Evaluation of postural stability in patients screened for osteoporosis: A retrospective study of 1086 cases

Simon, Alexander; Rupp, Tobias; Hoenig, Tim; Vettorazzi, Eik; Amling, Michael; Rolvien, Tim

doi:10.1016/j.gaitpost.2021.06.013

Cited by 8 publications

(16 citation statements)

References 29 publications

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“…9 We and others have previously reported that poor muscle performance and balance are associated with fragility fractures. 10,11 Furthermore, it has been demonstrated that poor muscle performance predicts fragility fractures in elderly women and men. 2 The gold standard for assessing bone mineral density (BMD) and risk of fragility fractures is dual-energy X-ray absorptiometry (DXA), where a standard deviation (i.e.…”

Section: Introductionmentioning

confidence: 99%

Compartment‐specific effects of muscle strength on bone microarchitecture in women at high risk of osteoporosis

Simon

Schäfer

Schmidt

et al. 2022

J cachexia sarcopenia muscle

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Background It is well known that skeletal integrity is influenced by the musculature. Poor muscle strength (i.e. sarcopenia) is considered a major predictor of fragility fractures. While this observation appears particularly relevant for older women with increased risk of osteoporosis, there has been no comprehensive investigation to determine the influence of muscle performance on compartment-specific bone microarchitecture in multiple body regions. Methods We retrospectively analysed data from different muscle performance and bone microarchitecture assessments in 230 women (aged 21 to 87 years) at high risk of osteoporosis. Muscle performance tests included grip strength and chair rising test (CRT) combined with mechanography. Balance was determined by Romberg posturography. Areal bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) at the hip and lumbar spine. Compartment-specific volumetric BMD, microarchitecture, and geometry were assessed by second-generation highresolution peripheral quantitative computed tomography (HR-pQCT) at multiple skeletal sites (distal radius, tibia, and fibula). Regression models were applied to test for interactions between muscle and bone parameters. Subgroups were defined to compare women with osteoporosis and osteosarcopenia regarding BMD and microarchitecture. Results While osteoporosis was diagnosed in 115/230 (50.0%) women, sarcopenia was detected in 38/230 (16.5%). Positive associations of both grip strength and CRT maximum force with cortical geometric and microarchitectural parameters were detected at all measured sites, with the strongest effect applying to CRT maximum force and tibial parameters (e.g. tibial cortical area R 2 = 0.36, P < 0.0001, and tibial cortical thickness R 2 = 0.26, P < 0.0001). Balance parameters showed much weaker or no associations with HR-pQCT parameters. Major associations between muscle strength and trabecular parameters could not be confirmed. Age and body mass index were confirmed as negative and positive predictors for several microarchitectural parameters, respectively. An independent predictive value of grip strength on radial, tibial, and fibular (all P < 0.01) cortical area and of CRT maximum relative force on cortical thickness (all P < 0.05) was revealed. Women with osteosarcopenia showed significantly reduced cortical HR-pQCT parameters but no differences in DXA values compared with women with osteoporosis but no sarcopenia. Stratification by fracture and treatment status revealed that vertebral fractures and denosumab treatment altered the muscle-bone interaction. Conclusions A systemic interaction between muscle strength and bone microarchitecture was demonstrated, and this interaction appears to be primarily with the cortical bone compartment. The value of muscle assessments in fracture risk evaluation may be partly mediated by their effects on bone microarchitecture.

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Section: Introductionmentioning

confidence: 99%

Compartment‐specific effects of muscle strength on bone microarchitecture in women at high risk of osteoporosis

Simon

Schäfer

Schmidt

et al. 2022

J cachexia sarcopenia muscle

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“…To maintain a stable standing position and to stand with as little sway as possible, the center of pressure (COP) must be continuously corrected. Disease (i.e., stroke) and injury (i.e., fracture) often impair the stability of the standing position [2][3][4]. Several studies have suggested that a decline in postural control leads to balance deficits and increases the risk of falling [5][6][7]; therefore, for several decades, many researchers have focused on the mechanisms underlying postural instability.…”

Section: Introductionmentioning

confidence: 99%

Changes in postural sway during upright stance after short-term lower limb physical inactivity: A prospective study

