Yes, people with Parkinson’s disease face a substantially higher risk of breaking a hip compared to the general population. Research consistently shows that individuals with Parkinson’s carry two to four times the risk of hip fracture, with approximately 27% experiencing a hip fracture within 10 years of diagnosis. This elevated risk stems from a combination of factors unique to Parkinson’s: motor symptoms that cause frequent falls, reduced bone mineral density, and the characteristic way people with the disease tend to fall””often straight down without the protective arm movements that might otherwise absorb impact. Consider a 72-year-old man with moderate Parkinson’s who experiences a freezing episode while walking to the bathroom at night.
Unable to catch himself due to impaired reflexes, he falls directly onto his hip rather than instinctively extending his arms. This scenario plays out frequently in the Parkinson’s community, where studies indicate that about 60% of patients fall each year, and two-thirds of those who fall do so multiple times. Of those who fall, roughly one-third sustain at least one fracture, with hip fractures accounting for 28% to 50% of these injuries. This article examines why Parkinson’s disease creates such a significant risk for hip fractures, the role of bone health in compounding this danger, what happens after a hip fracture occurs, and practical strategies for prevention. Understanding these connections can help individuals with Parkinson’s and their caregivers take meaningful steps to reduce fracture risk.
Table of Contents
- Why Does Parkinson’s Disease Increase Hip Fracture Risk?
- The Hidden Factor: Bone Health and Osteoporosis in Parkinson’s
- What Happens After a Hip Fracture: Recovery and Outcomes
- Exercise and Physical Therapy: The First Line of Defense
- Making the Home Safer: Environmental Modifications
- Medication Timing and Bone Health Screening
- Looking Ahead: Emerging Research and Better Outcomes
- Conclusion
Why Does Parkinson’s Disease Increase Hip Fracture Risk?
The motor symptoms that define Parkinson’s disease create a perfect storm for falls and fractures. Postural instability, bradykinesia (slowness of movement), muscle rigidity, and tremor all interfere with balance and the ability to recover when balance is lost. About 80% of falls in Parkinson’s result from postural instability and freezing of gait””that sudden, involuntary inability to move that can strike without warning. Unlike age-matched peers without Parkinson’s, people with the disease exhibit a threefold increase in fall risk. The distinct biomechanics of Parkinson’s falls compound this problem.
Most falls occur due to anterior collapse combined with failed postural corrections and diminished protective reflexes. In practical terms, people with Parkinson’s tend to fall “like a log” with their arms held close to their sides rather than extending outward to break the fall, which is why hip fractures occur more commonly than wrist fractures in this population. Muscle weakness adds another layer of vulnerability. In Parkinson’s, extensor weakness typically exceeds flexor weakness, and sarcopenia (age-related muscle loss) develops more rapidly due to physical inactivity, nutritional deficiencies, and neuromuscular degeneration. A Finnish longitudinal study published in 2025 found that elevated hip fracture risk appears as early as three years before Parkinson’s diagnosis and persists for up to ten years afterward, suggesting these vulnerabilities develop early and remain significant throughout disease progression.
The Hidden Factor: Bone Health and Osteoporosis in Parkinson’s
Beyond the increased fall risk, Parkinson’s disease directly affects bone health in ways that make fractures more likely when falls occur. People with Parkinson’s are nearly twice as likely to have osteoporosis compared to age-matched controls, with one review finding osteoporosis rates of 91% in women and 61% in men with the disease. In one study, 11.8% of Parkinson’s patients had osteoporosis and 41.4% had osteopenia, the precursor condition. Multiple factors contribute to this bone loss. Reduced mobility and muscle strength decrease the mechanical loading that helps maintain bone density. Lower body weight, common in Parkinson’s, provides less stress on bones.
Vitamin D deficiency occurs frequently due to reduced sunlight exposure, as mobility limitations keep people indoors. Laboratory research also suggests that dopamine receptors influence bone cells directly, meaning the dopamine deficiency central to Parkinson’s may independently weaken bones. Some evidence indicates that levodopa treatment itself may reduce bone formation rates. However, the relationship between bone treatments and fracture prevention in Parkinson’s is more complex than simply prescribing supplements. While vitamin D supplementation combined with bisphosphonates appears to reduce nonvertebral fracture risk in some studies, more recent meta-analyses have shown vitamin D alone has no significant effect on fractures, hip fractures, or falls. This means that treating low bone density without addressing fall risk provides incomplete protection. Any bone health intervention should be part of a comprehensive approach that includes fall prevention strategies.
What Happens After a Hip Fracture: Recovery and Outcomes
Hip fractures carry serious consequences for everyone, but outcomes tend to be worse for people with Parkinson’s. Research shows that hip fractures in Parkinson’s patients are associated with increased hospital length of stay, higher rates of post-operative infections including pneumonia and urinary tract infections, more pressure sores, and a decline in functional independence. Perhaps most telling: 98% of Parkinson’s patients were discharged to higher-level care facilities after hip fracture surgery, compared to 83% of patients without Parkinson’s. For example, a Parkinson’s patient who was walking independently before a hip fracture may need a wheelchair or walking aid afterward, and may require assisted living or skilled nursing care rather than returning home. Only about half of patients return to their previous level of function.
One-year mortality rates after hip fracture range from 19% to 29% in various studies of Parkinson’s patients, and those with hip fractures face approximately twice the mortality risk compared to Parkinson’s patients without fractures. The news is not uniformly grim, however. Some research shows that in-hospital complication rates and short-term mortality may be comparable between Parkinson’s and non-Parkinson’s patients when quality surgical and post-operative care is provided. The key appears to be avoiding delays in Parkinson’s medication administration, ensuring timely surgery, providing chest physiotherapy, and beginning mobilization early. Patients who were not mobilized in the first week after surgery historically showed dislocation rates as high as 37%, underscoring the importance of early movement despite the challenges Parkinson’s presents.
