Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair


This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7) years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212) = −0.14, p = 0.038, as well as history of smoking and BMD, r(212) = −0.14, p = 0.042. Bone health risk score was strongly correlated with heel use binary variable “yes/no,” r(210) = 0.21, p = 0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS.

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  1. 1.

    American Podiatric Medical Association (APMA). (2003) High heel survey. Available at Accessed 27 March 2012

  2. 2.

    Simonsen EB et al (2012) Walking on high heels changes muscle activity and the dynamics of human walking significantly. J Appl Biomech 28(1):20–28

    PubMed  Google Scholar 

  3. 3.

    Mika A, Olesky L, Mikolajczyk E, Marchewka A, Mika P (2011) Changes of bioelectrical activity in cervical paraspinal muscle during gait in low and high heel shoes. Acta Bioeng Biomech 13(1):27–33

    PubMed  Google Scholar 

  4. 4.

    Mika A, Olesky L, Mika P, Marchewka A, Clark BC (2012) The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait. Am J Phys Med Rehabil 91:425–434

    PubMed  Article  Google Scholar 

  5. 5.

    Karlsson MK, Rosengren BE (2012) Training and bone—from health to injury. Scand J Med Sci Sports 22:e15–e23

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Link TM (2012) Osteoporosis imaging: state of the art and advanced imaging. Radiology 263(1):3–17

    PubMed  Article  Google Scholar 

  7. 7.

    Frost HM (1987) Bone “mass” and the “mechanostat”. A proposal. Anat Rec 219(1):1–9

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Hologic, Inc. (2012) Hologic. The women's health company. Sahara. Available at Accessed 4 August 2012

  9. 9.

    Barkema DD, Derrick TR, Martin PE (2012) Heel height affects lower extremity frontal plane joint movements during walking. Gait Posture 35(3):483–488

    PubMed  Article  Google Scholar 

  10. 10.

    Mika A, Olesky L, Mika P, Marchewka A, Clark BC (2012) The influence of heel height on lower extremity kinematics and leg muscle activity during gait in young and middle aged women. Gait Posture 35(4):677–680

    PubMed  Article  Google Scholar 

  11. 11.

    Sarkis KS, de Medeiros-Pinheiro M, Szejnfeld VL, Martini LA (2012) High bone density and bone health. Endocrinol Nutr 59(3):207–214

    PubMed  Article  Google Scholar 

  12. 12.

    Seifert-Klauss V, Fillenberg S, Schneider H, Luppa P, Mueller D, Kiechle M (2012) Bone loss in premenopausal, perimenopausal, and postmenopausal women: results of a prospective observational study over 9 years. Climacteric (in press)

  13. 13.

    Krieg MA et al (2008) Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD official positions. J Clin Densitom 11(1):163–187

    PubMed  Article  Google Scholar 

  14. 14.

    Maggi S et al (2006) Quantitative heel ultrasound in a population-based study in Italy and its relationship with fracture history: the ESOPO study. Osteoporosis Int 17:237–244

    Article  CAS  Google Scholar 

  15. 15.

    Pothiwala P, Evans EM, Chapman-Novakofski KM (2006) Ethnic variation in risk for osteoporosis among women: a review of biological and behavioral factors. J Womens Health 15(6):709–719

    Article  Google Scholar 

  16. 16.

    Springbett P, Buglass S, Young AR (2010) Photoprotection and vitamin D status. J Photochem Photobiol B 101(2):160–168

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Yoon V, Maalouf NM, Sakhaee K (2012) The effects of smoking on bone metabolism. Osteoporos Int 23(8):2081–2092

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Kuehn BM (2008) New tool measures 10-year fracture risk. JAMA 299(14):1651–1652

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Sarkis KS, Martini LA, Szejnfeld VL, Pinheiro MM (2012) Low fatness, reduced fat intake and adequate plasmatic concentrations of LDL-cholesterol are associated with high bone mineral density in women: a cross sectional study with control group. Lipids Health Dis 11:37

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Gong J, Xu Y, Guo B, Xu H (2012) DXA femoral strength analysis in Chinese overweight and normal weight adolescents. J Clin Densitom 15:146–151

    PubMed  Article  Google Scholar 

  21. 21.

    Bunta AD (2011) Its time for everyone to own the bone. Osteoporos Int 22(3):S477–S482

    Article  Google Scholar 

  22. 22.

    Zagarins SE, Ronnenberg AG, Gehlbach SH, Lin R, Bertone-Johnson ER (2012) Are existing measures of overall diet quality associated with peak bone mass in young premenopausal women? J Hum Nutr 25(2):172–179

    Article  CAS  Google Scholar 

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Correspondence to Crystal M. Glassy.

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Glassy, C.M., Glassy, M.S. & Guggenheim, C. Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair. Clin Rheumatol 32, 37–41 (2013).

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  • Bone health
  • Bone mineral density
  • High-heel use
  • Osteoporosis
  • Quantitative ultrasound