Postural control among elderly women with and without osteoporosis: is there a difference?

CONTEXT AND OBJECTIVE: Little is known about postural control among elderly individuals with osteoporosis and its relationship with falls. It has been suggested that elderly women with kyphosis and osteoporosis are at greater risk of falling. The aim of this study was to evaluate posture and postural control among elderly women with and without osteoporosis. DESIGN AND SETTING: Cross-sectional study conducted at the Physical Therapy and Electromyography Laboratory, School of Medicine, Universidade de São Paulo (USP). METHODS: Sixty-six elderly women were selected from the bone metabolism disorders clinic, Division of Rheumatology, USP, and were divided into two groups: osteoporosis and controls, according to their bone mineral density (BMD). Postural control was assessed using the Limits of Stability (LOS) test and the Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) and posture, using photometry. RESULTS: The elderly women with osteoporosis swayed at higher velocity on a stable surface with opened eyes (0.30 versus 0.20 degrees/second; P = 0.038). In both groups, the center of pressure (COP) was at 30% in the LOS, but with different placements: 156° in the osteoporosis group and 178° in the controls (P = 0.045). Osteoporosis patients fell more than controls did (1.0 versus 0.0; P = 0.036). CONCLUSIONS: The postural control in elderly women with osteoporosis differed from that of the controls, with higher sway velocity and maximum displacement of COP. Despite postural abnormalities such as hyperkyphosis and forward head, the COP position was posteriorized.

Postural control among elderly women with and without osteoporosis: is there a difference? / Controle postural de idosas com e sem osteoporose: há diferenças?

CONTEXT AND OBJECTIVE: Little is known about postural control among elderly individuals with osteoporosis and its relationship with falls. It has been suggested that elderly women with kyphosis and osteoporosis are at greater risk of falling. The aim of this study was to evaluate posture and postural control among elderly women with and without osteoporosis. DESIGN AND SETTING: Cross-sectional study conducted at the Physical Therapy and Electromyography Laboratory, School of Medicine, Universidade de São Paulo (USP). METHODS: Sixty-six elderly women were selected from the bone metabolism disorders clinic, Division of Rheumatology, USP, and were divided into two groups: osteoporosis and controls, according to their bone mineral density (BMD). Postural control was assessed using the Limits of Stability (LOS) test and the Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) and posture, using photometry. RESULTS: The elderly women with osteoporosis swayed at higher velocity on a stable surface with opened eyes (0.30 versus 0.20 degrees/second; P = 0.038). In both groups, the center of pressure (COP) was at 30 percent in the LOS, but with different placements: 156° in the osteoporosis group and 178° in the controls (P = 0.045). Osteoporosis patients fell more than controls did (1.0 versus 0.0; P = 0.036). CONCLUSIONS: The postural control in elderly women with osteoporosis differed from that of the controls, with higher sway velocity and maximum displacement of COP. Despite postural abnormalities such as hyperkyphosis and forward head, the COP position was posteriorized.

CONTEXTO E OBJETIVO: Pouco se sabe sobre o controle postural de idosos com osteoporose e sua relação com as quedas. Foi sugerido que idosas cifóticas com osteoporose têm maior risco de quedas. Esta pesquisa teve como objetivo avaliar o controle postural e a postura em idosas com e sem osteoporose. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no Laboratório de Avaliação Fisioterapêutica e Eletromiografia da Faculdade de Medicina da Universidade de São Paulo (USP). MÉTODOS: Sessenta e seis mulheres idosas foram selecionadas da Clínica de Doenças Osteometabólicas da Divisão de Reumatologia da Universidade de São Paulo e divididas em dois grupos: osteoporose e controle, de acordo com a densidade mineral óssea (DMO). Foi avaliado o controle postural pelos testes Limite de Estabilidade (LOS) e Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) e a postura pela fotometria. RESULTADOS: As idosas com osteoporose oscilaram com maior velocidade em superfície firme com olhos abertos (0,30 x 0,20 graus/segundo, P = 0,038). O COP (centro de pressão) de ambos os grupos encontrava-se a 30 por cento do LOS, porém com posicionamentos distintos: 156° no grupo osteoporose e 178° no grupo controle (P = 0,045). As osteoporóticas caíram com maior frequência em comparação aos controles (1,0 x 0,0, P = 0,036). CONCLUSÃO: O controle postural de idosas com osteoporose diferiu dos controles, com maior velocidade de oscilação e máximo deslocamento do COP, e que apesar da presença de alterações posturais como hipercifose e anteriorização de cabeça, o COP se encontrou posteriorizado.

Postural control in elderly persons with osteoporosis: Efficacy of an intervention program to improve balance and muscle strength: a randomized controlled trial.

OBJECTIVE: To assess the efficacy of an exercise program aiming to improve balance and muscular strength, for postural control and muscular strength of women with osteoporosis. DESIGN: Sample consisted of 33 women with osteoporosis, randomized into one of two groups: intervention group, in which exercises for balance and improvement of muscular strength of the inferior members were performed for 8 wks (n = 17, age 72.8 +/- 3.6 yrs); control group, which was women not practicing exercises (n = 16, age 74.4 +/- 3.7 yrs). At baseline and after 8 wks of treatment, postural control was assessed using a force plate (Balance Master, Neurocom), and muscular strength during ankle dorsiflexion, knee extension, and flexion was assessed by dynamometry. RESULTS: Adherence to the program was 82%. When compared with the control group, individuals in the intervention group significantly improved the center of pressure velocity (P = 0.02) in the modified clinical test of sensory interaction for balance test, center of pressure velocity (P < 0.01), and directional control (P < 0.01) in limits of stability test, isometric force during ankle dorsiflexion (P = 0.01), knee extension (P < 0.01), and knee flexion (P < 0.01). CONCLUSIONS: Balance and strength exercises are effective in improving postural control and lower-limb strength in elderly women with osteoporosis.