Osteoporosis correlates with abnormal ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo

Osteoporosis correlates with abnormal ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Osteoporosis correlates with abnormal ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo Chen-Yan Zhou, Liang Shu, Jing Wu, Jie Chen, Ying-Xia Bai, Ran Yan, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7540385/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Osteoporosis may increase the risk of benign paroxysmal positional vertigo (BPPV). However, direct evidence remains elusive. Objective To analyze the correlation between bone mineral density (BMD) and vestibular function in elderly patients with BPPV. Methods Two hundred ninety-one idiopathic, unilateral BPPV patients aged 50–80 years were consecutively enrolled in our vertigo outpatient clinic. All the participants underwent BMD, cervical, and ocular vestibular evoked myogenic potential (c/oVEMP) evaluations. The associations between BMD and VEMP results were investigated. Results Eighty-one patients (27.8%) were diagnosed with osteoporosis, while 120 patients (41.2%) had osteopenia. Among BPPV patients, abnormal BMD demonstrated a marginal correlation with oVEMP response ( p = 0.098), but not with cVEMP response ( p = 0.405). Compared to those without osteoporosis, patients with osteoporosis were older (65.9 vs. 62.7 years, p = 0.001), had lower BMI (22.6 vs. 24.3, p < 0.001), showed a higher proportion of females (84.0% vs. 72.4%, p = 0.039), and were more likely to present with at least unilateral oVEMP absence (74.1% vs. 57.1%, p = 0.008). Patients exhibiting at least unilateral oVEMP absence also had reduced T-scores and BMD in the lumbar spine. After adjusting for confounding variables, osteoporosis remained independently associated with at least unilateral oVEMP absence in BPPV patients (OR = 2.038, p = 0.019). Conclusion Our study provides further evidence that osteoporosis may contribute to utricular dysfunction associated with the occurrence of BPPV. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research benign paroxysmal positional vertigo osteoporosis vestibular evoked myogenic potential utricular function Figures Figure 1 Introduction Benign paroxysmal positional vertigo (BPPV), the most common peripheral vestibular disorder, occurs when the otoconia detach from the utricle and enter the semicircular canal. Current evidence suggests that older adults [ 1 ], females [ 2 ], climate change [ 3 ], osteoporosis, vitamin D deficiency [ 4 , 5 ], and cerebral small vessel disease are significant risk factors for BPPV [ 6 ]. A large population-based Korean study involving about 350,000 participants reported BPPV incidence rates of 31.58 and 18.09 cases per 1,000 individuals in the osteoporosis and normal control groups, respectively, emphasizing that osteoporosis may be associated with increased rates of BPPV [ 7 ]. The risk of BPPV recurrence is elevated in people with osteoporosis [ 8 ]. Nevertheless, direct evidence establishing a causal link between osteoporosis and BPPV remains insufficient. Vestibular dysfunction is commonly observed in BPPV patients. Even after successful canalith repositioning procedure (CRP), more than 30% of patients continue to experience dizziness or balance disturbances [ 9 ]. Vestibular evoked myogenic potentials (VEMP) testing is a well-established and reliable electrophysiological method for evaluating vestibular responses at different segments of the vestibular pathway and assessing otolith organ function [ 10 ]. Depending on electrode placement, VEMP recordings are mainly categorized into cervical and ocular types, referred to as cVEMP and oVEMP, respectively. Previous studies have utilized changes in VEMP to evaluate vestibular dysfunction in BPPV patients [ 11 ]. BPPV patients have been reported to exhibit lower oVEMP amplitudes and greater interaural asymmetry ratios compared to healthy controls [ 12 ]. Additionally, another study demonstrated that the cVEMP interaural amplitude difference ratio (IAD) was correlated with the prognosis of BPPV [ 13 , 14 ]. Our prior research demonstrated that evaluating cVEMP could help predict short-term residual dizziness following an effective BPPV repositioning procedure [ 15 ]. Research has indicated that low bone mineral density (BMD) is linked to balance impairments [ 16 ], and osteoporosis may contribute to vestibular dysfunction in the aging population, especially in postmenopausal women [ 17 – 19 ]. However, it remains unclear whether abnormal BMD is correlated with vestibular dysfunction in patients with BPPV. We hypothesized that such a correlation may also be present in elderly BPPV patients. Furthermore, it is not yet established whether abnormal BMD is specifically associated with utricular or saccular dysfunction. This investigation focuses on exploring potential correlations between abnormal BMD and cVEMP or oVEMP outcomes in older individuals with unilateral idiopathic BPPV. Methods Patients In total, 291 BPPV patients suffering from this condition were enrolled in this research between June 2017 and February 2022. All BPPV patients complied with the diagnostic requirements of the Bárány Society [ 20 ]: (i) Brief, recurrent episodes of dizziness or lightheadedness, typically lasting no more than one minute, triggered by changes in head position relative to gravity. (ii) The positional test induced vertigo and revealed characteristic nystagmus. In posterior canal BPPV, the classic nystagmus is characterized by an upward-beating vertical motion with torsional components, observed when the affected ear is positioned downward during the Dix-Hallpike maneuver. In contrast, horizontal canal BPPV is identified by apogeotropic or geotropic nystagmus, which can be elicited during the roll test. (iii) Other conditions, such as Meniere’s disease, orthostatic hypotension, labyrinthitis, psychogenic vertigo, vestibular paroxysmia, posterior circulation ischemia, and vestibular migraine, were excluded. This investigation employed the following inclusion standards: (i) The type of nystagmus was consistent with the involved semicircular canal and acted as the unilateral canal involved. (ii) Patients aged 50–80 years. (iii) Have not taken calcium tablets in the past one month. Each participant diagnosed with BPPV underwent successful repositioning maneuvers at enrollment. Therapeutic interventions were canal-specific: the Epley procedure was employed for posterior canal BPPV, whereas horizontal canal variants were managed with either the barbecue or Gufoni maneuvers [ 21 ]. All participants completed both VEMP and BMD examinations within one week after CRP. This investigation was conducted with approval (SH9H-2020-T270-2) from the Ethics Committee of Shanghai Jiao Tong University-affiliated Ninth People's Hospital.All methods were performed in accordance with the relevant guidelines and regulations as stipulated in the Declaration of Helsinki.Each participant signed an informed consent document prior to enrollment Bone mineral density evaluation All enrolled individuals received baseline bone density evaluations within the study’s first week. The evaluation was conducted using a X-ray absorptiometry (DXA) densitometer(America, Lunar IDXA), which is widely accepted as the most authoritative method for measuring BMD [ 24 ]. The assessment included measurements