Low bone mineral density (LBMD) significantly contributes to loss of independence, gait impairment, and increased fall risk. Instrumental gait analysis provides an accurate evaluation of walking ability, that represent the first step for a personalized rehabilitation.
Objective
To collect and describe the available literature on the effect of LBMD on walking characteristics and the use of motion analysis systems in patients with LBMD.
Methods
We performed a literature search of the last ten years on PubMed, Web of Science and Scopus of papers on older people and patients with LBMD in terms of gait parameters, balance, and fall risk. The review protocol was registered on PROSPERO (CRD42024590090).
Results
The database search identified totally 756 records; after duplicates deletion, 13 were considered eligible. The results reported that subjects with LBMD had kinematic alterations of the walk, alterations of posture, speed of walking and the strength generated in the gait. Patients with osteoporosis show a reduction of gait speed and trunk asymmetry; moreover, there is a a decrease in body rotation and lower hip and ankle moments in post-menopausal women.
Conclusions
Patients with LBMD showed gait alterations that can higher the risk of falls. In this context, gait analysis can be useful in detecting variations in pattern, symmetry, gait speed and posture in elderly patients, that can represent an essential step for a personalized rehabilitation program.
CurtisELitwicACooperC,et al.Determinants of muscle and bone aging. J Cell Physiol2015; 230: 2618–2625.
2.
VaracalloMSeamanTJJanduJS,et al.Osteopenia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2024[cited 2024 Sep 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499878/.
3.
KarunanithiRGanesanSPanickerTMR, et al.Assessment of bone mineral density by DXA and the trabecular microarchitecture of the calcaneum by texture analysis in pre- and postmenopausal women in the evaluation of osteoporosis. J Med Phys Assoc Med Phys India2007; 32: 161–168.
4.
CurtisJRAroraTLiuY, et al.Comparative effectiveness of denosumab vs alendronate among postmenopausal women with osteoporosis. J Bone Miner Res2024 Jul 1; 39: 826–834.
5.
MigliaccioSFrancomanoDRomagnoliE, et al.Persistence with denosumab therapy in women affected by osteoporosis with fragility fractures: a multicenter observational real practice study in Italy. J Endocrinol Invest2017 Dec 1; 40: 1321–1326.
6.
BrownJPEngelkeKKeavenyTM, et al.Romosozumab improves lumbar spine bone mass and bone strength parameters relative to alendronate in postmenopausal women: results from the active-controlled fracture study in postmenopausal women with osteoporosis at high risk (ARCH) trial. J Bone Miner Res2021 Nov 1; 36: 2139–2152.
7.
KanisJANortonNHarveyNC, et al.SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos2021 Jun 2; 16: 82.
8.
AkkawiIZmerlyH. Osteoporosis: current concepts. Joints2018 Jun 14; 6: 122–127.
9.
TinettiMESpeechleyMGinterSF. Risk factors for falls among elderly persons living in the community. N Engl J Med1988 Dec 29; 319: 1701–1707.
10.
van StaaTPDennisonEMLeufkensHGM,et al.Epidemiology of fractures in England and Wales. Bone2001 Dec 1; 29: 517–522.
11.
GullbergBJohnellOKanisJA. World-wide projections for hip fracture. Osteoporos Int1997 Sep 1; 7: 407–413.
12.
CummingsSRBlackDMRubinSM. Lifetime risks of hip, colles’, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med1989 Nov 1; 149: 2445–2448.
13.
KaraguzelGHolickMF. Diagnosis and treatment of osteopenia. Rev Endocr Metab Disord2010 Dec 1; 11: 237–251.
14.
KanisJAMeltonLJChristiansenC, et al.The diagnosis of osteoporosis. J Bone Miner Res1994; 9: 1137–1141.
15.
BlakeAJMorganKBendallMJ, et al.Falls by elderly people at home: prevalence and associated factors. Age Ageing1988 Nov; 17: 365–372.
16.
ImmonenMHaapeaMSimiläH, et al.Association between chronic diseases and falls among a sample of older people in Finland. BMC Geriatr2020 Jun 26; 20: 225.
17.
LeLaurinJHShorrRI. Preventing falls in hospitalized patients: state of the science. Clin Geriatr Med2019 May; 35: 273–283.
18.
SchoeneDHellerCAungYN, et al.A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?Clin Interv Aging2019; 14: 701–719.
19.
SherringtonCFairhallNWallbankG, et al.Exercise for preventing falls in older people living in the community: an abridged cochrane systematic review. Br J Sports Med2020 Aug 1; 54: 885–891.
