Therapeutic management of osteoporosis in Parkinson’s disease

INTRODUCTION: Parkinson's disease (PD) is frequently complicated by osteoporosis (OP). PD is associated with a high risk of falls, meaning PD patients with osteoporosis have an increased risk of fractures, particularly hip fractures. Osteoporosis in PD is multifactorial, involving nutritional factors and vitamin deficiencies, weight loss associated with sarcopenia, and PD treatments such as levodopa. AREAS COVERED: This review addresses the assessment of bone involvement in PD and the therapeutic strategies that should be considered to reduce fracture risk. The literature was identified through a structured search of Medline/PubMed, prioritizing original articles, randomized trials, systematic reviews and meta-analyses. EXPERT OPINION: The assessment and management of osteoporosis in PD are multidisciplinary. Evaluation of bone involvement should be considered early in patient management, including assessment of risk factors, fracture history, fall risk, and specific bone evaluation (bone densitometry and calculation of FRAX score). Management involves general measures including fall prevention, as well as non-pharmacological and pharmacological interventions. Pharmacological treatments for osteoporosis have rarely been studied in patients with PD, highlighting the need for dedicated studies. International recommendations for the management of osteoporosis in PD would be valuable for this condition associated with a high risk of falls and fractures.