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Heritability of impaired balance: a nationwide cohort study in twins
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center. (Clinical pharmacogenetics and osteoporosis)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
2009 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 20, no 4, 577-583 p.Article in journal (Refereed) Published
Abstract [en]

In this large population-based twin study, a self-estimated impaired balance, an important risk factor for osteoporotic fractures, had a modest heritability of 0.27. Individual-specific environmental influences seem to be the dominating cause for impaired balance.

INTRODUCTION: The principal causal components of an osteoporotic fracture are falls and weakened bone strength. While bone strength has a strong genetic origin, the heritable influences on impaired balance that contribute to the risk of injurious falls at older age are uncertain.

METHODS: To evaluate the heritability and environmental influence on self-reported impaired balance in older men and women, we used data from a sample of 22,998 Swedish twins, 55 to 99 years of age.

RESULTS: An impaired balance was reported by 2,890 (12.3%) of the twins. The tetrachoric correlation for impaired balance was only slightly lower for like-sex dizygotic twins (0.31) compared to monozygotic twins (0.36). These correlations indicate a modest familial (genetic and shared environmental) influence. Model fitting results indicate that the age- and sex-adjusted heritability for impaired balance was 0.27 (95%CI = 0.01-0.45). Individual-specific environmental influences differed only slightly by sex and age.

CONCLUSION: These results imply that a self-reported impaired balance, an independent risk factor for osteoporotic fractures, has a modestly heritable etiology in older subjects. Our observation can partly explain the previously observed modest heritability for osteoporotic fractures even though there is a high heritability for bone mineral density.

Place, publisher, year, edition, pages
2009. Vol. 20, no 4, 577-583 p.
Keyword [en]
Balance, Environment, Heritability, Muscular weakness, Osteoporotic fractures, Twin study
National Category
Medical and Health Sciences
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-101177DOI: 10.1007/s00198-008-0710-3ISI: 000263916800009PubMedID: 18802660OAI: oai:DiVA.org:uu-101177DiVA: diva2:212020
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Genetic and Environmental Influences on Bone and Fractures
Open this publication in new window or tab >>Genetic and Environmental Influences on Bone and Fractures
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sweden and Norway have the worldwide highest incidence of osteoporotic fractures. As these fractures constitute a tremendous and growing problem, primary prevention is of great importance. The principal causes of an osteoporotic fracture are a fall and a fragile skeleton. The aim of the studies reported in these papers was therefore to determine the genetic and environmental influences on fractures and the genetic influence on the two main reasons to the emergence of osteoporotic fractures; bone mineral density and propensity to fall.

In the present thesis, we display that the heritability of fractures is dependent on fracture site and age. With increasing age, lifestyle becomes the dominant explanatory factor. These results indicate that focus should be on lifestyle interventions for the prevention of fractures in the elderly.

Although the genetic liability to impaired balance is modest, twins with self-reported impaired balance have a substantially increased risk of osteoporotic fractures compared to their co-twin without impaired balance. Asking a patient about his or her balance might be a simple tool for future risk assessment.

The genetic influence on bone phenotypes is under strong genetic influence in Swedish adult twins. These findings are in agreement with the results from previous studies in other countries, with a lower incidence of osteoporotic fractures compared to Sweden. The high heritability of bone phenotypes together with the low heritability of fractures at old age, indicates that bone mineral density has a modest influence on fracture risk at old age.

In summary, based on the results in this thesis, more emphasis should be targeted to the prevention of falls, by strength and balance training in order to prevent the occurrence of  low energy fractures in the elderly.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 51 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 746
Keyword
heritability, twin study, osteoporotic fractures, vertebral fractures, balance, bone mineral density, bone area, bone markers
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-169598 (URN)978-91-554-8291-6 (ISBN)
Public defence
2012-04-27, Rosénsalen, ing 95/96 nb, Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-04 Created: 2012-03-04 Last updated: 2012-04-19Bibliographically approved

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