Skip to main content

Advertisement

Log in

Lower leg muscle density is independently associated with fall status in community-dwelling older adults

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Muscle density is a risk factor for fractures in older adults; however, its association with falls is not well described. After adjusting for biologically relevant confounding factors, a unit decrease in muscle density was associated with a 17 % increase in odds of reporting a fall, independent of functional mobility.

Introduction

Falls are the leading cause of injury, disability, and fractures in older adults. Low muscle density (i.e., caused by muscle adiposity) and functional mobility have been identified as risk factors for incident disability and fractures in older adults; however, it is not known if these are also independently associated with falls. The purpose of this study was to explore the associations of muscle density and functional mobility with fall status.

Methods

Cross-sectional observational study of 183 men and women aged 60–98 years. Descriptive data, including a 12-month fall recall, Timed Up and Go (TUG) test performance, lower leg muscle area, and density. Odds ratio (OR) of being a faller were calculated, adjusted for age, sex, body mass index, general health status, diabetes, and comorbidities.

Results

Every mg/cm3 increase in muscle density (mean 70.2, SD 2.6 mg/cm3) independently reduced the odds of being a faller by 19 % (OR 0.81 [95 % CI 0.67 to 0.97]), and every 1 s longer TUG test time (mean 9.8, SD 2.6 s) independently increased the odds by 17 % (OR 1.17 [95 % CI 1.01 to 1.37]). When both muscle density and TUG test time were included in the same model, only age (OR 0.93 [95 % CI 0.87 to 0.99]) and muscle density (OR 0.83 [95 % CI 0.69 to 0.99]) were independently associated with fall status.

Conclusions

Muscle density was associated with fall status, independent of functional mobility. Muscle density may compliment functional mobility tests as a biometric outcome for assessing fall risk in well-functioning older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention CDC (2003) Public health and aging: nonfatal injuries among older adults treated in hospital emergency departments—United States, 2001. MMWR Morb Mortal Wkly Rep 52:1019–1022

    Google Scholar 

  2. Parkkari J, Kannus P, Palvanen M et al (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187

    Article  CAS  PubMed  Google Scholar 

  3. O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137:342–354

    Article  PubMed  Google Scholar 

  4. Gillespie LD, Robertson MC, Gillespie WJ et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146. doi:10.1002/14651858.CD007146.pub3

    Google Scholar 

  5. Davis JC, Robertson MC, Ashe MC et al (2010) International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 21:1295–1306. doi:10.1007/s00198-009-1162-0

    Article  CAS  PubMed  Google Scholar 

  6. Hartholt KA, van der Velde N, Looman CWN et al (2010) Trends in fall-related hospital admissions in older persons in the Netherlands. Arch Intern Med 170:905–911. doi:10.1001/archinternmed.2010.106

    Article  PubMed  Google Scholar 

  7. Moreland JD, Richardson JA, Goldsmith CH, Clase CM (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52:1121–1129. doi:10.1111/j.1532-5415.2004.52310.x

    Article  PubMed  Google Scholar 

  8. Pijnappels M, Reeves ND, Maganaris CN, Van Dieen JH (2008) Tripping without falling; lower limb strength, a limitation for balance recovery and a target for training in the elderly. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology 18:188–196. doi:10.1016/j.jelekin.2007.06.004

    Article  Google Scholar 

  9. Horlings C, van Engelen BG, Allum J, Bloem BR (2008) A weak balance: the contribution of muscle weakness to postural instability and falls. Nature Clinical Practice Neurology 4:504–515

    Article  PubMed  Google Scholar 

  10. Lang TF, Streeper T, Cawthon PM et al (2010) Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporos Int 21:543–559. doi:10.1007/s00198-009-1059-y

    Article  CAS  PubMed  Google Scholar 

  11. Marcus RL, Addison O, Lastayo PC (2013) Intramuscular adipose tissue attenuates gains in muscle quality in older adults at high risk for falling. A brief report. J Nutr Health Aging 17:215–218. doi:10.1007/s12603-012-0377-5

    Article  CAS  PubMed  Google Scholar 

  12. Peterson MD, Liu D, Gordish-Dressman H et al (2011) Adiposity attenuates muscle quality and the adaptive response to resistance exercise in non-obese, healthy adults. Int J Obes 35:1095–1103. doi:10.1038/ijo.2010.257

    Article  CAS  Google Scholar 

  13. Michaud M, Balardy L, Moulis G et al (2013) Proinflammatory cytokines, aging, and age-related diseases. J Am Med Dir Assoc 14:877–882. doi:10.1016/j.jamda.2013.05.009

    Article  PubMed  Google Scholar 

  14. Goodpaster BH, Kelley DE, Thaete FL et al (2000) Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol 89:104–110

    CAS  PubMed  Google Scholar 

  15. Wong AKO, Beattie KA, Min KKH et al (2014) Peripheral quantitative computed tomography-derived muscle density and peripheral magnetic resonance imaging-derived muscle adiposity: precision and associations with fragility fractures in women. J Musculoskelet Neuronal Interact 14:401–410

