Osteoporosis International

, Volume 16, Issue 8, pp 1004–1010 | Cite as

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

  • Mehrsheed SinakiEmail author
  • Robert H. Brey
  • Christine A. Hughes
  • Dirk R. Larson
  • Kenton R. Kaufman
Original Article


This controlled trial was designed to investigate the influence of osteoporosis-related kyphosis (O-K) on falls. Twelve community-dwelling women with O-K (Cobb angle, 50–65° measured from spine radiographs) and 13 healthy women serving as controls were enrolled. Mean age of the O-K group was 76 years (±5.1), height 158 cm (±5), and weight 61 kg (±7.9), and mean age of the control group was 71 years (±4.6), height 161 cm (±3.8), and weight 66 kg (±11.7). Quantitative isometric strength data were collected. Gait was monitored during unobstructed level walking and during stepping over an obstacle of four different heights randomly assigned (2.5%, 5%, 10%, and 15% of the subject’s height). Balance was objectively assessed with computerized dynamic posturography consisting of the sensory organization test. Back extensor strength, grip strength, and all lower extremity muscle groups were significantly weaker in the O-K group than the control group ( P <0.05), except right ankle plantar flexors ( P =0.09). There was a significant difference in the anteroposterior and mediolateral displacements and velocities. The O-K subjects had less anteroposterior displacement, greater mediolateral displacement, reduced anteroposterior velocity, and increased mediolateral velocity compared with controls for all conditions of unobstructed and obstructed level walking. Obstacle height had a significant effect on all center-of-mass variables. The O-K subjects had significantly greater balance abnormalities on computerized dynamic posturography than the control group ( P =0.002). Data show that thoracic hyperkyphosis on a background of reduced muscle strength plays an important role in increasing body sway, gait unsteadiness, and risk of falls in osteoporosis.


Balance Gait Kyphosis Muscle strength Osteoporosis Risk of fall 



The authors are grateful to Ms. Toni D. Stabile for her support of our research program on the rehabilitation of osteoporosis. The authors also thank the study coordinator, Ms. Sandra K. Fitzgerald, for her assistance in screening the subjects, organizing the data collection, and typing the manuscript.


