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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American Podiatric Medical Association (APMA). (2003) High heel survey. Available at http://www.apma.org/s_apma/doc.asp?CID=1233&DID=17112. Accessed 27 March 2012
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
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
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
Karlsson MK, Rosengren BE (2012) Training and bone—from health to injury. Scand J Med Sci Sports 22:e15–e23
Link TM (2012) Osteoporosis imaging: state of the art and advanced imaging. Radiology 263(1):3–17
Frost HM (1987) Bone “mass” and the “mechanostat”. A proposal. Anat Rec 219(1):1–9
Hologic, Inc. (2012) Hologic. The women's health company. Sahara. Available at http://www.hologic.com/en/product-support/bone-densitometry/sahara/. Accessed 4 August 2012
Barkema DD, Derrick TR, Martin PE (2012) Heel height affects lower extremity frontal plane joint movements during walking. Gait Posture 35(3):483–488
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
Sarkis KS, de Medeiros-Pinheiro M, Szejnfeld VL, Martini LA (2012) High bone density and bone health. Endocrinol Nutr 59(3):207–214
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)
Krieg MA et al (2008) Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD official positions. J Clin Densitom 11(1):163–187
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
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
Springbett P, Buglass S, Young AR (2010) Photoprotection and vitamin D status. J Photochem Photobiol B 101(2):160–168
Yoon V, Maalouf NM, Sakhaee K (2012) The effects of smoking on bone metabolism. Osteoporos Int 23(8):2081–2092
Kuehn BM (2008) New tool measures 10-year fracture risk. JAMA 299(14):1651–1652
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
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
Bunta AD (2011) Its time for everyone to own the bone. Osteoporos Int 22(3):S477–S482
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
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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). https://doi.org/10.1007/s10067-012-2088-z
- Bone health
- Bone mineral density
- High-heel use
- Quantitative ultrasound