at several key skeletal regions: the lumbar spine (L1–L4), greater trochanter, femoral shaft, Ward’s triangle, and femoral neck. The T-score formula is as follows: (Patient’s BMD - Reference population’s peak BMD) / Reference population’s peak BMD standard deviation. According to the WHO criteria, osteoporosis is diagnosed at ≤-2.5, normal bone mass at a T score ≥–1, and osteopenia at − 2.5 < T score<–1 [ 25 ]. VEMP evaluation VEMP evaluations were conducted in the hearing clinic of Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. VEMP measurements were obtained using an auditory-evoked potential analyzer in a noise-controlled environment(Neuro-Audio, Neurosoft LLC, Ivanovo, Russia). Acoustic stimuli consisted of 500 Hz tone bursts delivered via IP-30 insert earphones at a rate of 5.1 repetitions per second, with averaged responses derived from 60 to 200 trials. Signal filtering was set with cutoff frequencies of 8 Hz and 1500 Hz. The recordings were deemed acceptable only when the electrode impedance did not exceed 5 kΩ. During cervical VEMP assessments, participants were positioned supine with their heads rotated toward the side opposite to stimulation. Electromyographic activity was continuously recorded from the activated sternocleidomastoid muscle (SCM) during sound stimulation. Recording electrodes were placed on the proximal third of the SCM, with reference electrodes positioned at the sternal manubrium. A ground electrode was centrally positioned on the midline of the forehead. For oVEMP testing, participants remained supine and directed their gaze about 30 degrees above the head midline, a position known to elicit optimal responses. Recording electrodes were placed 10 mm below the midpoint of the infraorbital margin, with the reference electrode positioned an additional 10 mm below, while the ground electrode was placed at the central forehead. Throughout the examination, patients were instructed to maintain steady fixation on the target and minimize blinking. Non-responsiveness was defined as the absence of characteristic biphasic potentials, even at the maximum stimulation intensity (110 dB nHL)[ 15 ]. In patients with bilateral presence of cVEMP or oVEMP, detailed parameters, including latency, thresholds, amplitude, and amplitude asymmetry ratio (AAR), were recorded. AAR was calculated as follows: 100 times (amplitude on right side - amplitude on left side) / (sum of right and left side amplitudes). Statistical analysis Data analysis was conducted in SPSS (v26.0), and figures were produced with GraphPad Prism (v10.0). The mean and standard deviation were used for normally distributed continuous variables, whereas the median and interquartile range (IQR, 25th to 75th percentiles) were applied to skewed distributions. F-tests and T-tests were conducted on normally distributed data, with the Mann-Whitney U test applied to skewed data. Chi-square tests and Fisher's exact tests were used to analyze categorical variables. The independent correlates of abnormal oVEMP findings were examined through binary logistic regression analysis. Results with P-values below 0.05 were considered statistically significant. Results Among the cohort, average age of the patients was 63.6 ± 1.8 years, and 75.6% were female. 229 cases (78.7%) demonstrated posterior canal involvement, while horizontal canal BPPV was present in 62 individuals (21.3%). The involvement was right-sided in 185(63.4%) patients and left-sided in 106(36.4%) patients. Among the enrolled participants, 90(30.9%) had normal BMD, 120 (41.2%) had osteopenia, and 81 (27.8%) had osteoporosis. According to the VEMP test results, 64(22%) showed unilateral absence of cVEMP, 67(23%) demonstrated bilateral absence of cVEMP, 83(28.5%) exhibited unilateral absence of oVEMP, and 97(33.3%) presented with bilateral absence of oVEMP. Characteristics of BPPV Patients Stratified by Osteoporosis Status Since there was a marginal association between BMD and oVEMP response ( p = 0.098, Fig. 1 ), we divided all the participants into osteoporotic ( n = 81) and non-osteoporotic ( n = 210) groups for further analysis (Table 1 ). When compared to patients without osteoporosis, individuals with osteoporosis were typically older (65.9 ± 6.4 vs. 62.7 ± 7.2, p = 0.001), had decreased BMI (22.60 ± 2.71 vs. 24.29 ± 3.41, p <0.001), and showed a higher proportion of females (84.0% vs. 72.4%, p = 0.039). No significant disparities emerged between cohorts regarding the frequency of chronic vascular diseases, smoking, or drinking histories. Also, the vertigo severity at baseline and W1 was similar between the two groups. Table 1 Demographic and clinical characteristics between benign paroxysmal positional vertigo patients with and without osteoporosis Non-osteopenia ( n = 210) Osteoporosis ( n = 81) P value Age , years 62.7 ± 7.2 65.9 ± 6.4 0.001** BMI (kg/m 2 ) 24.29 ± 3.41 22.60 ± 2.71 <0.001*** Female , n (%) 152(72.4%) 68(84.0%) 0.039* HBP , n (%) 90(42.9%) 32(39.5%) 0.604 DM , n (%) 25(11.9%) 6(7.4%) 0.265 HL , n (%) 14(6.7%) 9(11.1%) 0.208 CHD , n (%) 21(10.0%) 10(12.3%) 0.561 Smoking , n (%) 21(10.0%) 7(8.6%) 0.725 Drinking , n (%) 15(7.1%) 2(2.5%) 0.213 Posterior semicircular canal , n (%) 166 (79.0%) 63(77.8%) 0.813 W0 Vertigo VAS 90(70–100) 90(80–100) 0.389 Dizziness VAS 40(10–60) 50(20–60) 0.073 DHI total score 35.5(20–48) 36(24–44) 0.896 W1 Vertigo VAS 0(0–0) 0(0–0) 0.349 Dizziness VAS 20(0–40) 20(0–48) 0.968 DHI total score 10(2–22) 8(4–22) 0.732 oVEMP , n (%) 0.025* Bilateral presence 90(42.9%) 21(25.9%) Unilateral absence 57(27.1%) 26(32.1%) Bilateral absence 63(30.0%) 34(42.0%) cVEMP , n (%) 0.347 Bilateral presence 119(56.7%) 41(50.6%) Unilateral absence 47(22.4%) 17(21.0%) Bilateral absence 44(21.0%) 23(28.4%) Notes: BMI, body mass index; HBP, high blood pressure; DM, diabetes mellitus; HL, hyperlipoidemia; CHD, Coronary Heart Disease; DHI, dizziness handicap inventory; W0, at enrollment; W1, 1 week after enrollment; VAS, visual analog scale; oVEMP, ocular vestibular evoked myogenic potential; cVEMP, cervical vestibular evoked myogenic potential. * p < 0.05; ** p < 0.01; *** p < 0.001 Comparative analysis of VEMP results revealed that osteoporosis patients showed significantly greater frequencies of bilateral and unilateral oVEMP absence compared to non-osteoporosis controls ( p = 0.025). On the contrary, the cVEMP results were similar between the two groups. For the subjects with bilateral elicited response, no statistically significant intergroup differences emerged in any electrophysiological measures, including threshold, latency, amplitude, or AAR in patients with and without osteoporosis ( Supplementary Table 1, Supplementary Table 2 ) Independently associated factors of BPPV patients with abnormal oVEMP Compared with patients with bilateral oVEMP presence, those with at least unilateral absence were older (64.6 ± 7.2 vs. 62.1 ± 6.7, p = 0.005) and had decreased lumbar T-score and BMD values (all p < 0.05). Sex proportions and BMI measurements did not differ significantly groups. (Table 2 ). Table 2 Bone mineral density and T-score in the lumbar vertebrae with different ocular vestibular evoked myogenic potential response groups Bilateral presence ( n = 111) At least unilateral absence ( n = 180) P Value Age , years 62.1 ± 6.7 64.6 ± 7.2 0.005** BMI (kg/m 2 ) 23.72 ± 3.33 23.88 ± 3.32 0.378 Female , n (%) 84(75.7%) 136(75.6%) 0.982 L1 