Impaired Vestibular Function and Low Bone Mineral Density: Data from the Baltimore Longitudinal Study of Aging

Abstract

Animal studies have demonstrated that experimentally induced vestibular ablation leads to a decrease in bone mineral density, through mechanisms mediated by the sympathetic nervous system. Loss of bone mineral density is a common and potentially morbid condition that occurs with aging, and we sought to investigate whether vestibular loss is associated with low bone mineral density in older adults. We evaluated this question in a cross-sectional analysis of data from the Baltimore Longitudinal Study of Aging (BLSA), a large, prospective cohort study managed by the National Institute on Aging (N = 389). Vestibular function was assessed with cervical vestibular evoked myogenic potentials (cVEMPs), a measure of saccular function. Bone mineral density was assessed using dual-energy X-ray absorptiometry (DEXA). In two-way t test analysis, we observed that individuals with reduced vestibular physiologic function had significantly lower bone mineral density. In adjusted multivariate linear regression analyses, we observed that older individuals with reduced vestibular physiologic function had significantly lower bone mineral density, specifically in weight-bearing hip and lower extremity bones. These results suggest that the vestibular system may contribute to bone homeostasis in older adults, notably of the weight-bearing hip bones at greatest risk of osteoporotic fracture. Further longitudinal analysis of vestibular function and bone mineral density in humans is needed to characterize this relationship and investigate the potential confounding effect of physical activity.

Bone Mineral Density in Patients Suffering from Ménière’s Disease

“…Retrospective studies have found an association between reduced head and to tal BMD, hearing, and balance impairments especially in elderly patients [Kahveci et al, 2014;Mendy et al, 2014]. Further crosssectional studies have reported associa tions between a reduced BMD of the weightbearing hip and lower extremity bones, and gait abnormality evalu ated by the modified Romberg test [Park and Kim, 2016] and saccular dysfunction measured by cVEMPs [Bigelow et al, 2016]. Increasing recent evidence has implicated osteoporosis as a risk factor for BPPV [Byun et al, 2019;Jang and Kang, 2009;Jeong et al, 2009;Parham et al, 2013;Vibert et al, 2003], its recurrence [Byun et al, 2019;Chan et al, De Stefano et al, 2014;Yamanaka et al, 2013], and treatment failure [Jang and Kang, 2009].…”

“…Recent studies have reported an association between reduced bone mineral density (BMD), the occurrence and recurrent events of benign paroxysmal positional vertigo (BPPV) [Jeong et al, 2009;Parham et al, 2013;Yamanaka et al, 2013], balance impairment [Mendy et al, 2014;Park and Kim, 2016], and saccular dysfunction [Bigelow et al, 2016]. Detachment of saccular otoconia obstructing the duc tus reuniens has been radiologically demonstrated and theorized as a mechanism for the development of cochle ar hydrops [Hornibrook and Bird, 2017;Yamane et al, 2012].…”

“…Current understanding of BPPV pathogenesis in volves otoconial fragmentation and dislodgement into the semicircular canal endolymph, while saccular dys function might include disrupted otoconial structure and turnover [Parnes et al, 2003;Yetiser et al, 2014]. These vestibular pathologies were both reported to be associat ed with reduced BMD [Bigelow et al, 2016;Jeong et al, 2009;Parham et al, 2013;Yamanaka et al, 2013] and Mé nière's disease [Kutlubaev et al, 2019;Maheu et al, 2017], while the consequences of otoconial displacement were suggested to play a major role in the pathogenesis of en dolymphatic hydrops [Hornibrook and Bird, 2017;Wan gemann, 2006]. A further publication reported that cor recting vitamin D deficiency, which is critical for the maintenance of bone homeostasis [DeLuca, 2004], de creased the necessity for ablative therapy in patients suf fering from Ménière's disease [Büki et al, 2018].…”

Understanding vestibular-related physiological functions could provide clues on adapting to a new gravitational environment

“…Further, the vestibular system modulates muscle fiber size and transcription factor expression in rats [14,42]. Clinical studies have reported a relation between benign paroxysmal positional vertigo with the vestibular dysfunction and osteoporosis, high bone turnover, and vitamin D deficiency in patients with osteoporosis [43][44][45]. Taken together, these findings indicate that vestibular system regulates both skeletal muscles and bones.…”

Audiovestibular functioning of post-menopausal females with osteoporosis and osteopenia

“…Osteoporosis and osteopenia can occur at any age, especially in postmenopausal women ( Nilas and Christiansen, 1987 ), and may lead to body pain, fractures, hearing loss and balance disorders ( Bigelow et al., 2016 ; Zuniga et al., 2012 ; Burke-Doe et al., 2008 ). A meta-analysis of five studies from different countries found that a decrease in bone mineral density (BMD) or osteoporosis was significantly associated with hearing loss ( Upala et al., 2017 ).…”