20.
LeighebMde SireAColangeloM, et al.Sarcopenia diagnosis: reliability of the ultrasound assessment of the Tibialis anterior muscle as an alternative evaluation tool. Diagnostics2021 Nov; 11: 2158.
21.
RodriguesFDomingosCMonteiroD,et al.A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. Int J Environ Res Public Health2022 Jan; 19: 874.
22.
RoeBHowellFRiniotisK, et al.Older people and falls: health status, quality of life, lifestyle, care networks, prevention and views on service use following a recent fall. J Clin Nurs2009; 18: 2261–2272.
23.
KikkertLHJde GrootMHvan CampenJP, et al.Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic. PLoS ONE2017 Jun 2; 12: e0178615.
24.
LeeMYoumCNohB,et al.Gait characteristics based on shoe-type inertial measurement units in healthy young adults during treadmill walking. Sensors2020 Jan; 20: 2095.
25.
AtchisonJW. The use of exercise in the elderly to enhance functional mobility and prevent falls. J Back Musculoskelet Rehabil1994 Jan 1; 4: 97–104.
26.
LippiLUbertiFFolliA, et al.Impact of nutraceuticals and dietary supplements on mitochondria modifications in healthy aging: a systematic review of randomized controlled trials. Aging Clin Exp Res2022 Nov; 34: 2659–2674.
27.
LippiLde SireAMezianK, et al.Impact of exercise training on muscle mitochondria modifications in older adults: a systematic review of randomized controlled trials. Aging Clin Exp Res2022 Jul 1; 34: 1495–1510.
28.
AlptekinKKaranADıracogluD, et al.Investigating the effectiveness of postural muscle electrostimulation and static posturography feedback exercises in elders with balance disorder. J Back Musculoskelet Rehabil2016 Jan 1; 29: 151–159.
29.
de SireAMarottaNMarinaroC, et al.Role of physical exercise and nutraceuticals in modulating molecular pathways of osteoarthritis. Int J Mol Sci2021 Jan; 22: 5722.
30.
YıldırımPOfluogluDAydoganS,et al.Tai chi vs. Combined exercise prescription: a comparison of their effects on factors related to falls. J Back Musculoskelet Rehabil2016 Jan 1; 29: 493–501.
31.
Abellan Van KanGRollandYAndrieuS, et al.Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. J Nutr Health Aging2009 Dec 1; 13: 881–889.
32.
DoiTHirataSOnoR, et al.The harmonic ratio of trunk acceleration predicts falling among older people: results of a 1-year prospective study. J NeuroEngineering Rehabil2013 Jan 28; 10: 7.
33.
van SchootenKSPijnappelsMRispensSM, et al.Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults. J Gerontol Ser A2015 May 1; 70: 608–615.
34.
DemecoAFrizzieroANuresiC, et al.Gait alteration in individual with limb loss: the role of inertial sensors. Sensors2023 Jan; 23: 1880.
35.
de SireADemecoAMarottaN, et al.Neuromuscular impairment of knee stabilizer muscles in a COVID-19 cluster of female volleyball players: which role for rehabilitation in the post-COVID-19 return-to-play?Appl Sci2022 Jan; 12: 557.
36.
DemecoAMarottaNMoggioL, et al.Quantitative analysis of movements in facial nerve palsy with surface electromyography and kinematic analysis. J Electromyogr Kinesiol2021 Feb 1; 56: 102485.
37.
BijalwanVSemwalVMandalT. Fusion of multi-sensor-based biomechanical gait analysis using vision and wearable sensor. IEEE Sens J2021 Mar 17; PP: 1–1.
38.
CarozzoSVatranoMCoschignanoF, et al.Efficacy of visual feedback training for motor recovery in post-operative subjects with knee replacement: a randomized controlled trial. J Clin Med2022 Jan; 11: 7355.
39.
HatamzadehMBuséLChorinF, et al.A kinematic-geometric model based on ankles’ depth trajectory in frontal plane for gait analysis using a single RGB-D camera. J Biomech2022 Dec 1; 145: 111358.
40.
PetragliaFScarcellaLPedrazziG, et al.Inertial sensors versus standard systems in gait analysis: a systematic review and meta-analysis. Eur J Phys Rehabil Med [Internet]2019 May [cited 2024 Sep 15]; 55. Available from: https://www.minervamedica.it/index2.php?show=R33Y2019N02A0265.
41.
Di RaimondoGVanwanseeleBvan der HaveA, et al.Inertial sensor-to-segment calibration for accurate 3D joint angle calculation for use in OpenSim. Sensors2022 Jan; 22: 3259.