Ikeda

Takano²,

Oka³

et al. 2022

PLoS ONE

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Previous studies have reported that motor behavior is affected by short-term physical inactivity using cast immobilization; however, the effects of inactivity on postural sway are not well-understood. This study aimed to investigate the effects of short-term lower limb disuse on postural sway in the upright position after cast removal. Twenty-two healthy young adults were enrolled, and each participant’s lower limb on one side was fixed with a soft bandage and medical splint made from metal and soft urethane for 10 h. Fluctuations in the center of pressure (COP) were measured before and after immobilization; the total trajectory length, mean velocity, COP root mean square (RMS) area, mean medial-lateral (M-L) COP, and mean anterior-posterior (A-P) COP were selected as evaluation parameters. Compared with the postural sway before cast application, we noted an increase and shift (from the fixed to the nonfixed side) in the postural sway after cast removal. Our results therefore suggest that short-term disuse may cause acute changes in COP movements during quiet standing. Moreover, patients may maintain their standing posture by adopting a compensatory strategy involving lateral control, similar to individuals with stroke and patients who have undergone total knee arthroplasty.

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“…al. showed that lower femoral BMD T-scores, higher age, and male sex were associated with greater sway, as assessed using a stabilometer, and a history of previous fragility fracture showed significantly increased values of sway length compared to that in individuals without a history of fragility fracture [ 70 ]. Grip strength was also assessed in their study, but it did not show any relationship with the sway status.…”

Section: Discussionmentioning

confidence: 99%

“…Grip strength assessment is a component in the diagnosis of sarcopenia. The reason their study did not find a relationship between grip strength and sway measurement may be because they assessed grip strength alone, not the status of sarcopenia [ 70 ], which requires assessing not only grip strength but also muscle volume. In our study, we assessed sarcopenia using the latest validated, ethnically adjusted criteria, namely AWGS 2019, and the status of sarcopenia was significantly associated with impaired postural stability.…”

Section: Discussionmentioning

confidence: 99%

“…However, as most fragility fractures are caused by falling [ 61 ], it is important to first focus on reducing the risk of falls. In this study, a prior fall episode in the preceding year was associated with the status of sarcopenia, which was significantly related to postural instability, even after adjusting for age, a well-known risk factor for postural instability [ 70 ]. The assessment of sarcopenia is important for distinguishing the population with a higher fall risk, and interventions for sarcopenia should be implemented along with osteoporosis management for these populations.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Sarcopenia and Its Association with Quality of Life, Postural Stability, and Past Incidence of Falls in Postmenopausal Women with Osteoporosis: A Cross-Sectional Study

Okayama¹,

Nakayama

Kashiwa³

et al. 2022

Healthcare

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In this cross-sectional analysis of 61 postmenopausal osteoporosis patients who regularly visited an osteoporosis outpatient clinic, we aimed to clarify the prevalence of sarcopenia and its related clinical factors. Of 61 patients (mean age 77.6 ± 8.1 years), 24 (39.3%) had osteosarcopenia and 37 (60.7%) had osteoporosis alone. Age, nutritional status, and the number of prescribed drugs were associated with the presence of sarcopenia (p = 0.002, <0.001, and 0.001, respectively), while bone mineral density (BMD) and % young adult mean BMD were not (p = 0.119 and 0.119, respectively). Moreover, patients with osteosarcopenia had lower quality of life (QOL) scores, greater postural instability, and a higher incidence of falls in the past year than patients with osteoporosis alone. In contrast, BMD status showed no correlation with the nutritional status, QOL score, postural instability, or incidence of falls in the past year. In conclusion, the incidence of sarcopenia was relatively high among postmenopausal osteoporosis female patients in an osteoporosis outpatient clinic. Our results suggest that in addition to routine BMD evaluation, assessment and management of sarcopenia may be promoted at osteoporosis outpatient clinics to limit the risk of falls and prevent consequent fragility fractures in osteoporosis patients.

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Evaluation of postural stability in patients screened for osteoporosis: A retrospective study of 1086 cases

Cited by 8 publications

References 29 publications

Compartment‐specific effects of muscle strength on bone microarchitecture in women at high risk of osteoporosis

Compartment‐specific effects of muscle strength on bone microarchitecture in women at high risk of osteoporosis

Changes in postural sway during upright stance after short-term lower limb physical inactivity: A prospective study

Prevalence of Sarcopenia and Its Association with Quality of Life, Postural Stability, and Past Incidence of Falls in Postmenopausal Women with Osteoporosis: A Cross-Sectional Study

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