Functional heterogeneity and outcomes in community-dwelling women with osteoporosis, with and without a history of falls

Abstract

Falls leading to osteoporotic fracture is a substantial issue clinically. By inference from the literature, women with osteoporosis who are classified as having a history of falls may not represent a distinct homogeneous population. However, studies exploring the potential heterogeneity within fallers in women with osteoporosis are scarce. The objective of this study was to better understand the physical function characteristics of women with osteoporosis, with and without a previous history of falls, by further stratifying them based on their single-leg stance (SLS) performance. Eighty-seven consecutive, community-dwelling women with osteoporosis were recruited from the Endocrinology Clinic at Singapore General Hospital. Laboratory-based and clinic-based standing balance tests, a lower limb strength test, and the 6-min walk test (6MWT) were measured. Fallers and non-fallers did not differ in standing balance, lower limb strength nor the 6MWT (P's>0.08). SLS performance was an independent predictor of the various functional measures, after adjusting for age and body mass index. Specifically, an increase in SLS time was associated with lower standing center-of-pressure velocities, greater lower limb strength, and greater 6-min walking distance. When the two groups were stratified based on their recent history of falls and clinic-based standing balance performance (SLS time), fallers with good SLS time (>30s) showed better functional outcomes than did non-fallers with poor SLS time (≤30s) (P's<0.08) and comparable functional outcomes with non-fallers with good SLS time (P's>0.11). The results indicate an important heterogeneity within fallers and non-fallers with osteoporosis and they argue for a individualized approach to rehabilitation.