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Goodpaster BH, Carlson CL, Visser M et al (2001) Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. J Appl Physiol 90:2157–2165

    CAS  PubMed  Google Scholar 

  17. Visser M, Goodpaster BH, Kritchevsky SB et al (2005) Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 60:324–333

    Article  PubMed  Google Scholar 

  18. Cawthon PM, Fox KM, Gandra SR et al (2011) Clustering of strength, physical function, muscle, and adiposity characteristics and risk of disability in older adults. J Am Geriatr Soc 59:781–787. doi:10.1111/j.1532-5415.2011.03389.x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cesari M, Rolland Y, Abellan van Kan G et al (2015) Sarcopenia-related parameters and incident disability in older persons: results from the “invecchiare in Chianti” study. J Gerontol A Biol Sci Med Sci 70:457–463. doi:10.1093/gerona/glu181

    Article  PubMed  Google Scholar 

  20. Lang TF, Cauley JA, Tylavsky FA et al (2010) Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: the health, aging, and body composition study. J Bone Miner Res 25:513–519. doi:10.1359/jbmr.090807

    Article  PubMed  Google Scholar 

  21. Lang TF, Koyama A, Li C, et al. (2008) Pelvic body composition measurements by quantitative computed tomography: association with recent hip fracture. 42:798–805. doi: 10.1016/j.bone.2007.12.002

  22. Sheu Y, Marshall LM, Holton KF et al (2013) Abdominal body composition measured by quantitative computed tomography and risk of non-spine fractures: the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 24:2231–2241. doi:10.1007/s00198-013-2322-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Schafer AL, Vittinghoff E, Lang TF et al (2010) Fat infiltration of muscle, diabetes, and clinical fracture risk in older adults. J Clin Endocrinol Metab 95:E368–72. doi:10.1210/jc.2010-0780

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cawthon PM, Fox KM, Gandra SR et al (2009) Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc 57:1411–1419. doi:10.1111/j.1532-5415.2009.02366.x

    Article  PubMed  PubMed Central  Google Scholar 

  25. Frank AW, Farthing JP, Chilibeck PD et al (2015) Community-dwelling female fallers have lower muscle density in their lower legs than non-fallers: evidence from the Saskatoon Canadian Multicentre Osteoporosis Study (CaMos) cohort. J Nutr Health Aging 19:113–120. doi:10.1007/s12603-014-0476-6

    Article  CAS  PubMed  Google Scholar 

  26. Lamb SE, Jørstad-Stein EC, Hauer K, Becker C (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 53:1618–1622. doi:10.1111/j.1532-5415.2005.53455.x

    Article  PubMed  Google Scholar 

  27. Brazier JE, Harper R, Jones NM et al (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. Br Med J 305:160–164

    Article  CAS  Google Scholar 

  28. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    Article  CAS  PubMed  Google Scholar 

  29. Frank-Wilson AW, Johnston JD, Olszynski WP, Kontulainen SA (2015) Measurement of muscle and fat in postmenopausal women: precision of previously reported pQCT imaging methods. Bone 75:49–54. doi:10.1016/j.bone.2015.01.016

    Article  PubMed  Google Scholar 

  30. Blew RM, Lee VR, Farr JN et al (2014) Standardizing evaluation of pQCT image quality in the presence of subject movement: qualitative versus quantitative assessment. Calcif Tissue Int 94:202–211. doi:10.1007/s00223-013-9803-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Beavers KM, Beavers DP, Houston DK et al (2013) Associations between body composition and gait-speed decline: results from the Health, Aging, and Body Composition study. Am J Clin Nutr 97:552–560. doi:10.3945/ajcn.112.047860

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Panel on Prevention of Falls in Older Persons, AGS and BGS (2011) Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157. doi:10.1111/j.1532-5415.2010.03234.x

    Article  Google Scholar 

  33. Taaffe DR, Henwood TR, Nalls MA et al (2009) Alterations in muscle attenuation following detraining and retraining in resistance-trained older adults. Gerontol 55:217–223. doi:10.1159/000182084

    Article  Google Scholar 

  34. Goodpaster BH, Chomentowski P, Ward BK et al (2008) Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial. J Appl Physiol 105:1498–1503. doi:10.1152/japplphysiol.90425.2008

    Article  PubMed  PubMed Central  Google Scholar 

  35. Santanasto AJ, Newman AB, Strotmeyer ES et al (2015) Effects of changes in regional body composition on physical function in older adults: a pilot randomized controlled trial. J Nutr Health Aging. doi:10.1007/s12603-015-0523-y

