Purpose <p>Bone plays pivotal roles in glucose homeostasis of the human body. Parkinson’s disease (PD) is accompanied by metabolic dysfunction and increased risks of bone diseases. Nevertheless, whether PD affects bone glucose metabolism remains unknown. This study aimed to assess cranial glucose metabolism in different stages of PD using brain ¹⁸F-fludeoxyglucose positron emission tomography (¹⁸F-FDG PET).</p> Methods <p>This prospective cross-sectional study included 190 participants, including 34 controls, 32 prodromal PD (pPD), 50 de novo PD (dnPD) and 74 medicated PD (mPD) patients. mPD patients were further separated into 3 stages: early-, middle- and late-stage PD patients. Comparisons of glucose uptake in the cranium was assessed using general linear model among controls, pPD, dnPD and mPD patients, as well as among mPD patients with different stages. Furthermore, effects of motor function, disease duration and dopaminergic medication on cranial glucose uptake were assessed using multiple linear regression.</p> Results <p>The results demonstrated cranial hypermetabolism in clinically confirmed PD patients (dnPD and mPD patients) compared to HCs in the cranium, frontal, sphenoid and parietal bones (<i>p</i> &lt; 0.05). In addition, mPD patients also demonstrated hypermetabolism in temporal and occipital bones compared to HCs (<i>p</i> &lt; 0.05). However, this metabolic pattern was not observed in the prodromal individuals. Moreover, multiple linear regression identified fasting blood glucose as a positive modulator (<i>β</i> = 0.020 ~ 0.043, <i>p</i> &lt; 0.05) and dopaminergic medication as a negative regulator (<i>β</i>=-1.207 × 10⁻⁴~-9.482 × 10⁻⁵, <i>p</i> &lt; 0.005) of cranial glucose metabolic activity.</p> Conclusion <p>The current study uncovered cranial metabolic abnormalities in PD, offering new perspectives and pathophysiological insights underlying bone-related comorbidities in PD.</p>