Original Article

Osteoporosis International

, Volume 20, Issue 4, pp 577-583

First online:

Heritability of impaired balance: a nationwide cohort study in twins

  • H. WagnerAffiliated withDepartment of Surgical Sciences, Section of Orthopaedics, University Hospital Email author 
  • , H. MelhusAffiliated withDepartment of Medical Sciences, Section of Clinical Pharmacology, University Hospital
  • , N. L. PedersenAffiliated withDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet
  • , K. MichaëlssonAffiliated withDepartment of Surgical Sciences, Section of Orthopaedics, University HospitalUppsala Clinical Research Center, University Hospital

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In this large population-based twin study, a self-estimated impaired balance, an important risk factor for osteoporotic fractures, had a modest heritability of 0.27. Individual-specific environmental influences seem to be the dominating cause for impaired balance.


The principal causal components of an osteoporotic fracture are falls and weakened bone strength. While bone strength has a strong genetic origin, the heritable influences on impaired balance that contribute to the risk of injurious falls at older age are uncertain.


To evaluate the heritability and environmental influence on self-reported impaired balance in older men and women, we used data from a sample of 22,998 Swedish twins, 55 to 99 years of age.


An impaired balance was reported by 2,890 (12.3%) of the twins. The tetrachoric correlation for impaired balance was only slightly lower for like-sex dizygotic twins (0.31) compared to monozygotic twins (0.36). These correlations indicate a modest familial (genetic and shared environmental) influence. Model fitting results indicate that the age- and sex-adjusted heritability for impaired balance was 0.27 (95%CI = 0.01–0.45). Individual-specific environmental influences differed only slightly by sex and age.


These results imply that a self-reported impaired balance, an independent risk factor for osteoporotic fractures, has a modestly heritable etiology in older subjects. Our observation can partly explain the previously observed modest heritability for osteoporotic fractures even though there is a high heritability for bone mineral density.


Balance Environment Heritability Muscular weakness Osteoporotic fractures Twin study