Original article
Association of Physical Performance Measures With Bone Mineral Density in Postmenopausal Women

Presented in part to the American Society for Bone and Mineral Research Conference, September 2000, Toronto, ON, Canada.
https://doi.org/10.1016/j.apmr.2004.09.028Get rights and content

Abstract

Lindsey C, Brownbill RA, Bohannon RA, Ilich JZ. Association of physical performance measures with bone mineral density in postmenopausal women. Arch Phys Med Rehabil 2005;86:1102–7.

Objective

To investigate the association between physical performance measures and bone mineral density (BMD) in older women.

Design

Cross-sectional analysis.

Setting

University research laboratory.

Participants

Healthy postmenopausal women (N=116; mean age ± standard deviation, 68.3±6.8y) in self-reported good health who were not taking medications known to affect bone, including hormone replacement therapy.

Interventions

Not applicable.

Main Outcome Measures

Anthropometrics and BMD of the hip, spine, whole body, and forearm. Physical performance measures included normal and brisk 8-m gait speed, normal step length (NSL), brisk step length (BSL), timed 1-leg stance (OLS), timed sit-to-stand (STS), and grip strength.

Results

NSL, BSL, normal gait speed, brisk gait speed, OLS, and grip strength correlated significantly with several skeletal sites (r range, .19–.38; P<.05). In multiple regression models containing body mass index, hours of total activity, total calcium intake, and age of menarche, NSL, BSL, normal and brisk gait speeds, OLS, and grip strength were all significantly associated with BMD of various skeletal sites (adjusted R2 range, .11–.24; P<.05). Analysis of covariance showed that subjects with longer step lengths and faster normal and brisk gait speeds had higher BMD at the whole body, hip, and spine (brisk speed only). Those with a longer OLS had greater femoral neck BMD, and those with a stronger grip strength had greater BMD in the whole body and forearm (P<.05). STS was not related to any skeletal site.

Conclusions

Normal and brisk gait speed, NSL, BSL, OLS, and grip strength are all associated with BMD at the whole body, hip, spine, and forearm. Physical performance evaluation may help with osteoporosis prevention and treatment programs for postmenopausal women when bone density scores have not been obtained or are unavailable.

Section snippets

Study Design and Subjects

This cross-sectional analysis included 116 postmenopausal, white women (mean age ± standard deviation [SD], 68.3±6.8y; range, 57.4–88.6y) who reported general good health. They were recruited via newspaper and senior center advertisement for a larger longitudinal clinical trial. Subject recruitment was described in detail earlier.18 In brief, subjects were living independently, were free of chronic disease (including kidney stones, uncontrolled hypertension, diabetes, severe osteoporosis, and

Results

Table 2 shows descriptive characteristics of subjects. NSL and BSL both correlated significantly with femoral neck, Ward’s triangle, and total body BMD (r range, .20–.30; P range, .03–.001). Brisk gait speed correlated significantly with whole body BMD (r=.25, P=.008). Normal and brisk gait speed correlated significantly with femoral neck BMD (r=.19, P=.04; r=.21, P=.03, respectively). OLS correlated significantly with femoral neck and whole body BMD (r=.21, P=.02; r=.22, P=.03, respectively).

Discussion

Although many factors are associated with BMD, this report focused on physical performance measures that could be easily obtained in community settings. The physical measures evaluated herein were chosen for their reliability and clinical ease of administration, and because each has been associated with balance and fall risks in older people.10, 12, 14, 16, 26 We hypothesized that better performance scores for gait speed, step length, OLS time, and STS time could be associated with higher bone

Conclusions

Step length, walking speed, balance, and grip strength evaluation may help with osteoporosis prevention and treatment programs for postmenopausal women when bone density scores have not been obtained or are unavailable. Because adjusted coefficients of determination were similar for all regression models, it appears that measuring only one of the physical performance variables (NSL, BSL, normal and brisk walking speed, and/or OLS) would be sufficient for estimating hip and whole body BMD,

References (42)

  • O.M. Rutherford

    Is there a role for exercise in the prevention of osteoporotic fractures?

    Br J Sports Med

    (1999)
  • J. Ilich-Ernst et al.

    Critical factors for bone health in women across the age spanhow important is muscle mass?

    Medscape Womens Health

    (2002)
  • R.A. Brownbill et al.

    Hip geometry and bone density in postmenopausal women

    Calcif Tissue Int

    (2003)
  • J.M. Guralnik et al.

    A short physical performance battery assessing lower extremity functionassociation with self-reported disability and prediction of mortality and nursing home admission

    J Gerontol

    (1994)
  • J.O. Judge et al.

    Step length reductions in advanced agethe role of ankle and hip kinetics

    J Gerontol A Biol Sci Med Sci

    (1996)
  • K. Berg et al.

    A comparison of clinical and laboratory measures of postural balance in an older population

    Arch Phys Med Rehabil

    (1992)
  • G.M. Gehlsen et al.

    Falls in the older: part II. Balance, strength, and flexibility

    Arch Phys Med Rehabil

    (1990)
  • B.J. Vellas et al.

    One-leg balance is an important predictor of injurious falls in older persons

    J Am Geriatr Soc

    (1997)
  • C. Lindsey et al.

    Association between physical performance, muscle mass and bone mass in apparently healthy postmenopausal women [abstract]

    J Bone Miner Res

    (2000)
  • J.Z. Ilich et al.

    Bone and nutrition in older womenprotein, energy and calcium as main determinants of bone mineral density, and effect of physical activity

    Eur J Clin Nutr

    (2003)
  • J.O. Judge et al.

    Balance improvements in older womeneffects of exercise training

    Phys Ther

    (1993)
  • Cited by (81)

    • Measures of physical performance as a predictor of fracture risk independent of BMD: The Chungju metabolic disease cohort study

      2021, Bone
      Citation Excerpt :

      Low BMD is correlated with low physical function as poor physical function reduces mechanical loading and leads to a loss of BMD [31]. Several studies have shown positive associations between the BMD in various skeletal sites and lower extremity physical performance measures [32,33]. Individuals who cannot stand on one leg for longer duration may exhibit not only poor static balance but also low muscle mass and strength around the hip.

    • Unipedal balance test for older adults: a systematic review and meta-analysis of studies providing normative data

      2018, Physiotherapy (United Kingdom)
      Citation Excerpt :

      Fig. 1 summarizes how the 23 articles in the review were selected from 156 unique articles identified by database and hand searches. Table 1 summarizes the specifics of the selected studies [12–15,17–37]. The studies included residents of 11 countries (United States = 7, Japan = 6, Taiwan = 2, and other = 8).

    • Beyond mobility assessment: Timed up and go test and its relationship to osteoporosis and fracture risk

      2016, Journal of Clinical Gerontology and Geriatrics
      Citation Excerpt :

      Taaffe et al20 found that physical capacity, assessed by repeated chair stands, gait speed, walking endurance, and standing balance, was modestly related to BMD at the hip. However, Lindsey et al21 showed that poor physical performance is associated with reduced hip, spine, and whole body BMD, while using normal and brisk gait speeds, normal and brisk step length, and one leg stance time. They explained that the decrease in bone density in patients with poor physical activity was due to the reduced mechanical load on bones.

    View all citing articles on Scopus

    Supported in part by the National Resources Inventory/US Department of Agriculture (grant no. 2001-00836), Donaghue Medical Research Foundation (grant no. DF98-056), and University of Connecticut Office for Sponsored Programs.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

    View full text