can achieve your objectives.

Some gyms offer free or reduced membership costs for people with Parkinson’s and a partner or friend.

It may help, at first, to go when the gym is less busy. Take things slow as you get started.

If you’re doing strength training, try to:

focus on different areas of your body during a workout
aim for 10 to 15 repetitions of each exercise at a time. If 10 starts to feel too easy, add a few more
avoid working on the same muscles on consecutive days.Muscles need to recover to become stronger.

If any exercise causes you pain, stop.

A physiotherapist may recommend specific exercises to strengthen your bones.

If you don’t like the gym

There are plenty of strength exercises you can do at home too.

Other types of exercise, like swimming or cycling, are good for your health generally, and may have a positive effect on your Parkinson’s symptoms. However, they are not weight-bearing exercises, so are not as helpful for your bones. Doing a range of different types of exercises is what’s important.

There are many exercise classes or groups for people with Parkinson’s.

Use our activity finder tool to see what’s available near you.

Functional strength training

Functional strength exercises use muscle groups that you might use for daily activities, like carrying your shopping or going up the stairs.

This type of activity builds muscles and strength. Because it involves weight-bearing exercise, it is good for your bones too.

Getting more active could be as simple as:

sitting and standing more often
getting off the bus earlier
walking with your shopping, if you’re able to do this.

Hear from the experts how to safely carry out functional strength activities.

Find out more about staying active with Parkinson's, including exercise videos and podcasts.

Find more ideas about physical activity and bone health on the Royal Osteoporosis Society website.

Physiotherapy

A physiotherapist can work with you on strength and balance training. By showing you exercises to help you move as independently and safely as possible, they can help you to keep your bones healthy and prevent falls.

Your doctor, Parkinson’s nurse or GP can refer you for physiotherapy. In some areas, you may be able to self-refer. If you’re referred to an NHS service, there may be a waiting list for treatment.

You can also pay to see a physiotherapist privately. Visit the Chartered Society of Physiotherapy website.

Eating well for bone health

Eating a balanced diet is important for our health generally.

Getting enough vitamin D and calcium is particularly important for keeping our bones healthy and lowering the risk of osteoporosis.

Vitamin D

Only a few foods contain vitamin D, including:

oily fish, like salmon and sardines
egg yolks
red meat.

Some foods, such as breakfast cereals, are "fortified", meaning they have vitamins like vitamin D added to them.

In the UK, during the spring and summer, our bodies make the vitamin D we need from the sun.

The Royal Osteoporosis Society recommends we all spend a short time in the sun each day, so we get enough vitamin D. It’s important to avoid sunburn. We don’t need to get sunburnt in order to get enough vitamin D from sunlight.

If you aren’t able to spend much time outdoors, or you cover up a lot of your skin when you go out, it may be more difficult to get enough vitamin D from the sun. This is also true for people with dark skin, such as people from an African, African-Caribbean or south Asian background.

Calcium

Calcium is important for healthy bones.

Most of us can get all the calcium we need from food.

Good sources of calcium include:

dairy products, like cheese and milk
leafy green vegetables, like kale and okra (but not spinach, as we aren’t able to absorb the calcium it contains)
tofu and beans, like green beans or baked beans
any products made with fortified flour.

Try online food choosers on the Royal Osteoporosis Society website.

Read information about food and keeping your bones healthy on the NHS website.

Dietitians

A dietitian can help you make changes to your diet in a safe and sustainable way. They can suggest ways to help you get more vitamin D and calcium into your diet, while still eating the food you enjoy.

Ask your GP or Parkinson’s nurse to refer you to a dietitian.

Find a registered private dietitian on the Health and Care Professions council website.

Read our information about diet and Parkinson’s.

Supplements

We can usually get the nutrients we need from a balanced diet.

Some people may benefit from taking supplements to make sure they’re getting the vitamins and minerals they need.

Vitamin D supplements

Clinical guidelines recommend that people with Parkinson’s take regular vitamin D supplements. A 10mg supplement daily is usually enough.

