Exp Clin Endocrinol Diabetes 2001; Vol. 109(2): 87-92
DOI: 10.1055/s-2001-14831
Articles

© Johann Ambrosius Barth

Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis

M. Pfeifer1 , B. Begerow1 , H. W. Minne1 , T. Schlotthauer1 , M. Pospeschill2 , M. Scholz1 , A. D. Lazarescu1 , W. Pollähne1
  • 1 Institute of Clinical Osteology “Gustav Pommer” and Clinic “Der Fürstenhof”, Bad Pyrmont, Germany
  • 2 University of Saarbrücken, Saarbrücken, Germany
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2001 (online)

Summary:

The aim of this study was to identify factors associated with fractures in patients with postmenopausal osteoporosis. The overall hypothesis was that trunk muscle strength, body sway and hypovitaminosis D would influence daily activities and the likelihood of falls and fractures. - In 237 women (mean age 62.9 ± 7.4 years) osteoporosis was defined by a T-score at the femoral neck below - 2.5 SD. Trunk muscle strength was determined using isokinetic dynamometry and body sway was measured according to Lord et al. Limitations in everyday life were assessed and the history of falls was documented. A fracture was defined as a vertebral height reduction of more than 20% or at least 4 mm. The assessment was carried out using the Spine Deformity Index (SDI) and was confirmed by an experienced radiologist. Pearson coefficients of correlation were calculated. - After correction for age, significant associations were found for body sway and 25-hydroxyvitamin D (p < 0.001), body sway and falls (p < 0.001), body sway and rib fractures (p < 0.01), trunk muscle strength and limitations in everyday life (p < 0.001), trunk muscle strength and SDI (p < 0.001), trunk muscle strength and bone density (p < 0.001), and bone density and 25-hydroxyvitamin D (p < 0.001). No significant correlation was found for trunk muscle strength and 25-hydroxyvitamin D (p = 0.712). - Findings suggest that hypovitaminosis D is associated with increased body sway and an elevated risk for falls and falls-related fractures. Musculoskeletal rehabilitation should include strengthening exercises for the trunk muscles and training of neuromuscular co-ordination and balance.

