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Postural control is associated with muscle power in post-menopausal women with low bone mass



Older women with low bone mass are at higher risk of fracture and there is limited data on what is associated with risk of falls. We found explosive jumping to relate most strongly to postural control. It may be beneficial to include power or speed training into falls prevention programs.


Post-menopausal women with low bone mass are at higher risk of bone fractures subsequent to falls. Understanding the correlates of postural control in this collective informs intervention design for falls prevention.


We examined postural control in single-leg stance on stable and unstable surfaces in 63 community-dwelling post-menopausal women with osteopenia or osteoporosis but without diagnosed neuromuscular, vestibular or arthritic diseases. Postural measures were compared to countermovement jump performance (height, force and power), leg-press strength (10 repetition maximum), calf muscle area and density (via peripheral quantitative computed tomography), body mass, height and age.


On step-wise regression, peak countermovement jump power and jump height (p ≤ 0.014), but not jump force, leg-press strength or calf muscle size, were related to postural control in single-leg stance on, respectively, an unstable surface (eyes open) and standing on a stable surface (eyes open). None of the parameters measured were significantly related to the postural control parameters in single-leg stance on a stable surface with eyes closed. With testing on the stable surface, body mass was associated with slow mean centre of pressure movement speed (p ≤ 0.030).


Our findings show that, in post-menopausal women with low bone mass, neuromuscular power is a more important determinant of postural control than muscle strength or size. Our findings provide evidence to support the integration of power or speed training into falls prevention and balance training programs in post-menopausal women with osteopenia and osteoporosis.

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  1. Abreu DC, Trevisan DC, Costa GC, Vasconcelos FM, Gomes MM, Carneiro AA (2010) The association between osteoporosis and static balance in elderly women. Osteoporos Int 21:1487–1491

    CAS  Article  Google Scholar 

  2. Burke TN, França FJR, Meneses SRF, Cardoso VI, Pereira RMR, Danilevicius CF, Marques AP (2010) Postural control among elderly women with and without osteoporosis: is there a difference? Sao Paulo Med J 128:219–224

    Article  Google Scholar 

  3. Hue O, Simoneau M, Marcotte J, Berrigan F, Doré J, Marceau P, Marceau S, Tremblay A, Teasdale N (2007) Body weight is a strong predictor of postural stability. Gait Posture 26:32–38

    Article  Google Scholar 

  4. Binda SM, Culham EG, Brouwer B (2003) Balance, muscle strength, and fear of falling in older adults. Exp Aging Res 29:205–219

    Article  Google Scholar 

  5. Carter ND, Khan KM, Mallinson A, Janssen PA, Heinonen A, Petit MA, McKay H, Fall-Free BC Research Group (2002) Knee extension strength is a significant determinant of static and dynamic balance as well as quality of life in older community-dwelling women with osteoporosis. Gerontology 48:360–368

    Article  Google Scholar 

  6. Hassan BS, Mockett S, Doherty M (2001) Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis 60:612–618

    CAS  Article  Google Scholar 

  7. Jadelis K, Miller ME, Ettinger WH, Messier SP (2001) Strength, balance, and the modifying effects of obesity and knee pain: results from the Observational Arthritis Study in Seniors (oasis). J Am Geriatr Soc 49:884–891

    CAS  Article  Google Scholar 

  8. Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A (2002) Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci 57:M539–M543

    Article  Google Scholar 

  9. Lord SR, Clark RD, Webster IW (1991) Postural stability and associated physiological factors in a population of aged persons. J Gerontol 46:M69–M76

    CAS  Article  Google Scholar 

  10. Ringsberg K, Gerdhem P, Johansson J, Obrant KJ (1999) Is there a relationship between balance, gait performance and muscular strength in 75-year-old women? Age Ageing 28:289–293

    CAS  Article  Google Scholar 

  11. Bohannon RW (1995) Standing balance, lower extremity muscle strength, and walking performance of patients referred for physical therapy. Percept Mot Skills 80:379–385

    CAS  Article  Google Scholar 

  12. Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65-89 years. Age Ageing 23:371–377

    CAS  Article  Google Scholar 

  13. Stolzenberg N, Belavý DL, Rawer R, Felsenberg D (2013) Vibration or balance training on neuromuscular performance in osteopenic women. Int J Sports Med 34:956–962

    CAS  Article  Google Scholar 

  14. Stolzenberg N, Belavý DL, Beller G, Armbrecht G, Semler J, Felsenberg D (2013) Bone strength and density via pQCT in post-menopausal osteopenic women after 9 months resistive exercise with whole body vibration or proprioceptive exercise. J Musculoskelet Neuronal Interact 13:66–76

    CAS  PubMed  Google Scholar 

  15. Stolzenberg N, Belavý DL, Rawer R, Felsenberg D (2013) Whole-body vibration versus proprioceptive training on postural control in post-menopausal osteopenic women. Gait Posture 38:416–420

    Article  Google Scholar 

  16. Goodpaster BH, Kelley DE, Thaete FL, He J, Ross R (2000) Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol Bethesda Md 1985(89):104–110

    Google Scholar 

  17. Farr JN, Funk JL, Chen Z, Lisse JR, Blew RM, Lee VR, Laudermilk M, Lohman TG, Going SB (2011) Skeletal muscle fat content is inversely associated with bone strength in young girls. J Bone Miner Res 26:2217–2225

    Article  Google Scholar 

  18. Le Pellec A, Maton B (2002) Initiation of a vertical jump: the human body’s upward propulsion depends on control of forward equilibrium. Neurosci Lett 323:183–186

    Article  Google Scholar 

  19. Horak FB (2006) Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 35(Suppl 2):ii7–ii11

    Article  Google Scholar 

  20. Preventive Services Task Force US et al (2018) Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA 319:1696–1704

    Article  Google Scholar 

  21. Orr R, Raymond J, Fiatarone Singh M (2008) Efficacy of progressive resistance training on balance performance in older adults: a systematic review of randomized controlled trials. Sports Med 38:317–343

    Article  Google Scholar 

  22. Orr R, de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Fiatarone-Singh MA (2006) Power training improves balance in healthy older adults. J Gerontol A Biol Sci Med Sci 61:78–85

    Article  Google Scholar 

  23. Maki BE, McIlroy WE (2006) Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age Ageing 35(Suppl 2):ii12–ii18

    Article  Google Scholar 

  24. Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Sanders KM, Hill K, Daly RM (2014) Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. J Bone Miner Res 29:182–191

    Article  Google Scholar 

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The subjects who participated in the study are thanked for their involvement. We also thank the staff from the radiology department (Charité Campus Benjamin Franklin) and the Center of Muscle and Bone Research for their assistance. The Sport-Gesundheitspark Berlin e.V. assisted with the medical screening. We also acknowledge the assistance of the Immanuel Krankenhaus Berlin, particularly Drs. Semler and Hellmich, as well as the SBK Siemens Krankenkasse for the assistance with subject recruitment. The lead author thanks his family for their support during the course of his PhD. The companies Zebris (CMS 10 system) and Haider-Bioswing (Posturomed system) loaned equipment for use in the current project.

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Correspondence to D. L. Belavy.

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The current study was approved by the ethical commission of the Charité Universitätsmedizin Berlin and the subjects gave their informed written consent.

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Stolzenberg, N., Felsenberg, D. & Belavy, D.L. Postural control is associated with muscle power in post-menopausal women with low bone mass. Osteoporos Int 29, 2283–2288 (2018).

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  • Elderly
  • Function
  • Falls
  • Jumping mechanography
  • Leg press
  • Muscle force
  • Muscle power
  • Postural control
  • pQCT