    PubMed  Google Scholar 

  36. Miljkovic-Gacic I, Zmuda JM (2010) Epidemiology of myosteatosis. Curr Opin Clin Nutr Metab Care 13:260–264. doi:10.1097/MCO.0b013e328337d826

    Article  Google Scholar 

  37. Schaap LA, Pluijm SMF, Deeg DJH et al (2009) Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci 64:1183–1189. doi:10.1093/gerona/glp097

    Article  PubMed  Google Scholar 

  38. Lauretani F, Bandinelli S, Bartali B et al (2006) Axonal degeneration affects muscle density in older men and women. Neurobiol Aging 27:1145–1154. doi:10.1016/j.neurobiolaging.2005.06.009

    Article  PubMed  Google Scholar 

  39. Rodeheffer MS (2010) Tipping the scale: muscle versus fat. Nat Cell Biol 12:102–104. doi:10.1038/ncb0210-102

    Article  CAS  PubMed  Google Scholar 

  40. Rowan SL, Rygiel K, Purves-Smith FM et al (2012) Denervation causes fiber atrophy and myosin heavy chain co-expression in senescent skeletal muscle. PLoS ONE 7:e29082. doi:10.1371/journal.pone.0029082

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Viccaro LJ, Perera S, Studenski SA (2011) Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc 59:887–892. doi:10.1111/j.1532-5415.2011.03336.x

    Article  PubMed  PubMed Central  Google Scholar 

  42. Donoghue OA, Savva GM, Cronin H et al (2014) Using timed up and go and usual gait speed to predict incident disability in daily activities among community-dwelling adults aged 65 and older. Arch Phys Med Rehab 95:1954–1961. doi:10.1016/j.apmr.2014.06.008

    Article  Google Scholar 

  43. Kojima G, Masud T, Kendrick D et al (2015) Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial. BMC Geriatr 15:38. doi:10.1186/s12877-015-0039-7

    Article  PubMed  PubMed Central  Google Scholar 

  44. Delmonico MJ, Harris TB, Visser M et al (2009) Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90:1579–1585. doi:10.3945/ajcn.2009.28047

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. de Rekeneire N, Visser M, Peila R et al (2003) Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study. J Am Geriatr Soc 51:841

    Article  PubMed  Google Scholar 

  46. Goodpaster BH, Krishnaswami S, Resnick H et al (2003) Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women. Diabetes Care 26:372–379. doi:10.2337/diacare.26.2.372

    Article  PubMed  Google Scholar 

  47. Wijlhuizen GJ, Chorus AMJ, Hopman-Rock M (2008) The 24-h distribution of falls and person-hours of physical activity in the home are strongly associated among community-dwelling older persons. Preventive medicine 46:605–608. doi:10.1016/j.ypmed.2008.01.017

    Article  PubMed  Google Scholar 

  48. Wijlhuizen GJ, Chorus AMJ, Hopman-Rock M (2010) The FARE: a new way to express Falls Risk among older persons including physical activity as a measure of exposure. Preventive medicine 50:143–147. doi:10.1016/j.ypmed.2009.12.014

    Article  PubMed  Google Scholar 

  49. Etman A, Wijlhuizen GJ, van Heuvelen MJG et al (2012) Falls incidence underestimates the risk of fall-related injuries in older age groups: a comparison with the FARE (Falls risk by Exposure). Age Ageing 41:190–195. doi:10.1093/ageing/afr178

    Article  PubMed  Google Scholar 

  50. Sanders KM, Hayles AL, Kotowicz MA, Nicholson GC (2009) Monitoring falls in cohort studies of community-dwelling older women. J Am Geriatr Soc 57:733–734. doi:10.1111/j.1532-5415.2009.02205.x

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research could not have been possible without the benevolence and altruism of the CaMOs study volunteers. We would like to recognize Saskatoon CaMOs Coordinator Jola Thingvold, as well as Chantal Kawalilak, Juliegh Clarke, Megan Labas, Emma Burke, and Christopher Bespflug for their assistance with the recruitment and data collection. We would also like to acknowledge Claudie Berger for her assistance with CaMOs data, and the CaMOs Research Group for the study approval.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to A. W. Frank-Wilson or S. A. Kontulainen.

Ethics declarations

Conflicts of interest

None.

Funding sources

A Canadian Institutes of Health Research Saskatchewan Regional Partnership Program (CIHR-RPP) Doctoral Award supports A.W. Frank-Wilson. This work was supported in part by S.A. Kontulainen’s CIHR-RPP New Investigator Award, and funding from the Saskatchewan Health Research Foundation, and Canadian Foundation for Innovation (CFI 16935) and a CIHR Operating Grant (MOP98002).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frank-Wilson, A.W., Farthing, J.P., Chilibeck, P.D. et al. Lower leg muscle density is independently associated with fall status in community-dwelling older adults. Osteoporos Int 27, 2231–2240 (2016). https://doi.org/10.1007/s00198-016-3514-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-016-3514-x

Keywords

Navigation