42.
O’KeeffeKArgentRBourkeA, et al.Test-retest reliability of wireless inertial-sensor derived measurements of knee joint kinematics. In: 2022 44th annual international conference of the IEEE engineering in medicine & biology society (EMBC) [internet]. 2022[cited 2024 Sep 15], pp.4218–4221. Available from: https://ieeexplore.ieee.org/document/9871584.
43.
KiernanDHawkinsDAManoukianMAC, et al.Accelerometer-based prediction of running injury in national collegiate athletic association track athletes. J Biomech2018 May 17; 73: 201–209.
44.
LeeSKimKKimY,et al.Motion anlaysis in lower extremity joints during ski carving turns using wearble inertial sensors and plantar pressure sensors. SEOB2017: 695–698.
45.
BoFYerebakanMDaiY, et al.IMU-Based Monitoring for assistive diagnosis and management of IoHT: a review. Healthcare2022 Jul; 10: 1210.
46.
FallCLQuevillonFBlouinM, et al.A multimodal adaptive wireless control interface for people with upper-body disabilities. IEEE Trans Biomed Circuits Syst2018 Jun; 12: 564–575.
47.
FonsecaLTigraWNavarroB, et al.Assisted grasping in individuals with tetraplegia: improving control through residual muscle contraction and movement. Sensors2019 Oct 18; 19: 4532.
48.
MilosevicBLeardiniAFarellaE. Kinect and wearable inertial sensors for motor rehabilitation programs at home: state of the art and an experimental comparison. Biomed Eng OnLine2020 Apr 23; 19: 25.
49.
AndrenacciIBoccacciniRBolzoniA, et al.A comparative evaluation of inertial sensors for gait and jump analysis. Sensors2021 Jan; 21: 5990.
50.
BhattacharyyaSDeprettereELeupersR,et al.Handbook of signal processing systems. Handbook of Sig Proc Syst2019.
51.
BjerkMBrovoldTSkeltonDA,et al.Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care. BMC Geriatr2018 Oct 22; 18: 253.
52.
TriccoACLillieEZarinW, et al.PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med2018 Oct 2; 169: 467–473.
53.
DemecoAForestiRFrizzieroA, et al.The upper limb orthosis in the rehabilitation of stroke patients: the role of 3D printing. Bioengineering2023 Oct 27; 10: 1256.
54.
FranklinSGreyMJHeneghanN, et al.Barefoot vs common footwear: a systematic review of the kinematic, kinetic and muscle activity differences during walking. Gait Posture2015 Sep 1; 42: 230–239.
55.
HalvarssonAFranzénEStåhleA. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clin Rehabil2015 Apr 1; 29: 365–375.
56.
ElDeebAMAbdel-AziemAA. Effect of whole-body vibration exercise on power profile and bone mineral density in postmenopausal women with osteoporosis: a randomized controlled trial. J Manipulative Physiol Ther2020 May 1; 43: 384–393.
57.
DohrnIMHagströmerMHelléniusML,et al.Short- and long-term effects of balance training on physical activity in older adults with osteoporosis: a randomized controlled trial. J Geriatr Phys Ther2017 Apr; 40: 102–111.
58.
JacobsESendenRMcCrumC, et al.Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture. Clin Interv Aging2019; 14: 671–680.
59.
DoshiKBMoonSHWhitakerMD,et al.Assessment of gait and posture characteristics using a smartphone wearable system for persons with osteoporosis with and without falls. Sci Rep2023 Jan 11; 13: 538.
ElDeebAMKhodairAS. Three-dimensional analysis of gait in postmenopausal women with low bone mineral density. J NeuroEngineering Rehabil2014 Apr 11; 11: 55.
62.
TakanoYMutohTTatewakiY, et al.Assessment of gait symmetry in elderly women with low bone mineral density using a portable trunk accelerometer: a pilot study. Med Sci Monit Int Med J Exp Clin Res2019 Sep 5; 25: 6669–6674.
63.
DostanporADobsonCAVanicekN. Relationships between walking speed, T-score and age with gait parameters in older post-menopausal women with low bone mineral density. Gait Posture2018 Jul 1; 64: 230–237.
64.
ChoiWChoiJHChungCY, et al.Can gait kinetic data predict femoral bone mineral density in elderly men and women aged 50 years and older?J Biomech2021 Jun 23; 123: 110520.
65.
FujitaKIijimaHEguchiR, et al.Gait analysis of patients with distal radius fracture by using a novel laser timed up-and-go system. Gait Posture2020 Jul 1; 80: 223–227.