  1. 1.
    Lynn SG, Sinaki M, Westerlind KC (1997) Balance characteristics of persons with osteoporosis. Arch Phys Med Rehabil 78:273–277CrossRefPubMedGoogle Scholar
  2. 2.
    Wolfson LI, Whipple R, Amerman P, Kleinberg A (1986) Stressing the postural response: a quantitative method for testing balance. J Am Geriatr Soc 34:845–850PubMedGoogle Scholar
  3. 3.
    Peterka RJ, Black FO (1990–91) Age-related changes in human posture control: sensory organization tests. J Vestib Res 1:73–85PubMedGoogle Scholar
  4. 4.
    Peterka RJ, Black FO (1990–91) Age-related changes in human posture control: motor coordination tests. J Vestib Res 1:87–96PubMedGoogle Scholar
  5. 5.
    Overstall PW, Exton-Smith AN, Imms FJ, Johnson AL (1977) Falls in the elderly related to postural imbalance. Br Med J 1:261–264PubMedGoogle Scholar
  6. 6.
    Horak FB, Shupert CL, Mirka A (1989) Components of postural dyscontrol in the elderly: a review. Neurobiol Aging 10:727–738. DOI:10.1016/0197–4580(89)90010–9Google Scholar
  7. 7.
    Lord SR, Clark RD, Webster IW (1991) Postural stability and associated physiological factors in a population of aged persons. J Gerontol 46:M69–76PubMedGoogle Scholar
  8. 8.
    Tinetti ME (2003) Clinical practice: preventing falls in elderly persons. N Engl J Med 348:42–49. DOI:10.1056/NEJMcp020719Google Scholar
  9. 9.
    Itoi E (1991) Roentgenographic analysis of posture in spinal osteoporotics. Spine 16:750–756PubMedGoogle Scholar
  10. 10.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. DOI:10.1016/0022–3956(75)90026–6Google Scholar
  11. 11.
    Sinaki M, Offord KP (1988) Physical activity in postmenopausal women: effect on back muscle strength and bone mineral density of the spine. Arch Phys Med Rehabil 69:277–280PubMedGoogle Scholar
  12. 12.
    Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45:P239–243PubMedGoogle Scholar
  13. 13.
    Goh S, Price RI, Leedman PJ, Singer KP (1999) Age-independent correlation of optically determined thoracic kyphosis with lumbar spine bone mineral density. J Musculoskelet Res 3:267–274. DOI:10.1142/S0218957799000294Google Scholar
  14. 14.
    Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon SF (2002) Can the thoracic kyphosis be modeled with a simple geometric shape? The results of circular and elliptical modeling in 80 asymptomatic patients. J Spinal Disord Tech 15:213–220PubMedGoogle Scholar
  15. 15.
    Nashner LM (1993) Computerized dynamic posturography. In: Jacobson GP, Newman CW, Kartush JM (eds) Handbook of balance function testing. Mosby Year Book, St. Louis, pp 280–307Google Scholar
  16. 16.
    Kadaba MP, Ramakrishnan HK, Wootten ME, Gainey J, Gorton G, Cochran GV (1989) Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait. J Orthop Res 7:849–860PubMedGoogle Scholar
  17. 17.
    Meglan DA (1991) Enhanced analysis of human locomotion [dissertation]. Ohio State University, Ohio, USAGoogle Scholar
  18. 18.
    Chou LS, Kaufman KR, Brey RH, Draganich LF (2001) Motion of the whole body’s center of mass when stepping over obstacles of different heights. Gait Posture 13:17–26. DOI:10.1016/S0966–6362(00)00087–4Google Scholar
  19. 19.
    Dempster WT (1955) Space requirements of the seated operator: geometrical, kinematic, and mechanical aspects of the body with special reference to the limbs. WADC Technical Report 55–159. Wright Air Development Center, Wright-Patterson Air Force Base, OH, USAGoogle Scholar
  20. 20.
    McConville JT (1981) Anthropometric relationships of body and body segment moments of inertia. AFAMRL-TR 80–119. Air Force Aerospace Medical Research Laboratory, Aerospace Medical Division, Air Force Systems Command, Wright-Patterson Air Force Base, Ohio, USAGoogle Scholar
  21. 21.
    Growney E, Meglan D, Johnson M, Cahalan T, An K-N (1997) Repeated measures of adult normal walking using a video tracking system. Gait Posture 6:147–162. DOI:10.1016/S0966–6362(97)01114–4Google Scholar
  22. 22.
    Eng JJ, Winter DA (1993) Estimations of the horizontal displacement of the total body centre of mass: considerations during standing activities. Gait Posture 1:141–144CrossRefGoogle Scholar
  23. 23.
    Jian Y, Winter DA, Ishac MG, Gilchrist L (1993) Trajectory of the body COG and COP during initiation and termination of gait. Gait Posture 1:9–22CrossRefGoogle Scholar
  24. 24.
    Winter DA (1991) The biomechanics and motor control of human gait: normal, elderly and pathological, 2nd edn. University of Waterloo Press, Waterloo, Ontario, CanadaGoogle Scholar
  25. 25.
    Andres PL, Hedlund W, Finison L, Conlon T, Felmus M, Munsat TL (1986) Quantitative motor assessment in amyotrophic lateral sclerosis. Neurology 36:937–941PubMedGoogle Scholar
  26. 26.
    Limburg PJ, Sinaki M, Rogers JW, Caskey PE, Pierskalla BK (1991) A useful technique for measurement of back strength in osteoporotic and elderly patients. Mayo Clin Proc 66:39–44PubMedGoogle Scholar
  27. 27.
    Sinaki M (1989) Relationship of muscle strength of back and upper extremity with level of physical activity in healthy women. Am J Phys Med Rehabil 68:134–138PubMedGoogle Scholar
  28. 28.
    Sinaki M, Nwaogwugwu NC, Phillips BE, Mokri MP (2001) Effect of gender, age, and anthropometry on axial and appendicular muscle strength. Am J Phys Med Rehabil 80:330–338. DOI:10.1097/00002060–200105000–00002Google Scholar
  29. 29.
    Sinaki M, Khosla S, Limburg PJ, Rogers JW, Murtaugh PA (1993) Muscle strength in osteoporotic versus normal women. Osteoporos Int 3:8–12Google Scholar
  30. 30.
    Schmorl G, Junghanns H (1959) The human spine in health and disease: anatomicopathologic studies. Grune and Stratton, New YorkGoogle Scholar
  31. 31.
    Ashley MJ, Gryfe CI, Amies A (1977) A longitudinal study of falls in an elderly population. II: Some circumstances of falling. Age Ageing 6:211–220PubMedGoogle Scholar
  32. 32.
    Prudham D, Evans JG (1981) Factors associated with falls in the elderly: a community study. Age Ageing 10:141–146PubMedGoogle Scholar
  33. 33.
    Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SB, Arie TH et al (1988) Falls by elderly people at home: prevalence and associated factors. Age Ageing 17:365–372PubMedGoogle Scholar
  34. 34.
    Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 1990;19:136–141 [published erratum appears in Age Ageing 19:345–346]Google Scholar
  35. 35.
    Rubenstein LZ, Robbins AS, Schulman BL, Rosado J, Osterweil D, Josephson KR (1988) Falls and instability in the elderly. J Am Geriatr Soc 36:266–278PubMedGoogle Scholar
  36. 36.
    Tinetti ME, Speechley M (1989) Prevention of falls among the elderly. N Engl J Med 320:1055–1059PubMedGoogle Scholar
  37. 37.
    Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 315:1065–1069PubMedGoogle Scholar
  38. 38.
    Robertson MC, Devlin N, Gardner MM, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 322:697–701. DOI:10.1136/bmj.322.7288.697Google Scholar
  39. 39.
    Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C (1999) Prevention of Falls in the Elderly Trial (PROFET): a randomised controlled trial. Lancet 353:93–97. DOI:10.1016/S0140–6736(98)06119–4Google Scholar
  40. 40.
    Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M et al (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331:821–827. DOI:10.1056/NEJM199409293311301Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Mehrsheed Sinaki
    • 1
    Email author
  • Robert H. Brey
    • 2
  • Christine A. Hughes
    • 3
  • Dirk R. Larson
    • 4
  • Kenton R. Kaufman
    • 3
  1. 1.Department of Physical Medicine and RehabilitationMayo ClinicRochesterUSA
  2. 2.Division of AudiologyMayo ClinicRochesterUSA
  3. 3.Division of Orthopedic ResearchMayo ClinicRochesterUSA
  4. 4.Division of BiostatisticsMayo ClinicRochesterUSA

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