References

  • 1 Bian K, Ishibashi K, Bukoski R D. 1,25(OH)2D3 modulates intracellular Ca2+ and force generation in resistance arteries.  Am J Physiol. 270 H230-H237 1996; 
  • 2 Chapuy M C, Arlot M E, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas P D, Meunier P J. Vitamin D3 and calcium to prevent hip fractures in elderly women.  N Engl J Med. 327 1637-1642 1992; 
  • 3 Chapuy M C, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier P J. Prevalence of vitamin D insufficiency in an adult normal population.  Osteoporos Int. 7 439-443 1997; 
  • 4 Cooper C, Barker D JP, Wickham C. Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain.  Br Med J. 297 1443-1446 1988; 
  • 5 Dawson-Hughes B, Harris S S, Krall E A, Dallal G E. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older.  N Engl J Med. 337 670-676 1997; 
  • 6 Grady D, Halloran B, Cummings S, Leveille S, Wells L, Black D, Byl N. 1,25-dihydroxyvitamin D and muscle strength in the elderly: a randomized controlled trial.  J Clin Endocrinol Metab. 73 1111-1117 1991; 
  • 7 Heikinheimo R J, Inkovaara J A, Harju E J, Haavisto M V, Kaarela R H, Kataja J M. Annual injection of vitamin D and fractures of aged bones.  Calcif Tissue Int. 51 105-110 1992; 
  • 8 Leidig G, Minne H W, Sauer P, Wüster C, Wüster J, Lojen M, Raue F, Ziegler R. A study of complaints and their relation to vertebral destruction in patients with osteoporosis.  Bone Miner. 8 217-229 1990; 
  • 9 Leidig-Bruckner G, Minne H W, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T, Gebest H J, Ziegler R. Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with vertebral osteoporosis.  J Bone Miner Res. 12 663-675 1997; 
  • 10 Lord S R, Clark R D, Webster I W. Postural stability and associated physiological factors in a population of aged persons.  J Gerontol. 46 M69-M76 1991; 
  • 11 Lord S R, Sambrook P, Gilbert C, Kelly P J, Nguyen T, Webster I W, Eisman E A. Postural stability, falls and fractures in the elderly: results from the dubbo osteoporosis study.  Med J Aust. 160 688-691 1994; 
  • 12 Minne H W, Leidig G, Wüster C, Siromachkostov L, Baldauf G, Bickel R, Sauer P, Lojen M, Ziegler R. A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis.  Bone Miner. 3 335-349 1988; 
  • 13 Neveu I, Naveilhan P, Jehan F. Rat brain glial cells synthesize and respond to 1,25-dihydroxyvitamin D3 by an increased production of nerve growth factor. In: Norman AW, Bouillon R, Thomasset M (eds) Vitamin D. A pluripotent steroid hormone: structural studies, molecular endocrinology and clinical applications. Proceedings of the Ninth Workshop on Vitamin D, Orlando, FL, USA 621-628 1994
  • 14 Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J, Eisman E A. Prediction of osteoporotic fractures by postural instability and bone density.  Br Med J. 307 1111-1115 1993; 
  • 15 NIH Consensus Development Conference . Diagnosis, prophylaxis, and treatment of osteoporosis.  Am J Med. 94 646-650 1998; 
  • 16 Ooms M E, Roos J C, Bezemer P D, van der Vijgh W JF, Boutier L M, Lips P. Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind study.  J Clin Endocrinol Metab. 80 1052-1058 1995; 
  • 17 Pfeifer M, Begerow B, Minne H W, Abrams C, Nachtigall D, Hansen C. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women.  J Bone Miner Res. 15 1113-1118 2000; 
  • 18 Pfeifer M, Minne H W. Vitamin D and hip fracture.  Trends Endocrinol Metab. 10 417-420 1999; 
  • 19 Pfeifer M, Pollähne W, Minne H W. Ultrasound analyses of the calcaneus predict relative risk of the presence of at least one vertebral fracture and reflect different physical qualities of bone in different regions of the skeleton.  Horm Metab Res. 29 76-79 1997; 
  • 20 Sauer P, Leidig G, Minne H W, Duckeck G, Schwarz G, Siromachkostov L, Ziegler R. Spine deformity index (SDI) versus other objective procedures of vertebral fracture identification in patients with osteoporosis: a comparative study.  J Bone Miner Res. 6 227-238 1991; 
  • 21 Simpson R U, Thomas G A, Arnold A J. Identification of 1,25-dihydroxyvitamin D3 receptors and activities on muscle.  J Biol Chem. 260 8882-8891 1985; 
  • 22 Sinaki M, Opitz J L, Wahner H W. Bone mineral content: relationship to muscle strength in normal subjects.  Arch Phys Med Rehabil. 55 508-512 1974; 
  • 23 Sinaki M, McPhee M C, Hodgson S F, Merritt J M, Offord K P. Relationship between bone mineral density of spine and strength of back extensors.  Mayo Clin Proc. 61 116-122 1986; 
  • 24 Sinaki M, Offord K P. Physical activity in postmenopausal women: effect on back muscle strength and bone mineral density of the spine.  Arch Phys Med Rehabil. 69 277-280 1988; 
  • 25 Sinaki M. Musculoskeletal rehabilitation. In: Riggs BL, Melton LJ (eds) Osteoporosis: etiology, diagnosis, and management, Second Edition. Lippincott-Raven Publishers, Philadelphia 435-474 1995
  • 26 Thomas M K, Lloyd-Jones D M, Thadhani R I, Shaw A C, Deraska D J, Kitch B T, Vamvakas E C, Dick I M, Prince R L, Finkelstein J S. Hypovitaminosis D in medical inpatients.  N Engl J Med. 338 777-783 1998; 
  • 27 Turner C H, Forwood M R, Rho J Y, Yoshikawa T. Mechanical loading thresholds for lamellar and woven bone formation.  J Bone Miner Res. 9 87-97 1994; 

Dr. Michael Pfeifer

Institute of Clinical Osteology “Gustav Pommer”

Am Hylligen Born 7

D-31812 Bad Pyrmont

Germany

Telefon: +49-5281-151414

Fax: +49-5281-151100

eMail: ikopyrmont@t-online.de