According to research reviewed by Gram, failing a simple one-leg balance test was linked to 1.7 times the risk of any fracture in 85-year-old women, even after accounting for bone density and other risk factors. The study followed 382 women for an average of 4.3 years.
Broken bones are a serious concern for women in their 80s, and doctors need better ways to spot who is at risk. According to research reviewed by Gram, a new study of 382 women aged 85 found that a simple one-leg balance test was linked to a higher chance of breaking a bone. Women who could not stand on one leg for 5 seconds had about 1.7 times the risk of any fracture over roughly 4.3 years, even after accounting for bone density and other known risk factors. Slow walking speed and a history of falls were also linked to higher fracture risk. Bone density measured in the arm and shin, which looks at bone quality rather than just bone amount, was also linked to fracture risk. The findings suggest that physical function tests may add useful information to standard bone density scans. Larger studies are needed before these tests become part of routine care.
Key Statistics
A 2026 prospective study of 382 women aged 85 found that failing a one-leg balance test was associated with 1.70 times the risk of any fracture after adjusting for clinical risk factors and hip bone density.
Over an average follow-up of 4.3 years, 116 of 382 women (30%) in a 2026 study of 85-year-old women sustained at least one fracture.
In the same 2026 study, failing the one-leg balance test was associated with a hip fracture hazard ratio of 2.30 (95% confidence interval 1.05 to 5.02) after adjustment.
The Quick Take
- What they studied: Researchers wanted to know whether bone quality measurements, balance, walking speed, leg strength, and past falls could predict which 85-year-old women would break a bone, and how well these measures work compared with the standard hip bone density scan.
- Who participated: The study included 382 women who were all 85 years old at the start. They were part of the Osteoporosis Prospective Risk Assessment (OPRA) study and were followed for an average of about 4.3 years.
- Key finding: During the follow-up, 116 women (30%) broke at least one bone. Women who failed the one-leg balance test had about 1.7 times the risk of any fracture, and about 2.3 times the risk of a hip fracture, compared with women who passed. These results held after accounting for other risk factors and hip bone density.
- What it means for you: If you care for or are an older woman, a simple balance check may offer a useful clue about fracture risk alongside a bone density scan. Balance is also something that can often be improved with exercise. Talk with a doctor before changing any medicines or starting a new exercise program.
The Research Details
This was a prospective cohort study, which means the researchers recruited women at one point in time, measured their health and physical abilities, and then followed them forward to see who broke a bone. The women were part of the OPRA study, a larger project designed to understand bone health in older adults.
At the start, each woman had several bone scans. Some used a DXA scanner, the standard machine that measures bone density at the hip and spine. Others used a pQCT scanner, which takes detailed three-dimensional pictures of bone in the forearm and lower leg. The pQCT method can separate the inner, spongier bone from the outer, harder shell, which may tell doctors more about bone strength than a single number alone.
The women also completed physical tests. These included standing on one leg for up to 5 seconds, walking at their normal pace while speed was tracked, and pushing their knee straight out against a force gauge to measure leg strength. They also reported how many times they had fallen. The researchers then used a statistical method called Cox regression to estimate how each factor was linked to fracture risk over time, while adjusting for body weight, prior fractures, smoking, and use of certain medicines.
Following women over several years is a strong way to see whether a measurement can predict future events, rather than just noticing that two things happen together. Because the researchers measured the balance and bone tests before any fractures occurred, they could check which measures actually came before breaks.
Adjusting for other factors helps show whether a result might be explained by something else, such as body weight or medication use. The fact that the balance test still mattered after these adjustments makes the finding more interesting, though it does not prove that balance causes fractures.
The study followed a defined group of women over a meaningful period and used several different types of bone and physical measurements, which adds to its usefulness. The use of standard statistical methods and adjustments for known risk factors also supports the reliability of the results.
Still, this is an observational study, so it can show links but cannot prove cause and effect. The group included only women who were 85 years old, so the results may not apply to men or to younger or older adults. Readers should also keep in mind that some of the confidence ranges were wide, meaning the true size of the effect could be smaller or larger than the single number reported.
What the Results Show
Bone quality measured in the forearm and lower leg was linked to lower fracture risk. Women with higher trabecular bone density, the spongier inner bone, at the radius (forearm) had about a 32% lower chance of any fracture (hazard ratio 0.68). A similar pattern appeared in the lower leg (hazard ratio 0.69). Forearm bone quality was also linked to lower hip fracture risk (hazard ratio 0.64).
Hip bone density measured by the standard DXA scan was linked to lower risk of any fracture (hazard ratio 0.75). However, it was not clearly linked to hip fracture in this group, since the confidence range included the possibility of no effect.
