title: Low bone mineral density is associated with balance and hearing impairments.
abstract: OBJECTIVE
  Bone demineralization affects the skeletal system, including the temporal bone, which contains the cochlea and the vestibular labyrinth. However, research on the association of bone mineral density (BMD) with balance and hearing sensitivity is limited with conflicting results. Therefore, we examined the relationship in a population representative sample.
  
  
  METHODS
  We analyzed 8863 participants to the National Health and Nutrition Examination Survey (1999-2004) aged 40 years and older. Total and head BMD were measured by dual energy x-ray absorptiometry. Balance was evaluated using the Romberg Test of Standing Balance on Firm and Compliant Support Surfaces condition 4, also indicative of vestibular dysfunction. Hearing condition was self-reported. The associations of total and head BMD with balance and hearing were assessed using multiple and multinomial logistic regressions adjusting for covariates.
  
  
  RESULTS
  On multiple logistic regression, low total BMD was associated with balance impairment (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.43-4.75), especially in older adults (≥65 years old; OR, 3.72; 95% CI, 1.07-12.85). In multinomial regression, low total BMD was associated with report of significant hearing impairment in older adults (OR, 5.30; 95% CI, 1.20-23.26).
  
  
  CONCLUSIONS
  Low BMD is associated with balance and hearing impairments, especially in older adults.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa. Electronic address: angelico-mendy@uiowa.edu.
authors.forename: Angelico
authors.initials: A
authors.lastname: Mendy
authors.affiliation: Department of Physical Therapy, Florida International University, Miami, Florida.
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Vieira
authors.affiliation: Department of Biostatistics, Florida International University, Miami, Florida.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Albatineh
authors.affiliation: Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Augustine K
authors.initials: AK
authors.lastname: Nnadi
authors.affiliation: Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Dana
authors.initials: D
authors.lastname: Lowry
authors.affiliation: South Florida Asthma Consortium, Fort Lauderdale, Florida.
authors.forename: Janvier
authors.initials: J
authors.lastname: Gasana
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone / Q000379:methods; D001309:Auditory Threshold / Q000502:physiology; D015519:Bone Density / Q000502:physiology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D034381:Hearing Loss / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D004856:Postural Balance / Q000502:physiology*; D015995:Prevalence; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Balance; Bone mineral density; Deafness; Gait; Hearing; Osteoporosis