T-score -1.3 ± 1.3 -1.7 ± 1.2 0.018* BMD, g/cm 2 0.896 ± 0.016 0.836 ± 0.015 0.002** L2 T-score -1.3 ± 1.5 -1.7 ± 1.4 0.007** BMD, g/cm 2 0.948 ± 0.018 0.868 ± 0.017 <0.001*** L3 T-score -1.1 ± 1.5 -1.7 ± 1.5 0.001** BMD, g/cm 2 0.999 ± 0.019 0.913 ± 0.018 <0.001*** L4 T-score -1.0 ± 1.5 -1.4 ± 1.6 0.021* BMD, g/cm 2 0.997 ± 0.019 0.923 ± 0.019 0.002** Total T-score -1.2 ± 1.4 -1.7 ± 1.4 0.005** BMD, g/cm 2 0.964 ± 0.017 0.887 ± 0.017 <0.001*** Notes: BMI, body mass index; BMD, bone mineral density; L1, the first lumbar vertebra; L2, the second lumbar vertebra; L3, the third lumbar vertebra; L4, the fourth lumbar vertebra; * p < 0.05; ** p < 0.01; *** p < 0.001 As shown in the univariate logistic regression, age (OR = 1.050, 95% CI 1.015–1.087, p = 0.005) and osteoporosis (OR = 2.142, 95% CI 1.215–3.778, p = 0.008) may be related to the occurrence of abnormal oVEMP. Whereas sex and BMI did not emerge as contributing factors to oVEMP abnormality. After controlling the confounding factors, including age, sex, and BMI, we found that osteoporosis (OR = 2.038, 95% CI 1.122–3.701, p = 0.019) was still an independent associated factor for oVEMP abnormality (Table 3 ). Table 3 Independent risk factors for abnormal ocular vestibular evoked myogenic potential in benign paroxysmal positional vertigo patients Univariate regression Multivariate regression OR (95% CI) P Value OR (95% CI) P Value Age 1.050(1.015–1.087) 0.005** 1.042(1.006–1.080) 0.021* Female 0.994(0.573–1.724) 0.982 0.925 (0.523–1.638) 0.790 BMI 1.015(0.944–1.091) 0.688 1.038(0.962–1.119) 0.340 Osteoporosis 2.142(1.215–3.778) 0.008** 2.038 (1.122–3.701) 0.019* Notes: BMI, body mass index; * p < 0.05; ** p < 0.01. Discussion For the first time, as far as we know, this study employed a cross-sectional methodology to evaluate associations linking BMD and VEMP results in elderly patients with BPPV with a large sample size. BPPV patients with osteoporosis are generally older, have a lower BMI, are more likely to be female, and have at least one unilateral absence of oVEMP. Osteoporosis is an independent factor associated with abnormal oVEMP among individuals with BPPV. Since the utriculo-ocular pathway mediates oVEMP responses, whereas the sacculo-collic pathway underlies cVEMP responses, our study presents a novel observation: osteoporosis may be linked specifically to utricular dysfunction rather than saccular dysfunction in BPPV. Several lines of evidence support this phenomenon. i) From a theoretical perspective, the displaced otoconia in BPPV cases primarily originate from the utricle instead of the saccule. This disorder more frequently involves utricular rather than saccular dysfunction; II) On a pathophysiological level, the endolymph is characterized by a low Ca 2+ environment. BMD may elevate Ca 2+ concentrations in the endolymph, promoting otoconia accumulation and diminishing vestibular excitation in BPPV[ 26 , 27 ]; iii) In the aging population, especially in menopause women, both Baltimore Longitudinal Study of aging and a few observational studies suggested that low BMD may associate with vestibular dysfunction as evaluated by Romberg test condition 4 or VEMP tests (Table 4 ). iv) A pilot study in BPPV patients in China also revealed an inverse relationship between canal paresis and low BMD [ 28 ], which also supports our results. Therefore, we speculate that osteoporosis influences calcium metabolism in the endolymph and vestibular excitation reduction, increasing the incidence of utricular dysfunction, which is involved in BPPV occurrence. Table 4 Previous studies on low bone mineral density and vestibular dysfunction in humans. Studies Subjects (sample size) Evaluation methods Main findings Mendy A, et al . Ann Epidemiol. 2014 [ 16 ] Participants aged 40 years and older ( n = 8863) BMD, Romberg test condition 4 Low BMD is associated with balance impairment, especially in older adults Bigelow RT, et al . J Assoc Res Otolaryngol. 2016[ 17 ] Older adults ( n = 389) BMD, cVEMP Older individuals with reduced vestibular function had lower BMD Gargeshwari A, et al . Braz J Otorhinolaryngol. 2018[ 18 ] Healthy controls ( n = 12), osteopenia ( n = 12), and osteoporosis ( n = 11) BMD, c/o VEMP oVEMP (rather than cVEMP) absent rate was increased in the osteoporosis group Juneja MK, et al . J Otol. 2021[ 19 ] Postmenopausal women with normal BMD ( n = 28), osteopenia ( n = 25) and osteoporosis ( n = 23) BMD, c/o VEMP The percentage of vestibular dysfunction was increased in subjects with osteopenia and osteoporosis Jiang X, et al . Otol Neurotol. 2022[ 28 ] Postmenopausal women with BPPV ( n = 65) BMD, caloric test CP value in the caloric test was negatively correlated with the T value in the BMD Zhou CY, et al . The present study Patients with BPPV, aged 50–80 years ( n = 291) BMD and c/o VEMP Osteoporosis was an independently associated factor for at least unilateral oVEMP absence in patients with BPPV Notes: BMD, bone mineral density; BPPV, benign paroxysmal positional vertigo; oVEMP, ocular vestibular evoked myogenic potential; cVEMP, cervical vestibular evoked myogenic potential; CP, canal paresis. Our investigation demonstrated that participants in the osteoporosis group, as well as those exhibiting abnormal oVEMP, were generally older, aligning with previous animal studies. Both bone metabolism and vestibular system function decline with age. Existing literature indicates that vestibular balance in older mice is more susceptible to impairment compared to younger mice, and cholinergic receptor transmission within the vestibular hair cells is less efficient in aged mice than in their younger counterparts [ 29 , 30 ]. Our study has important clinical implications for linking osteoporosis with utricular dysfunction in BPPV, which contributes to disease occurrence. A few limitations should be mentioned. We did not include healthy controls or disease controls with other vestibular disorders. For vestibular function evaluation, we only used VEMPs. The study did not include caloric tests or video-head impulse tests (v-HITs). More detailed vestibular evaluations with a multicenter design are needed in the future. In summary, our study provides further evidence suggesting that osteoporosis may play a role in utricular dysfunction associated with the development of BPPV. The potential for osteoporosis treatment to improve disease prognosis in patients with BPPV warrants additional research. Declarations Ethics Statement This investigation was conducted with approval (SH9H-2020-T270-2) from the Ethics Committee of Shanghai Jiao Tong University-affiliated Ninth People's Hospital. Consent All subjects voluntarily provided signed consent forms before participating in this research. Conflicts of Interest There are no declared conflicts of interest among the contributing authors. Funding Wei Chen received grants from the Clinical Research Program of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (JYLJ202003) and Project of Biobank from Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (YBKB202120). Author Contribution Y.C.Z.: conceptualization, validation, software, investigation, formal analysis, writing—original draft. L.S.: resources, validation, methodology, writing—review and editing. J.W.: resources, data curation, validation, investigation. J. C.: investigation, resources, data curation. X.Y.B.: resources, software, data curation.R.Y.: resources, data curation. H.X. S.: data curation, resources. S.X.: software, resources. R.J.L.: resources, data curation, supervision. B.H.S.: conceptualization, methodology, resources, validation, data curation, manuscript writing and editing. 