The physical tests told a notable story. Failing the one-leg balance test was linked to a 55% higher risk of any fracture in the first analysis (hazard ratio 1.55). Slower walking speed was also linked to higher risk (hazard ratio 1.22). After adjusting for other clinical risk factors and hip bone density, the balance test still stood out, with a hazard ratio of 1.70 for any fracture and 2.30 for hip fracture.
Taken together, the results suggest that a short balance check may capture information about fracture risk that a bone density scan alone does not. The hip fracture finding is based on fewer events and has a wide confidence range, so it should be viewed with caution.
Walking speed and a history of falls were linked to fracture risk at a level similar to hip bone density, which suggests that how a person moves may be just as informative as how dense the bones appear. Adding these simple measures to the picture may help doctors think about risk more fully.
The forearm bone measurement remained linked to any fracture even after adjusting for other factors, which suggests that the detailed pQCT scan may add value beyond standard testing. Because the study focused on fracture outcomes, these findings point to bone quality and physical function as areas worth watching in older women.
Previous research has consistently found that bone density predicts fracture risk, which this study supports. Its new contribution is showing that detailed bone quality scans and simple physical tests can add to that prediction, especially in women who are already very old.
Falls and poor balance have long been recognized as contributors to broken bones, mainly because a fall is often the event that causes a fracture. This study adds evidence that balance may signal risk even before a fall occurs, though more research is needed to confirm how well this holds in different groups.
This study had several limits. First, it was observational, so the balance test and bone measures may be linked to fracture risk because of other factors not measured here. Second, all participants were 85-year-old women, so the findings may not apply to men, younger older adults, or women with different health backgrounds.
Third, the hip fracture results were based on a smaller number of events, which leads to wide confidence ranges. Some of the lower bounds came close to 1, meaning the true effect could be small. Fourth, the researchers tested many measures, so some results could occur by chance. Fifth, fall history was self-reported, which can be less accurate than tracked data. Finally, the balance test used a single cutoff of 5 seconds, and different cutoffs or test methods might give different results.
The Bottom Line
Research suggests that a simple one-leg balance test may help identify 85-year-old women who have a higher chance of fracture. Because the result held after accounting for bone density and other risk factors, it appears to add useful information. Confidence is moderate because the study was observational and included only one age and sex group. Clinicians should view balance and walking speed as additional clues rather than stand-alone diagnostic tools.
Older women, especially those in their 80s, and the family members or caregivers who support them may find this research relevant. Doctors and physical therapists who assess fall and fracture risk may also find the balance findings useful. People under 80 or men should not assume these exact results apply to them, since the study did not include those groups.
Balance and strength can often be improved within a few weeks to months of regular, supervised exercise, although changes in bone density usually take much longer, often a year or more. Fracture risk changes gradually over time, so this research is best seen as a long-term picture rather than a short-term goal.
Frequently Asked Questions
Can a balance test predict whether an 85-year-old woman will break a bone?
A 2026 study of 382 women suggests it may help. Women who could not stand on one leg for 5 seconds had about 1.7 times the risk of any fracture over roughly 4.3 years, even after accounting for other risk factors. The test is best used alongside bone density scans.
Is a bone density scan enough to know my fracture risk after age 80?
Bone density is an important measure, but research on 382 women aged 85 suggests it may not tell the whole story. Balance, walking speed, and past falls were also linked to fracture risk, and a balance test added information beyond standard hip bone density.
What is a hazard ratio in fracture studies?
A hazard ratio compares how quickly an event happens in two groups over time. A hazard ratio of 1.7 means the group had about 1.7 times the rate of fractures, while a value below 1 means a lower rate. Confidence ranges show how certain the estimate is.
How can older adults improve balance to lower fracture risk?
Balance and strength can often improve with regular, supervised exercise such as standing on one leg while holding support, walking, and leg strengthening. Research linking balance to fractures suggests that building these skills may be worthwhile, but people should check with a doctor first.
Want to Apply This Research?
- Track the number of seconds you can stand on one leg, near a sturdy surface for safety, once a week at the same time of day. Also record your usual walking speed over a measured 4 meter (about 13 feet) path every two weeks. Note any falls or near falls in the app.
- Add a short balance routine, such as standing on one leg for 10 to 30 seconds while holding a counter, two to three times a day. Pair it with a daily walk and gentle strength work for the legs. Share your weekly balance and walking results with your doctor at routine visits.
- Review balance, walking speed, and fall history monthly in the app to spot trends. Use the data to ask your healthcare provider whether a bone density scan or other fracture risk review is appropriate. Update your records after any medication change, illness, or fall, and keep the long-term picture in view rather than reacting to single readings.
This article summarizes an observational study of 85-year-old women and is for general information only. It does not provide medical advice, and the findings may not apply to men or to people of other ages. Do not change medications, exercise routines, or bone health care based on this article alone. Talk with a doctor, physical therapist, or other qualified health professional about your personal fracture risk.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.