Yes, hip fractures are significantly more common in people with Parkinson’s disease. Research shows that individuals with Parkinson’s face approximately [twice the risk of hip fracture](https://pubmed.ncbi.nlm.nih.gov/33735882/) compared to people without the condition, and this elevated risk can appear as early as three years before diagnosis. The incidence rate is roughly [four times higher](https://pmc.ncbi.nlm.nih.gov/articles/PMC12460458/) than in age-matched peers without Parkinson’s.
For perspective, consider a 72-year-old man newly diagnosed with Parkinson’s: his risk of sustaining a hip fracture over the next decade is not merely elevated””it is substantially higher than his brother of the same age who does not have the disease, even if both share similar overall health profiles. This heightened risk stems from a convergence of factors unique to Parkinson’s disease: the motor symptoms that cause falls, changes in bone density, medication effects, and reduced physical activity. A [15-year longitudinal study from Finland](https://pmc.ncbi.nlm.nih.gov/articles/PMC12460458/) published in 2025 confirmed that elevated hip fracture risk persists from three years before diagnosis through at least ten years after. This article examines why this connection exists, what happens when someone with Parkinson’s sustains a hip fracture, and practical strategies for reducing this risk.
Table of Contents
- Why Are People With Parkinson’s Disease at Higher Risk for Hip Fractures?
- The Role of Osteoporosis and Bone Health in Parkinson’s-Related Fractures
- How Parkinson’s Medications Can Contribute to Fall Risk
- Practical Strategies to Prevent Hip Fractures in Parkinson’s Disease
- Recovery Challenges and Outcomes After Hip Fracture in Parkinson’s
- Early Warning Signs and When Risk Begins
- The Importance of Bone Health Screening and Treatment
- Conclusion
Why Are People With Parkinson’s Disease at Higher Risk for Hip Fractures?
The increased hip fracture rate in Parkinson’s disease results from what researchers call a “perfect storm” of risk factors. First, there is the fall risk: [prospective studies](https://pmc.ncbi.nlm.nih.gov/articles/PMC6616496/) indicate that between 45 and 68 percent of people with Parkinson’s will fall each year, with a large proportion experiencing recurrent falls. About 80 percent of these falls are attributed to postural instability and freezing of gait””that sudden, involuntary inability to move that can strike mid-step. The mechanics of how someone with Parkinson’s falls matters too. Unlike a healthy older adult who might catch themselves or fall backward, people with Parkinson’s often fall forward and lack the protective arm reflexes to break their fall.
This falling pattern directs impact toward the hip. Additionally, the disease affects bone health: [reduced mobility decreases bone mineral density](https://pmc.ncbi.nlm.nih.gov/articles/PMC3279061/), and dopamine signaling changes may directly influence bone strength. However, someone with early-stage Parkinson’s who remains physically active and has good bone density will have a different risk profile than someone with advanced disease and documented osteoporosis””risk is not uniform across all patients. Comparing Parkinson’s to other neurological conditions illustrates this compounded danger. While stroke survivors also face fall risks, they typically do not experience the same progressive deterioration in balance and protective reflexes. Someone with multiple sclerosis may have mobility challenges, but the specific combination of rigidity, bradykinesia, and postural instability in Parkinson’s creates a particularly hazardous situation for hip injuries.
The Role of Osteoporosis and Bone Health in Parkinson’s-Related Fractures
Bone health deterioration in Parkinson’s disease is remarkably common yet often overlooked. [Studies report](https://pubmed.ncbi.nlm.nih.gov/19346153/) that osteoporosis and osteopenia affect up to 91 percent of women and 61 percent of men with Parkinson’s. This bone loss begins early””research shows reduced bone mineral density and low vitamin D levels even in patients at stage 1 of the disease, before significant motor impairment develops. Several mechanisms drive this bone deterioration. Reduced mobility plays the largest role, as bones require weight-bearing stress to maintain density.
people with Parkinson’s also tend to have lower vitamin D levels, partly because symptoms like fatigue and mobility limitations reduce time spent outdoors. There is also emerging evidence that dopamine receptors exist on bone cells, meaning the dopamine deficiency central to Parkinson’s may directly weaken bones. However, if someone maintains an active lifestyle, receives adequate vitamin D supplementation, and undergoes bone density screening, this trajectory can be modified. The problem is that [most Parkinson’s patients do not undergo proper screening or preventive treatment](https://pmc.ncbi.nlm.nih.gov/articles/PMC9364183/) for osteoporosis, even though the disease is a recognized risk factor. A patient whose physician orders a DEXA scan at diagnosis and starts appropriate interventions will have meaningfully different outcomes than one whose bone health is never assessed.
How Parkinson’s Medications Can Contribute to Fall Risk
The medications that control Parkinson’s symptoms can paradoxically increase fall risk through a condition called orthostatic hypotension””a sudden drop in blood pressure upon standing. This affects [30 to 58 percent](https://pmc.ncbi.nlm.nih.gov/articles/PMC7029426/) of people with Parkinson’s and is a major underlying cause of falls and fainting in this population. Levodopa, the most effective Parkinson’s medication, can induce or worsen orthostatic hypotension. One study found that [38 percent of patients had orthostatic hypotension after levodopa administration](https://www.sciencedirect.com/science/article/abs/pii/S1353802023009392/) compared to 22 percent before taking the medication.
Dopamine agonists can trigger acute drops in blood pressure, particularly when starting therapy or increasing doses. This creates a difficult treatment balancing act: the medications that best control tremor, rigidity, and slowness may simultaneously increase the risk of falls that lead to fractures. For example, a patient who takes their morning levodopa dose and then stands quickly to answer the door may experience sudden lightheadedness and fall. This scenario is preventable with proper education about rising slowly, staying hydrated, and timing position changes appropriately. Physicians can also adjust medication timing or add treatments specifically for orthostatic hypotension, such as midodrine or droxidopa, though these require careful monitoring to avoid elevated blood pressure while lying down.
