Analysis of the Moderating Effect of Walk Ratio on the Relationship Between Bone Mineral Density and Fall Efficacy and Balance Confidence in Elderly

PURPOSE: This study aimed to analyze the moderating effect of the walk ratio (WR), a quantitative indicator of gait pattern, on the relationship between bone mineral density (BMD), fall efficacy scale (FES) score, and activity-specific balance confidence (ABC) in the elderly.METHODS: A total of 275 participants were categorized based on BMD into normal, osteopenia, and osteoporosis groups, and based on WR levels into high 25%, middle 50%, and low 25% groups. Logistic regression analysis was performed to determine the odds ratios (OR) for decreased FES and ABC exposure based on BMD and WR levels. To examine the moderating effect of WR on the relationship among BMD, FES, and ABC, a moderation analysis using Process Macro Model 1 was performed.RESULTS: After adjusting for age and sex, individuals with osteopenia (FES, OR=2.738, p=.013; ABC, OR=4.020, p=.002) and osteoporosis (FES, OR=4.550, p=.001; ABC, OR=5.015, p=.001) showed significantly higher ORs for decreased FES and ABC compared to those in the normal group, while individuals in the high WR group (FES, OR=0.389, p=.015; ABC, OR=0.235, p<.001) and middle WR group (FES, OR=0.519, p=.040; ABC, OR=0.389, p=.004) exhibited significantly lower ORs for decreased FES and ABC compared to those in the low WR group. Furthermore, moderation analysis indicated that regardless of covariates, the impact of decreased BMD on FES and ABC varied depending on the level of WR (FES, β=3.185, p=.017; ABC, β=4.570, p=.012).CONCLUSIONS: This study suggests that the decline in FES and ABC scores due to decreased BMD can be mitigated by a high WR. These findings highlight the need for strategies to enhance the walking function and prevent fractures in elderly patients with osteoporosis.