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Sci. 78 , 920–929. https://doi.org/10.1093/gerona/glad067 (2023). Jang, Y. S. et al. Age-related changes on the morphology of the otoconia. Laryngoscope 116 , 996–1001. https://doi.org/10.1097/01.mlg.0000217238.84401.03 (2006). Additional Declarations No competing interests reported. Supplementary Files supplementalmaterial.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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14:59:44","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99835,"visible":true,"origin":"","legend":"","description":"","filename":"4b79cdb342a140809891b4de58591efe1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7540385/v1/69e62881670195a3878a80e2.xml"},{"id":93244633,"identity":"df76c9b7-bae4-45e5-9a9e-39ffcb94eaaf","added_by":"auto","created_at":"2025-10-10 15:07:44","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110909,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7540385/v1/1016df5ea0483d312da719d9.html"},{"id":93243647,"identity":"1075a789-bdf6-48d0-a8b7-ac94cf11a1df","added_by":"auto","created_at":"2025-10-10 14:59:44","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62660,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe relationship between vestibular evoked myogenic potential and bone mineral density results in benign paroxysmal positional vertigo patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNotes: BMD, bone mineral density; VEMP, vestibular evoked myogenic potential.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7540385/v1/5ae54319bbb41cda2c5a0c0f.jpeg"},{"id":93555169,"identity":"900e615c-bfd4-4b40-a122-350dbe45c55b","added_by":"auto","created_at":"2025-10-15 06:24:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1084787,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7540385/v1/efc5bc27-d342-40f7-a57f-6974d1302a1f.pdf"},{"id":93243648,"identity":"cb1f632c-99ac-4a9a-9842-8d73f9e06934","added_by":"auto","created_at":"2025-10-10 14:59:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":136771,"visible":true,"origin":"","legend":"","description":"","filename":"supplementalmaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7540385/v1/5f2a8538499bb12ac8b2297b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Osteoporosis correlates with abnormal ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBenign paroxysmal positional vertigo (BPPV), the most common peripheral vestibular disorder, occurs when the otoconia detach from the utricle and enter the semicircular canal. Current evidence suggests that older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], females [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], climate change [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], osteoporosis, vitamin D deficiency [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and cerebral small vessel disease are significant risk factors for BPPV [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A large population-based Korean study involving about 350,000 participants reported BPPV incidence rates of 31.58 and 18.09 cases per 1,000 individuals in the osteoporosis and normal control groups, respectively, emphasizing that osteoporosis may be associated with increased rates of BPPV [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The risk of BPPV recurrence is elevated in people with osteoporosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nevertheless, direct evidence establishing a causal link between osteoporosis and BPPV remains insufficient.\u003c/p\u003e\u003cp\u003eVestibular dysfunction is commonly observed in BPPV patients. Even after successful canalith repositioning procedure (CRP), more than 30% of patients continue to experience dizziness or balance disturbances [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Vestibular evoked myogenic potentials (VEMP) testing is a well-established and reliable electrophysiological method for evaluating vestibular responses at different segments of the vestibular pathway and assessing otolith organ function [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Depending on electrode placement, VEMP recordings are mainly categorized into cervical and ocular types, referred to as cVEMP and oVEMP, respectively. Previous studies have utilized changes in VEMP to evaluate vestibular dysfunction in BPPV patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. BPPV patients have been reported to exhibit lower oVEMP amplitudes and greater interaural asymmetry ratios compared to healthy controls [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, another study demonstrated that the cVEMP interaural amplitude difference ratio (IAD) was correlated with the prognosis of BPPV [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Our prior research demonstrated that evaluating cVEMP could help predict short-term residual dizziness following an effective BPPV repositioning procedure [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch has indicated that low bone mineral density (BMD) is linked to balance impairments [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and osteoporosis may contribute to vestibular dysfunction in the aging population, especially in postmenopausal women [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, it remains unclear whether abnormal BMD is correlated with vestibular dysfunction in patients with BPPV. We hypothesized that such a correlation may also be present in elderly BPPV patients. Furthermore, it is not yet established whether abnormal BMD is specifically associated with utricular or saccular dysfunction. This investigation focuses on exploring potential correlations between abnormal BMD and cVEMP or oVEMP outcomes in older individuals with unilateral idiopathic BPPV.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003eIn total, 291 BPPV patients suffering from this condition were enrolled in this research between June 2017 and February 2022. All BPPV patients complied with the diagnostic requirements of the B\u0026aacute;r\u0026aacute;ny Society [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]: (i) Brief, recurrent episodes of dizziness or lightheadedness, typically lasting no more than one minute, triggered by changes in head position relative to gravity. (ii) The positional test induced vertigo and revealed characteristic nystagmus. In posterior canal BPPV, the classic nystagmus is characterized by an upward-beating vertical motion with torsional components, observed when the affected ear is positioned downward during the Dix-Hallpike maneuver. In contrast, horizontal canal BPPV is identified by apogeotropic or geotropic nystagmus, which can be elicited during the roll test. (iii) Other conditions, such as Meniere\u0026rsquo;s disease, orthostatic hypotension, labyrinthitis, psychogenic vertigo, vestibular paroxysmia, posterior circulation ischemia, and vestibular migraine, were excluded. This investigation employed the following inclusion standards: (i) The type of nystagmus was consistent with the involved semicircular canal and acted as the unilateral canal