Practical Strategies to Prevent Hip Fractures in Parkinson’s Disease
Fall prevention in Parkinson’s requires a multi-pronged approach that addresses both the disease-specific motor challenges and general fracture risk factors. The [Parkinson’s Foundation recommends](https://www.parkinson.org/blog/awareness/finding-balance) beginning fall prevention strategies at diagnosis, not waiting until falls occur. Research demonstrates that [consistent exercise of at least 2.5 hours per week](https://www.parkinson.org/living-with-parkinsons/treatment/exercise) can slow symptom progression and improve balance. The most beneficial exercise programs combine several elements: balance training through activities like tai chi or dance, resistance training to strengthen the muscles that support standing and walking, and aerobic exercise for overall conditioning. A comparison illustrates the tradeoffs involved: tai chi may offer superior balance benefits but requires instruction and practice to perform correctly, while walking on a treadmill is more accessible but provides less targeted balance work.
The ideal approach incorporates both, but someone who will realistically only do one activity should choose based on their specific deficits and preferences. Physical modifications also matter. Removing throw rugs, improving lighting, installing grab bars in bathrooms, and wearing appropriate footwear reduce environmental hazards. Some patients benefit from walking aids””four-wheeled walkers with features like lasers or metronomes can help with freezing of gait. Hip protectors, which are padded undergarments that cushion falls, have shown benefit in high-risk populations, though compliance can be challenging because some people find them uncomfortable or stigmatizing.
Recovery Challenges and Outcomes After Hip Fracture in Parkinson’s
When someone with Parkinson’s does sustain a hip fracture, their recovery path differs substantially from that of other older adults. [Research indicates](https://www.sciencedirect.com/science/article/pii/S0020138322002042/) higher rates of complications including pneumonia (38 percent increased risk), urinary tract infections (58 percent increased risk), and 30-day mortality. Studies show considerable variation in 6-month mortality rates, ranging from 14 to 47 percent. The functional outcomes present the greatest challenge. Patients with Parkinson’s disease have [worse mobility scores](https://pubmed.ncbi.nlm.nih.gov/16130353/), are more likely to need walking aids post-surgery, experience higher rates of pressure sores, and require longer hospital stays.
The motor symptoms of Parkinson’s””tremors, rigidity, bradykinesia””make rehabilitation exercises more difficult and slow the recovery of independence. Nearly [98 percent of Parkinson’s patients](https://pmc.ncbi.nlm.nih.gov/articles/PMC9364183/) in one study were discharged to a higher level of care facility rather than home, compared to 83 percent of patients without the disease. A key limitation to understand: even with optimal surgical care, the underlying Parkinson’s disease continues to affect recovery. A patient who was independently mobile before fracture may require ongoing assistance afterward, not solely because of the fracture but because the period of immobility often accelerates Parkinson’s symptom progression. Families should prepare for the possibility that pre-fracture function may not fully return.
Early Warning Signs and When Risk Begins
Hip fracture risk in Parkinson’s begins earlier than most people realize. A [nested case-control study](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001954) found elevated fall and fracture risk up to 26 years before Parkinson’s diagnosis, though the risk accelerates notably in the three to five years preceding diagnosis. Another study documented significantly more presentations of dizziness and balance impairment at five years before diagnosis compared to matched controls.
This has practical implications. Someone experiencing new-onset balance problems, frequent near-falls, or unexplained dizziness should discuss these symptoms with their physician””not only because they might indicate early Parkinson’s but because they warrant fall prevention measures regardless of cause. Consider a 65-year-old who has started using handrails more frequently and feels unsteady getting out of chairs: these subtle changes merit medical evaluation and proactive intervention rather than dismissal as normal aging.
The Importance of Bone Health Screening and Treatment
Current guidelines from the [National Osteoporosis Guideline Group](https://academic.oup.com/ageing/article/54/3/afaf052/8086520) now recommend that Parkinson’s disease should trigger a bone health risk assessment. This represents recognition that Parkinson’s itself””independent of other risk factors””warrants attention to bone density. Treatment with vitamin D supplementation and bisphosphonates has been shown to [reduce nonvertebral fracture risk](https://pubmed.ncbi.nlm.nih.gov/19346153/) in people with Parkinson’s.
An ongoing clinical trial called TOPAZ is investigating zolendronate, an FDA-approved osteoporosis medication, specifically for fracture prevention in Parkinson’s patients. This research acknowledges that standard osteoporosis treatments may need adaptation for this population. Proactive bone health management””including DEXA scanning, vitamin D level testing, and appropriate medication when indicated””represents one of the most evidence-based interventions available to reduce hip fracture risk.
Conclusion
Hip fractures represent a serious and disproportionately common threat to people with Parkinson’s disease, with risk elevated approximately two to four times above the general population. This vulnerability emerges from the intersection of motor symptoms that cause falls, progressive bone loss, medication effects on blood pressure, and changes in protective reflexes. The consequences of hip fracture are also more severe in this population, with higher complication rates, longer recoveries, and increased likelihood of losing independence.
Prevention requires early and sustained attention to multiple factors: regular exercise emphasizing balance and strength, bone health screening and treatment, medication management to address orthostatic hypotension, and environmental modifications to reduce fall hazards. Patients and families should discuss hip fracture risk with their healthcare team at diagnosis, not after the first fall. Given the challenges of recovery when fractures do occur, prevention remains the most effective strategy for maintaining quality of life with Parkinson’s disease.
