August 8, 2026

@michaelokun

One of the discussions that really resonated with me at Aspen was how often we underestimate bone health in Parkinson's disease. This outstanding new JAMA review reminds us that hip fractures are common, devastating, and associated with a striking one-year mortality of about 22%, and that prevention requires much more than simply prescribing calcium. Hip fracture risk is driven by the combination of weaker bones and falls, and Parkinson's disease contributes to both through impaired balance, gait dysfunction, reduced weight-bearing activity, and potentially indirect effects of the neurodegeneration on the skeleton. Dopamine D2 receptors are expressed on osteoblasts and osteoclasts. Dopamine can influence bone remodeling by suppressing excessive osteoclast activity and supporting normal bone formation. What is often overlooked is that osteoporosis is about twice as common in Parkinson's disease, including in men, yet many folks are never screened. We need to be far more proactive by routinely assessing bone health with DXA and fracture risk tools, treating osteoporosis aggressively with evidence-based medications when "soft bones" are identified rather than relying on calcium supplements alone, and making fall prevention a cornerstone of Parkinson's care through exercise, physical therapy, balance training, medication review, and home safety interventions. Protecting the brain is only part of the story. Protecting the skeleton may be just as important for preserving independence and quality of life. https://jamanetwork.com/journals/jama/fullarticle/2851723