involved. (ii) Patients aged 50\u0026ndash;80 years. (iii) Have not taken calcium tablets in the past one month. Each participant diagnosed with BPPV underwent successful repositioning maneuvers at enrollment. Therapeutic interventions were canal-specific: the Epley procedure was employed for posterior canal BPPV, whereas horizontal canal variants were managed with either the barbecue or Gufoni maneuvers [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. All participants completed both VEMP and BMD examinations within one week after CRP. This investigation was conducted with approval (SH9H-2020-T270-2) from the Ethics Committee of Shanghai Jiao Tong University-affiliated Ninth People's Hospital.All methods were performed in accordance with the relevant guidelines and regulations as stipulated in the Declaration of Helsinki.Each participant signed an informed consent document prior to enrollment\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBone mineral density evaluation\u003c/h3\u003e\n\u003cp\u003eAll enrolled individuals received baseline bone density evaluations within the study\u0026rsquo;s first week. The evaluation was conducted using a X-ray absorptiometry (DXA) densitometer(America, Lunar IDXA), which is widely accepted as the most authoritative method for measuring BMD [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The assessment included measurements at several key skeletal regions: the lumbar spine (L1\u0026ndash;L4), greater trochanter, femoral shaft, Ward\u0026rsquo;s triangle, and femoral neck. The T-score formula is as follows: (Patient\u0026rsquo;s BMD - Reference population\u0026rsquo;s peak BMD) / Reference population\u0026rsquo;s peak BMD standard deviation. According to the WHO criteria, osteoporosis is diagnosed at \u0026le;-2.5, normal bone mass at a T score \u0026ge;\u0026ndash;1, and osteopenia at \u0026minus;\u0026thinsp;2.5\u0026thinsp;\u0026lt;\u0026thinsp;T score\u0026lt;\u0026ndash;1 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eVEMP evaluation\u003c/h3\u003e\n\u003cp\u003eVEMP evaluations were conducted in the hearing clinic of Shanghai Ninth People\u0026rsquo;s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. VEMP measurements were obtained using an auditory-evoked potential analyzer in a noise-controlled environment(Neuro-Audio, Neurosoft LLC, Ivanovo, Russia). Acoustic stimuli consisted of 500 Hz tone bursts delivered via IP-30 insert earphones at a rate of 5.1 repetitions per second, with averaged responses derived from 60 to 200 trials. Signal filtering was set with cutoff frequencies of 8 Hz and 1500 Hz. The recordings were deemed acceptable only when the electrode impedance did not exceed 5 kΩ.\u003c/p\u003e\u003cp\u003eDuring cervical VEMP assessments, participants were positioned supine with their heads rotated toward the side opposite to stimulation. Electromyographic activity was continuously recorded from the activated sternocleidomastoid muscle (SCM) during sound stimulation. Recording electrodes were placed on the proximal third of the SCM, with reference electrodes positioned at the sternal manubrium. A ground electrode was centrally positioned on the midline of the forehead. For oVEMP testing, participants remained supine and directed their gaze about 30 degrees above the head midline, a position known to elicit optimal responses. Recording electrodes were placed 10 mm below the midpoint of the infraorbital margin, with the reference electrode positioned an additional 10 mm below, while the ground electrode was placed at the central forehead. Throughout the examination, patients were instructed to maintain steady fixation on the target and minimize blinking. Non-responsiveness was defined as the absence of characteristic biphasic potentials, even at the maximum stimulation intensity (110 dB nHL)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In patients with bilateral presence of cVEMP or oVEMP, detailed parameters, including latency, thresholds, amplitude, and amplitude asymmetry ratio (AAR), were recorded. AAR was calculated as follows: 100 times (amplitude on right side - amplitude on left side) / (sum of right and left side amplitudes).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData analysis was conducted in SPSS (v26.0), and figures were produced with GraphPad Prism (v10.0). The mean and standard deviation were used for normally distributed continuous variables, whereas the median and interquartile range (IQR, 25th to 75th percentiles) were applied to skewed distributions. F-tests and T-tests were conducted on normally distributed data, with the Mann-Whitney U test applied to skewed data. Chi-square tests and Fisher's exact tests were used to analyze categorical variables. The independent correlates of abnormal oVEMP findings were examined through binary logistic regression analysis. Results with P-values below 0.05 were considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the cohort, average age of the patients was 63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 years, and 75.6% were female. 229 cases (78.7%) demonstrated posterior canal involvement, while horizontal canal BPPV was present in 62 individuals (21.3%). The involvement was right-sided in 185(63.4%) patients and left-sided in 106(36.4%) patients. Among the enrolled participants, 90(30.9%) had normal BMD, 120 (41.2%) had osteopenia, and 81 (27.8%) had osteoporosis. According to the VEMP test results, 64(22%) showed unilateral absence of cVEMP, 67(23%) demonstrated bilateral absence of cVEMP, 83(28.5%) exhibited unilateral absence of oVEMP, and 97(33.3%) presented with bilateral absence of oVEMP.\u003c/p\u003e\n\u003ch3\u003eCharacteristics of BPPV Patients Stratified by Osteoporosis Status\u003c/h3\u003e\n\u003cp\u003eSince there was a marginal association between BMD and oVEMP response (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.098, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), we divided all the participants into osteoporotic (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;81) and non-osteoporotic (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;210) groups for further analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). When compared to patients without osteoporosis, individuals with osteoporosis were typically older (65.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 vs. 62.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), had decreased BMI (22.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71 vs. 24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and showed a higher proportion of females (84.0% vs. 72.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039). No significant disparities emerged between cohorts regarding the frequency of chronic vascular diseases, smoking, or drinking histories. Also, the vertigo severity at baseline and W1 was similar between the two groups.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and clinical characteristics between benign paroxysmal positional vertigo patients with and without osteoporosis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-osteopenia\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;210)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOsteoporosis\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e152(72.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68(84.