Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength

Sinaki, Mehrsheed; Brey, Robert H.; Hughes, Christine; Larson, Dirk R.; Kaufman, Kenton R.

doi:10.1007/s00198-004-1791-2

Cited by 320 publications

(260 citation statements)

References 37 publications

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“…We have previously published that the correlations between these four different measures were strong, ranging between 0.63 and 0.76, and our current study findings provide solid evidence of construct validity [24]. In related literature, several reports of varying quality have been published that employed alternative measures for kyphosis and used balance as a surrogate outcome for falls [19,20,[28][29][30][31][32][33]. These studies as a whole suggest that kyphosis adversely affects balance, and it is known that poor balance is a fall risk factor.…”

Section: Discussionsupporting

confidence: 74%

“…Similarly, a study of women with chronic back pain found OWD was associated with balance and gait issues, both of which could lead to increased fall risk [29]. Using the Debrunner Kyphometer as a measure of kyphosis, a large study of women found that greater quartiles of kyphotic angle were associated with longer TUG times in fully adjusted models [32], while a small study of women found that hyperkyphotic women had reduced gait velocity and reduced falls efficacy compared to women with normal kyphosis [33]. However, in contrast, two other published studies reported no association between kyphosis and the Berg Balance Score [20] and force plate measures of balance [31].…”

Section: Discussionmentioning

confidence: 99%

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Kyphosis and incident falls among community-dwelling older adults

et al. 2017

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Summary Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits. Introduction To determine the association between four measures of kyphosis and incident and injurious falls in older persons. Methods Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview. Results Mean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. Conclusions Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Kyphosis and incident falls among community-dwelling older adults

et al. 2017

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“…Advanced age, number of underlying diseases, motor paralysis, impaired vision, decreased muscle strength, body imbalance, and history of falling have been reported as risk factors for fall [9,34]. A study of 12 female osteoporosis patients with thoracic kyphosis showed poor balance and an increased propensity to fall on a fall efficacy scale [37]. But, unfortunately, detailed data on spinal sagittal alignment and ROM were not included, and the history of fall was not examined.…”

Section: Discussionmentioning

confidence: 99%

Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

et al. 2013

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Objective Risk factors for falling in elderly people remain uncertain, and the effects of spinal factors and physical ability on body balance and falling have not been examined. The objective of this study was to investigate how factors such as spinal sagittal alignment, spinal range of motion, body balance, muscle strength, and gait speed influence falling in the prospective cohort study. Methods The subjects were 100 males who underwent a basic health checkup. Balance, SpinalMouse Ò data, grip strength, back muscle strength, 10-m gait time, lumbar lateral standing radiographs, body mass index, and fall history over the previous year were examined. Platform measurements of balance included the distance of movement of the center of pressure (COP) per second (LNG/TIME), the envelopment area traced by movement of the COP (E AREA), and the LNG/E AREA ratio. The thoracic/lumbar angle ratio (T/L ratio) and sagittal vertical axis (SVA) were used as an index of sagittal balance. Results LNG/TIME and E AREA showed significant positive correlations with age, T/L ratio, SVA, and 10-m gait time; and significant negative correlations with lumbar lordosis angle, sacral inclination angle, grip strength and back muscle strength. Multiple regression analysis showed significant differences for LNG/TIME and E AREA with T/L ratio, SVA, lumbar lordosis angle and sacral inclination angle (R 2 = 0.399). Twelve subjects (12 %) had experienced a fall over the past year. Age, T/L ratio, SVA, lumbar lordosis angle, sacral inclination angle, grip strength, back muscle strength, 10-m gait time, height of the intervertebral disc, osteophyte formation in radiographs and LNG/E AREA differed significantly between fallers and non-fallers. The group with SVA [ 40 mm (n = 18) had a significant higher number of subjects with a single fall (6 single fallers/18: p = 0.0075) and with multiple falls (4 multiple fallers/18: p = 0.0095). Conclusion Good spinal sagittal alignment, muscle strength and 10-m gait speed improve body balance and reduce the risk of fall. Muscle strength and physical ability are also important for spinal sagittal alignment. Body balance training, improvement of physical abilities including muscle training, and maintenance of spinal sagittal alignment can lead to prevention of fall.

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“…Thoracic kyphosis, assessed using Cobb's angle, has been proved to be associated with poor physical fitness, osteoporosis, and the risk of falls (12,13). However, measuring Cobb's angle requires radiologic equipment and therefore this measure is not easily performed.…”

Section: Discussionmentioning

confidence: 99%