One leg standing time predicts fracture risk in older women independent of clinical risk factors and BMD

Key points

1. 01This was a large prospective cohort of 3,028 women aged 75 to 80 followed for a median of 3.6 years.
2. 02Women who could not stand on one leg for 10 seconds had about 3 times the risk of hip fracture.
3. 03The link held even after adjusting for bone mineral density, age, height, and weight.
4. 04Adding the balance result raised the estimated 4-year fracture probability by roughly 1.3 to 1.5 times in a 75-year-old woman.

How it was conducted

Design

Prospective cohort study (SUPERB cohort)

Participants

3,028 women aged 75 to 80; 2,405 had one-leg standing time recorded

Exposure

One-leg standing time (OLST) at baseline, with a cutoff of under 10 seconds

Follow-up

Median 3.6 years; fractures identified from health records

Analysis

Cox models adjusted for age, height, and weight, plus bone mineral density (BMD) from DXA

What they found

• One-leg standing time under 10 seconds was associated with higher hip fracture risk (HR 3.02, 95% CI 1.49 to 6.10).
• Low OLST was also associated with higher risk of major osteoporotic fracture and nonvertebral fracture.
• Estimated 4-year fracture probability increased by a factor of 1.3 to 1.5 in a 75-year-old woman with low OLST, depending on BMD.

Limitations

• Only women aged 75 to 80 were studied, so results may not apply to men or other age groups.
• As an observational cohort, it shows association rather than proving that poor balance causes fractures.
• The median follow-up of 3.6 years is relatively short for long-term fracture prediction.
• About 600 of the women did not have a usable one-leg standing time recorded.

Why it matters

For patients

If you are an older woman, how long you can balance on one leg may be a simple sign of your fracture risk, worth mentioning to your doctor.

For clinicians

A quick one-leg standing test under 10 seconds can flag higher fracture risk independent of BMD and standard clinical risk factors.

For readers

A low-cost bedside balance test added meaningful predictive value beyond bone density in older women.