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.039*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHBP\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90(42.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(39.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.604\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDM\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(11.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(7.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHL\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHD\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(12.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.561\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(8.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.725\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrinking\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.213\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePosterior semicircular canal\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e166 (79.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63(77.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eW0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVertigo VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90(70\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90(80\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDizziness VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40(10\u0026ndash;60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(20\u0026ndash;60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDHI total score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.5(20\u0026ndash;48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(24\u0026ndash;44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.896\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eW1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVertigo VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.349\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDizziness VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20(0\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(0\u0026ndash;48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.968\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDHI total score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(2\u0026ndash;22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(4\u0026ndash;22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.732\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eoVEMP\u003c/b\u003e,\u003cb\u003en\u003c/b\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.025*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral presence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90(42.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(25.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnilateral absence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57(27.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(32.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral absence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63(30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(42.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ecVEMP\u003c/b\u003e, \u003cb\u003en\u003c/b\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.347\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral presence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119(56.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(50.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnilateral absence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47(22.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(21.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral absence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44(21.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(28.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: BMI, body mass index; HBP, high blood pressure; DM, diabetes mellitus; HL, hyperlipoidemia; CHD, Coronary Heart Disease; DHI, dizziness handicap inventory; W0, at enrollment; W1, 1 week after enrollment; VAS, visual analog scale; oVEMP, ocular vestibular evoked myogenic potential; cVEMP, cervical vestibular evoked myogenic potential.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eComparative analysis of VEMP results revealed that osteoporosis patients showed significantly greater frequencies of bilateral and unilateral oVEMP absence compared to non-osteoporosis controls (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025). On the contrary, the cVEMP results were similar between the two groups. For the subjects with bilateral elicited response, no statistically significant intergroup differences emerged in any electrophysiological measures, including threshold, latency, amplitude, or AAR in patients with and without osteoporosis (\u003cb\u003eSupplementary Table\u0026nbsp;1, Supplementary Table\u0026nbsp;2\u003c/b\u003e)\u003c/p\u003e\n\u003ch3\u003eIndependently associated factors of BPPV patients with abnormal oVEMP\u003c/h3\u003e\n\u003cp\u003eCompared with patients with bilateral oVEMP presence, those with at least unilateral absence were older (64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 vs. 62.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) and had decreased lumbar T-score and BMD values (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Sex proportions and BMI measurements did not differ significantly groups. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBone mineral density and T-score in the lumbar vertebrae with different ocular vestibular evoked myogenic potential response groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBilateral presence\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;111)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAt least unilateral absence\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.005**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.378\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84(75.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136(75.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.982\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eL1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.018*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.896\u0026thinsp;\u0026plusmn;\u0026thinsp;0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.836\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eL2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.007**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.948\u0026thinsp;\u0026plusmn;\u0026thinsp;0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.868\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eL3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.999\u0026thinsp;\u0026plusmn;\u0026thinsp;0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.913\u0026thinsp;\u0026plusmn;\u0026thinsp;0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eL4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.021*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.997\u0026thinsp;\u0026plusmn;\u0026thinsp;0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.923\u0026thinsp;\u0026plusmn;\u0026thinsp;0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.005**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.964\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.887\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: