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

Alexander Simon 1Tobias Rupp 1Tim Hoenig 2Eik Vettorazzi 3Michael Amling 4Tim Rolvien 5

Gait Posture. 2021 Jun 12;88:304-310.

 doi: 10.1016/j.gaitpost.2021.06.013. Online ahead of print.


Background: Although the interactions between balance, falls and fracture risk have been demonstrated in various aspects, the clinical focus of fracture risk evaluation has been on bone properties, e.g., bone mineral density (BMD). Accordingly, the role of balance parameters in the setting of osteoporosis assessment remained to be further explored.

Research question: Is postural stability assessed by Romberg quiet stance posturography influenced by BMD or prior fragility fractures in a cohort of more than 1000 patients screened for osteoporosis?

Methods: Patients who completed both Romberg test and dual energy X-ray absorptiometry (DXA) were included retrospectively from a large database. Quantification of the Romberg test was performed by using posturography. Center of pressure (CoP) movements were tracked and the corresponding path length for ten seconds as well as an ellipse area including 90 % of all CoP were calculated. To determine potential predictors of posturography, simple and multiple linear regression analyses were performed including DXA results, grip strength, age, sex and BMI. As a secondary outcome, the influence of a previous fragility fracture on postural stability was evaluated.

Results: Overall, 1086 patients (801 women, 285 men) met the inclusion criteria. Lower femoral BMD T-score (p < 0.05), higher age (p < 0.001) and male sex (p < 0.001) were associated with higher Romberg path length (both eyes open and eyes closed). Both women and men with any previous fragility fracture showed significantly increased values in the path length with eyes open (p < 0.05) and eyes closed (women p < 0.001, men p < 0.05) compared to those without a history of a fragility fracture.

Significance: Our study indicates that postural stability is affected by femoral BMD, age and sex. As a history of prior fragility fracture was associated with postural instability, assessment and management of impaired balance in everyday clinical practice is advisable for optimal fracture prevention.