You can buy vitamin D supplements from your pharmacy, health food shop or large supermarket. They often come as tablets or capsules you can swallow, or sometimes as a spray or powder which you mix into a drink.

Your Parkinson’s nurse or speech and language therapist can give you more advice about swallowing tablets safely or finding alternatives to tablets.

Calcium supplements

Most people get the calcium they need through their food and drink, so calcium supplements aren’t always needed.

But your doctor may recommend calcium supplements if they think you would benefit from them. Many vitamin D supplements include calcium, which is an easy way to take both.

Other ways to keep your bones healthy

Have regular eye tests. Vision problems can affect your balance, or make you more likely to fall. Read our information about eyes and Parkinson’s.
Stop smoking. Find out more about free NHS services to help you stop on the NHS website.
Wear the right shoes when you exercise and protecting your feet generally.
Keep alcohol intake low. This means less than 14 units of alcohol a week (around 6 pints of beer or 6 medium-sized glasses of wine).

Medication for bone health

When your risk of a broken bone is high, a good diet and exercise programme won't be enough to improve your bone health. This is when medication may be offered to strengthen your bones. You and your doctor can discuss what would work best for you.

Osteoporosis medication should not have any effect on your Parkinson’s drugs or make your Parkinson’s symptoms worse.

Bisphosphonates

Bisphosphonates are medicines which can:

help your bones to "turnover" more slowly. This slows down the loss of bone density
reduce your chance of breaking a bone.

Bisphosphonates and Parkinson’s

You should take bisphosphonates on an empty stomach, ideally at the start of the day. You should also avoid all food or drink, except water, for an hour after taking this medication.

It’s best to take them half an hour before any other medication, including your Parkinson’s drugs, so that your body absorbs them well.

You may need to take other medication when you wake up, or take lots of other medication throughout the day. If you’re finding it difficult to manage your medication, make sure to raise this with your doctor who can give you advice on what to do.

Bisphosphonates need to be taken when you’re upright (sitting or standing up), and washed down with a glass of water. This reduces the risk of irritation to your food pipe (oesophagus).

You normally take bisphosphonates once a week.

Bisphosphonates can cause side-effects, although these are usually mild. They can include:

pain in your stomach
swallowing problems
irritating your food pipe.

Tell your doctor or Parkinson’s nurse if you have any side effects. You should let them know if it’s difficult to sit up straight or swallow tablets when you wake up. They may be able to offer advice about your posture to help you swallow your tablets.

If you have trouble swallowing (dysphagia), your doctor is less likely to recommend that you take bisphosphonates as a tablet. They will discuss this with you.

Taking bisphosphonates by injection or drip

If taking bisphosphonate tablets doesn’t work for you, you may be given a bisphosphonate called zolendronate through an injection or a drip instead. This is done in hospital.

Other medication for your bones

If bisphosphonates aren’t right for you, you may be given another type of treatment by injection, which is done either at hospital or in your GP practice.

In some cases, your Parkinson's team will refer you to another doctor, like a rheumatologist (a doctor specialising in bone, joint or muscle problems). They can then consider other possible treatments for your bones.

For some women, hormone replacement therapy (HRT) may be an option.

Your doctor will explain the pros and cons of each medication option.

Find more information about drug treatments for osteoporosis the Royal Osteoporosis Society website.

Our helpline and other useful contacts

Call our helpline free on 0808 800 0303 for advice on bone health or any aspect of living with Parkinson's.

More information and support

The British Dietetic Association has information on how dietitians can help and how to find one. Visit the British Dietetic Association website.

The Chartered Society of Physiotherapy provides information about finding a private physiotherapy. Visit the Chartered Association of Physiotherapy website.

The Royal Osteoporosis Society offers information and support about osteoporosis and looking after your bones. Visit the Royal Osteoporosis Society website.

Living Made Easy provides free and impartial information on aids and equipment to help people live well and independently. Visit the Living Made Easy website.

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Last updated 26 January 2026

This content will next be reviewed within 3 years of that date. If you'd like to find out more about how we put our information together, including references and the sources of evidence we use, please contact us at [email protected]