BMI, body mass index; BMD, bone mineral density; L1, the first lumbar vertebra; L2, the second lumbar vertebra; L3, the third lumbar vertebra; L4, the fourth lumbar vertebra;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in the univariate logistic regression, age (OR\u0026thinsp;=\u0026thinsp;1.050, 95% CI 1.015\u0026ndash;1.087, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) and osteoporosis (OR\u0026thinsp;=\u0026thinsp;2.142, 95% CI 1.215\u0026ndash;3.778, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) may be related to the occurrence of abnormal oVEMP. Whereas sex and BMI did not emerge as contributing factors to oVEMP abnormality. After controlling the confounding factors, including age, sex, and BMI, we found that osteoporosis (OR\u0026thinsp;=\u0026thinsp;2.038, 95% CI 1.122\u0026ndash;3.701, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019) was still an independent associated factor for oVEMP abnormality (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIndependent risk factors for abnormal ocular vestibular evoked myogenic potential in benign paroxysmal positional vertigo patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate regression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariate regression\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.050(1.015\u0026ndash;1.087)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.005**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.042(1.006\u0026ndash;1.080)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.021*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.994(0.573\u0026ndash;1.724)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.925 (0.523\u0026ndash;1.638)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.790\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.015(0.944\u0026ndash;1.091)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.038(0.962\u0026ndash;1.119)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.340\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOsteoporosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.142(1.215\u0026ndash;3.778)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.008**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.038 (1.122\u0026ndash;3.701)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.019*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNotes: BMI, body mass index;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFor the first time, as far as we know, this study employed a cross-sectional methodology to evaluate associations linking BMD and VEMP results in elderly patients with BPPV with a large sample size. BPPV patients with osteoporosis are generally older, have a lower BMI, are more likely to be female, and have at least one unilateral absence of oVEMP. Osteoporosis is an independent factor associated with abnormal oVEMP among individuals with BPPV.\u003c/p\u003e\u003cp\u003eSince the utriculo-ocular pathway mediates oVEMP responses, whereas the sacculo-collic pathway underlies cVEMP responses, our study presents a novel observation: osteoporosis may be linked specifically to utricular dysfunction rather than saccular dysfunction in BPPV. Several lines of evidence support this phenomenon. i) From a theoretical perspective, the displaced otoconia in BPPV cases primarily originate from the utricle instead of the saccule. This disorder more frequently involves utricular rather than saccular dysfunction; II) On a pathophysiological level, the endolymph is characterized by a low Ca\u003csup\u003e2+\u003c/sup\u003e environment. BMD may elevate Ca\u003csup\u003e2+\u003c/sup\u003e concentrations in the endolymph, promoting otoconia accumulation and diminishing vestibular excitation in BPPV[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]; iii) In the aging population, especially in menopause women, both Baltimore Longitudinal Study of aging and a few observational studies suggested that low BMD may associate with vestibular dysfunction as evaluated by Romberg test condition 4 or VEMP tests (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). iv) A pilot study in BPPV patients in China also revealed an inverse relationship between canal paresis and low BMD [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which also supports our results. Therefore, we speculate that osteoporosis influences calcium metabolism in the endolymph and vestibular excitation reduction, increasing the incidence of utricular dysfunction, which is involved in BPPV occurrence.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevious studies on low bone mineral density and vestibular dysfunction in humans.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubjects (sample size)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvaluation methods\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMain findings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMendy A, \u003cem\u003eet al\u003c/em\u003e. Ann Epidemiol. 2014\u003c/p\u003e\u003cp\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParticipants aged 40 years and older (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8863)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMD, Romberg test condition 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow BMD is associated with balance impairment, especially in older adults\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBigelow RT, \u003cem\u003eet al\u003c/em\u003e. J Assoc Res Otolaryngol. 2016[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOlder adults\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;389)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMD, cVEMP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOlder individuals with reduced vestibular function had lower BMD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGargeshwari A, \u003cem\u003eet al\u003c/em\u003e. Braz J Otorhinolaryngol. 2018[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy controls (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12),\u003c/p\u003e\u003cp\u003eosteopenia (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12), and\u003c/p\u003e\u003cp\u003eosteoporosis (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMD, c/o VEMP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eoVEMP (rather than cVEMP) absent rate was increased in the osteoporosis group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJuneja MK, \u003cem\u003eet al\u003c/em\u003e. J Otol. 2021[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostmenopausal women with normal BMD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28), osteopenia (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25) and osteoporosis (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMD, c/o VEMP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe percentage of vestibular dysfunction was increased in subjects with osteopenia and osteoporosis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJiang X, \u003cem\u003eet al\u003c/em\u003e. Otol Neurotol. 