Can a simple leg stand test predict hip-fracture risk in women?

New study shows that, even in comparatively younger women, a simple test of muscle coordination and balance was an early predictor of hip fracture.

A new study shows that  the inability to stand on one leg for 10 seconds or to squat down to reach the floor are strong early predictors of hip fracture and mortality in postmenopausal women.

The finding resulted from a 15-year follow-up study presented at the American Society for Bone and Mineral Research (ASBMR) 2014 annual meeting. The findings were particularly notable considering that the study participants were followed at the relatively young ages of between 59 to 74 years.

First author  Dr Toni Rikkonen, of the University of Eastern Finland, in Kuopio said,

Squatting down to reach a floor and maintaining balance on one foot for a moment are essential functional abilities and very simple to measure. Inability to accomplish either of them demonstrates functional decline with increased risk of mortality and fractures."

While bone-mineral-density tests and other measures provide essential information on when a patient may need stepped-up osteoporosis prevention, research on signs of physical deterioration that can predict hip fracture is lacking. In an effort to better identify such signs, Dr. Rikkonen and colleagues evaluated data on 2791 women, average age of 59.1 years, in the Osteoporosis Risk Factor and Prevention Study (OSPRE). At a mean follow-up of 13.1 years, 578 fractures were reported among the women, including 35 hip fractures, and there were 258 deaths (9.2%). At the start of the trial the women had been asked to perform three physical tests  —to squat down and touch the floor; to stand on one leg for 10 seconds; and grip strength was measured (with weakest grip indicative of inability to perform the test).

A total of 1587 women (56.9%) showed no functional decline at baseline according to these physical tests and were considered to be the reference group. Compared with the reference group, the women who did have signs in any of the three categories of functional decline had a significantly higher risk for hip fracture and mortality risk was also higher as was the risk for any fracture among those showing inability to perform any of the 3 tests.

Women who were unable to complete the leg-stand test, however, had the highest risk for hip fracture, compared with those who could complete the test. The second strongest predictor of hip fracture was failure in squatting and touching the floor.

The results remained consistent after adjustment for factors including hip bone mineral density (BMD), age, body mass index (BMI), and smoking.Only modest increases in risk were seen when the risk factors were combined, and adjustments for factors including hip BMD and age or adjusting mortality risk for BMI and smoking did not change the results.

The good news is that balance and coordination can be improved. Dr Rikkonen noted,

As functional limitations are usually modifiable, patients with poor balance and muscle strength should be encouraged to use their legs and train their balance in a safe manner, regardless of their age.”

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Abstract FR0455. Summarized from