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Antonia Diegisser - Physiotherapeutin, M.Sc. in phys.

Network Aging Research
Bergheimer Straße 20
69115 Heidelberg

Phone: +49 (0)6221 54 81 39
diegisser@nar.uni-hd.de

Fellows: PD Dr. Philipp Drees; Dr. Ulrich Betz

Risk of fall with osteoporosis

The question of the evaluation with osteoporosis patients is: is there a correlation between spinal pain, spinal mobility and spinal column statics and the risk of falling?

About one - third of the people requiring care in old age are subject to an increased risk of falling. The number of falls rises steeply with increasing age, especially in patients suffering from osteoporosis [1, 2]. The governing symptom of osteoporosis is a pain in the back, caused by one or more vertebral fractures engendering a reflex hypertonus of the muscle-tendon system. In addition statical changes develop towards a kyphosis and a diminished mobility of the entire spine system [3]. Dr. U. Betz and his working group at the Institute of Physical Therapy, Prevention and Rehabilitation of the University of Mainz Medical Center have hypothesized that every one of these symptoms typical of osteoporosis may contribute to the tendency to fall.

Permanent back pain induces the patient to avoid certain body movements. The activity level is thus reduced, resulting in a decrease in muscle strength. Body movements are more uncoordinated and less differentiated thus potentially interfering with an appropriate response to disturbances of equilibrium. A spinal column with reduced mobility reduces the variety of equilibrium reactions. A kyphosis of the spine promotes a shift of the center of gravity of the upper body mass in the anterior direction which may result in an increased instability of standing body postures. In osteoporosis patients these chains of symptoms could result in a vicious cycle. Fear of falling and a gait instability lead to falls and fractures [3] and may, as a consequence, create new fears and insecurity. Osteoporosis patients are ideal for an investigation of the tendency of the elderly to fall with regard to the factors spine pain, spine statics and spine mobility, since they all exhibit age specific protracted changes of the spine. In previous fall-prevention training programs for older people emphasis has been put almost exclusively on improving the strength and balance considering the above-mentioned factors only marginally or not at all [7]. Even in scientific studies pain, kyphosis or reduced mobility of the spine have as yet cought little attention as risk factors for falls and have been underrated in this respect [4-6]. We thus consider the question whether there is a relationship between spinal pain, spinal mobility, and spinal column statics and the risk of falls an extraordinarily interesting problem to be solved in the context of geriatric research.

References
1. Close JC, L.S., Menz HB, Sherrington C. , What is the role of falls? Best Pract Res Clin Rheumatol 2005. 19: p. 913-935.

2. Tinetti, M., Preventing falls in elderly persons. N Engl J Med 2003. 348: p. 42-49.

3. DVO, Prophylaxe, Diagnostik und Therapie der Osteoporose bei Frauen ab der Menopause, bei Männern ab dem 60.Lebensjahr. S3-Leitlinie des Dachverbandes der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaft e.V. 2006

4. Leveille SG, J.R., Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM, Kiel DP, Lipsitz LA, Bean JF., Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA., 2009. 302(20): p. 2214-21.

5. Leveille SG, K.D., Jones RN, Roman A, Hannan MT, Sorond FA, Kang HG, Samelson EJ, Gagnon M, Freeman M, Lipsitz LA., The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population. BMC Geriatr. , 2008. 18(8): p. 16.

6. Liu-Ambrose T, E.J., Khan KM, Carter ND, McKay HA., Older women with osteoporosis have increased postural sway and weaker quadriceps strength than counterparts with normal bone mass: overlooked determinants of fracture risk? J Gerontol A biol Sci Med Sci., 2003. 58(9): p. M862-2.

7. Ziganek-Soehlke. StuBs, Sturzprophylaxe durch Bewegungsschulung, Mehr Bewegungssicherheit im Alltag. Pflaum-Verlag, München (2008).

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