2022[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostmenopausal women with BPPV (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMD, caloric test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCP value in the caloric test was negatively correlated with the T value in the BMD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhou CY, \u003cem\u003eet al\u003c/em\u003e. The present study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients with BPPV, aged 50\u0026ndash;80 years (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;291)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMD and c/o VEMP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOsteoporosis was an independently associated factor for at least unilateral oVEMP absence in patients with BPPV\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: BMD, bone mineral density; BPPV, benign paroxysmal positional vertigo; oVEMP, ocular vestibular evoked myogenic potential; cVEMP, cervical vestibular evoked myogenic potential; CP, canal paresis.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOur investigation demonstrated that participants in the osteoporosis group, as well as those exhibiting abnormal oVEMP, were generally older, aligning with previous animal studies. Both bone metabolism and vestibular system function decline with age. Existing literature indicates that vestibular balance in older mice is more susceptible to impairment compared to younger mice, and cholinergic receptor transmission within the vestibular hair cells is less efficient in aged mice than in their younger counterparts [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study has important clinical implications for linking osteoporosis with utricular dysfunction in BPPV, which contributes to disease occurrence. A few limitations should be mentioned. We did not include healthy controls or disease controls with other vestibular disorders. For vestibular function evaluation, we only used VEMPs. The study did not include caloric tests or video-head impulse tests (v-HITs). More detailed vestibular evaluations with a multicenter design are needed in the future.\u003c/p\u003e\u003cp\u003eIn summary, our study provides further evidence suggesting that osteoporosis may play a role in utricular dysfunction associated with the development of BPPV. The potential for osteoporosis treatment to improve disease prognosis in patients with BPPV warrants additional research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eEthics Statement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis investigation was conducted with approval (SH9H-2020-T270-2) from the Ethics Committee of Shanghai Jiao Tong University-affiliated Ninth People's Hospital.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsent\u003c/b\u003e\u003c/p\u003e\u003cp\u003e All subjects voluntarily provided signed consent forms before participating in this research.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003cp\u003eThere are no declared conflicts of interest among the contributing authors.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eWei Chen received grants from the Clinical Research Program of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (JYLJ202003) and Project of Biobank from Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (YBKB202120).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.C.Z.: conceptualization, validation, software, investigation, formal analysis, writing\u0026mdash;original draft. L.S.: resources, validation, methodology, writing\u0026mdash;review and editing. J.W.: resources, data curation, validation, investigation. J. C.: investigation, resources, data curation. X.Y.B.: resources, software, data curation.R.Y.: resources, data curation. H.X. S.: data curation, resources. S.X.: software, resources. R.J.L.: resources, data curation, supervision. B.H.S.: conceptualization, methodology, resources, validation, data curation, manuscript writing and editing. W.C.: conceptualization, methodology, resources, funding acquisition, validation, supervision, data curation, manuscript writing and editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe investigators wish to express appreciation to all research participants.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eStudy data are accessible from the corresponding author upon formal application.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eParham, K. \u0026amp; Kuchel, G. A. A Geriatric Perspective on Benign Paroxysmal Positional Vertigo. \u003cem\u003eJ. Am. Geriatr. 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However, direct evidence remains elusive.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo analyze the correlation between bone mineral density (BMD) and vestibular function in elderly patients with BPPV.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eTwo hundred ninety-one idiopathic, unilateral BPPV patients aged 50\u0026ndash;80 years were consecutively enrolled in our vertigo outpatient clinic. All the participants underwent BMD, cervical, and ocular vestibular evoked myogenic potential (c/oVEMP) evaluations. The associations between BMD and VEMP results were investigated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEighty-one patients (27.8%) were diagnosed with osteoporosis, while 120 patients (41.2%) had osteopenia. Among BPPV patients, abnormal BMD demonstrated a marginal correlation with oVEMP response (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.098), but not with cVEMP response (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.405). Compared to those without osteoporosis, patients with osteoporosis were older (65.9 \u003cem\u003evs.\u003c/em\u003e 62.7 years, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), had lower BMI (22.6 \u003cem\u003evs.\u003c/em\u003e 24.3, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), showed a higher proportion of females (84.0% \u003cem\u003evs.\u003c/em\u003e 72.4%, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.039), and were more likely to present with at least unilateral oVEMP absence (74.1% \u003cem\u003evs.\u003c/em\u003e 57.1%, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.008). Patients exhibiting at least unilateral oVEMP absence also had reduced T-scores and BMD in the lumbar spine. After adjusting for confounding variables, osteoporosis remained independently associated with at least unilateral oVEMP absence in BPPV patients (OR\u0026thinsp;=\u0026thinsp;2.038, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.019).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eOur study provides further evidence that osteoporosis may contribute to utricular dysfunction associated with the occurrence of BPPV.\u003c/p\u003e","manuscriptTitle":"Osteoporosis correlates with abnormal ocular vestibular evoked myogenic potential in patients with benign paroxysmal positional vertigo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 14:59:39","doi":"10.21203/rs.3.rs-7540385/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37e940c7-7173-4816-a874-5d033f2461b3","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55877062,"name":"Health sciences/Diseases"},{"id":55877063,"name":"Health sciences/Health care"},{"id":55877064,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-10-15T06:24:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-10 14:59:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7540385","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7540385","identity":"rs-7540385","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}