Exercise and Physical Therapy: The First Line of Defense
Exercise represents the most effective intervention for reducing both falls and fractures in Parkinson’s disease, yet it remains underutilized. Physical therapy and targeted exercise programs improve balance, strength, and mobility while also providing some protection against bone loss. Higher levels of physical activity correlate with better functional independence, decreased fall risk, lower fracture rates, and even delayed mortality. Traditionally, Parkinson’s patients are referred to physical therapy only after significant disability develops””often after a hip fracture has already occurred. This represents a missed opportunity. Evidence supports initiating physical therapy early in the disease course, ideally at diagnosis, rather than waiting for falls to become a problem.
Balance training performed three times weekly can significantly improve stability, while resistance exercise training has been shown to improve muscle strength, balance, and functional mobility with effects lasting at least 12 weeks. The trade-off lies in the type and intensity of exercise. High-intensity programs produce greater benefits for strength and balance but may initially increase fall risk if not properly supervised. Lower-intensity programs like tai chi and yoga offer gentler entry points and have demonstrated effectiveness for relaxation, stretching, and balance improvement, though they may produce smaller strength gains. Most experts recommend a combination approach: balance training, resistance exercises, and stretching or relaxation work, ideally supervised by a physical therapist familiar with Parkinson’s disease. The Parkinson’s Foundation emphasizes that while fall risks are more commonly associated with advanced disease, fall prevention should begin at diagnosis.
Making the Home Safer: Environmental Modifications
Environmental modifications can substantially reduce fall risk, yet many homes remain full of hazards. The bathroom is the most common site of falls at home due to slippery surfaces, poor lighting, and the physical demands of using the toilet and bathtub. Bedrooms and stairs present additional dangers, particularly at night when Parkinson’s medications may be at their lowest effectiveness. Effective bathroom modifications include installing grab bars secured with screws (not suction cups, which cannot support full body weight) near the toilet, tub, sink, and shower. Non-slip mats at shower and tub entries, walk-in showers or tub transfers, and raised toilet seats all reduce fall risk.
In bedrooms, raising bed height so feet touch the floor when seated at the bedside, installing half side rails or bed poles, and using bright nightlights create safer conditions. Throughout the home, removing throw rugs, securing loose cords, installing even bright lighting, and using low-pile carpeting or low-gloss hard flooring helps prevent both trips and the freezing episodes that patterned or shiny surfaces can trigger. One warning: generic fall-prevention advice may not account for Parkinson’s-specific challenges. For instance, standard recommendations to “hold onto something when you feel unsteady” may not help someone experiencing a freezing episode, who often cannot initiate movement at all. Visual cues like brightly colored tape at stair edges, laser pointers that project a line to step over, and metronome apps that provide rhythmic cues can help overcome freezing in ways that standard grab bars cannot. An occupational therapist with Parkinson’s expertise can provide a home safety evaluation tailored to the specific motor symptoms present.
Medication Timing and Bone Health Screening
Proper management of Parkinson’s medications plays an underappreciated role in fracture prevention. Motor symptoms fluctuate throughout the day based on medication levels, meaning fall risk varies as well. Falls often occur during “off” periods when medication effectiveness wanes, particularly in the morning before the first dose takes effect or late at night. Understanding these patterns allows for targeted precautions during high-risk times.
Anyone with Parkinson’s disease should discuss bone health screening with their physician. The FRAX tool, commonly used to assess fracture risk, does not directly incorporate falls””a significant limitation given that 60% of Parkinson’s patients experience falls annually. Updated guidelines from the National Osteoporosis Guideline Group now recommend that a Parkinson’s diagnosis should trigger a bone health risk assessment. This typically includes a DEXA scan to measure bone mineral density and blood tests to check vitamin D levels.
Looking Ahead: Emerging Research and Better Outcomes
Research continues to refine our understanding of Parkinson’s-related fracture risk and prevention. The BONE PARK 2 protocol, published in 2025, is developing better tools for assessing and managing bone health specifically in people with Parkinsonism. The TOPAZ clinical trial is investigating whether zolendronate, a bisphosphonate already approved for osteoporosis, can prevent fractures in Parkinson’s patients.
These studies acknowledge that standard approaches need adaptation for the unique circumstances Parkinson’s creates. The recognition that Parkinson’s is, to some extent, a disease of the bones as well as the brain opens new avenues for comprehensive care. Early intervention””beginning bone health screening and fall prevention programs at diagnosis rather than after the first fracture””offers the best opportunity to reduce the substantial burden hip fractures place on people living with Parkinson’s disease.
Conclusion
People with Parkinson’s disease face two to four times the risk of hip fracture compared to their peers, a consequence of the convergence between frequent falls and weakened bones. The motor symptoms that define the disease””postural instability, rigidity, bradykinesia, and freezing””create ongoing fall risk, while reduced mobility, vitamin D deficiency, and possibly the disease process itself lead to osteoporosis at high rates. When fractures occur, outcomes are generally worse, with longer hospital stays, reduced functional independence, and higher rates of discharge to care facilities.
Prevention requires a multifaceted approach: regular exercise focusing on balance and strength, environmental modifications that address Parkinson’s-specific hazards, bone health screening and appropriate treatment, and attention to medication timing. Physical therapy should begin early in the disease course rather than after disability has developed. For those who do experience a hip fracture, early mobilization, continued Parkinson’s medication without interruption, and comprehensive rehabilitation offer the best chance of maintaining independence. The research makes clear that hip fractures in Parkinson’s are not inevitable””but preventing them requires proactive, sustained effort.