66.
LöfgrenNHalvarssonAStåhleA,et al.Gait characteristics in older women with osteoporosis and fear of falling. Eur J Physiother2013 Aug 30; 15: 139–145.
67.
MatsumotoHMakabeTMoritaT, et al.Accelerometry-based gait analysis predicts falls among patients with a recent fracture who are ambulatory: a 1-year prospective study. Int J Rehabil Res2015 Jun; 38: 131–136.
68.
HalvarssonAOddssonLFranzénE,et al.Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study. Clin Rehabil2016 Nov 1; 30: 1049–1059.
69.
LordSRClarkRDWebsterIW. Physiological factors associated with falls in an elderly population. J Am Geriatr Soc1991; 39: 1194–1200.
70.
OsobaMYRaoAKAgrawalSK,et al.Balance and gait in the elderly: a contemporary review. Laryngoscope Investig Otolaryngol2019 Feb 4; 4: 143–153.
71.
HuangMZRogersMWPizacD, et al.Effect of multicomponent home-based training on gait and muscle strength in older adults after hip fracture surgery: a single site randomized trial. Arch Phys Med Rehabil2023 Feb 1; 104: 169–178.
72.
LarsenPLundHLaessoeU, et al.Restrictions in quality of life after intramedullary nailing of tibial shaft fracture: a retrospective follow-up study of 223 cases. J Orthop Trauma2014 Sep; 28: 507–512.
73.
CansecoKBeckerBMMuscottRK, et al.Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture. J Orthop Res2024; 42: 618–627.
74.
SzulcP. Impact of bone fracture on muscle strength and physical performance—narrative review. Curr Osteoporos Rep2020 Dec 1; 18: 633–645.
75.
IsmailAACooperCFelsenbergD, et al.Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. Osteoporos Int1999 Mar 1; 9: 206–213.
76.
JacobsEMcCrumCSendenR, et al.Gait in patients with symptomatic osteoporotic vertebral compression fractures over 6 months of recovery. Aging Clin Exp Res2020; 32: 239–246.
77.
HofALGazendamMGJSinkeWE. The condition for dynamic stability. J Biomech2005 Jan 1; 38: 1–8.
78.
ShamsRDrasitesKPZamanV, et al.The pathophysiology of osteoporosis after spinal cord injury. Int J Mol Sci2021 Mar 17; 22: 3057.
79.
DalyRMDalla ViaJDuckhamRL, et al.Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Braz J Phys Ther2019; 23: 170–180.
80.
Uusi-RasiKKannusPChengS, et al.Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone2003 Jul 1; 33: 132–143.
81.
ZhaoRZhangMZhangQ. The effectiveness of combined exercise interventions for preventing postmenopausal bone loss: a systematic review and meta-analysis. J Orthop Sports Phys Ther2017 Apr; 47: 241–251.
82.
BasseyEJRothwellMCLittlewoodJJ,et al.Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise. J Bone Miner Res Off J Am Soc Bone Miner Res1998 Dec; 13: 1805–1813.
83.
DemecoASalernoAGusaiM, et al.The role of virtual reality in the management of football injuries. Medicina (Mex)2024 Jun; 60: 1000.
84.
de SireALippiLAprileV, et al.Pharmacological, nutritional, and rehabilitative interventions to improve the Complex management of osteoporosis in patients with chronic obstructive pulmonary disease: a narrative review. J Pers Med2022 Oct 1; 12: 1626.
85.
NutiRBrandiMLChecchiaG, et al.Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med2019 Jan; 14: 85–102.
86.
PhuSBani HassanEVogrinS, et al.Effect of denosumab on falls, muscle strength, and function in community-dwelling older adults. J Am Geriatr Soc2019; 67: 2660–2661.
87.
ViethR. What is the optimal vitamin D status for health?Prog Biophys Mol Biol2006 Sep; 92: 26–32.
88.
RodmanJSBakerT. Changes in the kinetics of muscle contraction in vitamin D-depleted rats. Kidney Int1978 Mar 1; 13: 189–193.
89.
van BakelSIJGoskerHRLangenRC,et al.Towards personalized management of sarcopenia in COPD. Int J Chron Obstruct Pulmon Dis2021; 16: 25–40.
90.
AnnweilerCHenniSWalrandS, et al.Vitamin D and walking speed in older adults: systematic review and meta-analysis. Maturitas2017 Dec; 106: 8–25.
91.
Guzon-IllescasOFernandezEPVillariasNC, et al.Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg2019 Jul 4; 14: 203.
