Incidence of kinesiophobia in postmenopausal osteoporosis and its relationship with pain, quality of life, fear of falling, balance and depression

The risk of osteoporosis (OP) increases with age and is especially important in postmenopausal women. It is known as a painless and silent disease unless there are fragility fractures. However, even if it is painless, kinesiophobia may develop in osteoporotic individuals due to insufficient or wrong information about OP and wrong perception of the disease. Osteoporotic patients may be afraid to move and limit their activities due to the fear of falling and the fear of fragility fracture during daily physical activity. In addition, deteriorating quality of life, depression, balance disorder and fear of falling can be expected in people with osteoporosis. The aim of this study is to evaluate the level of kinesiophobia in postmenopausal OP and osteopenia and to determine the relationship of kinesiophobia with sociodemographic characteristics, quality of life, pain, balance, fear of falling and depression. In this study, 40 postmenopausal osteoporosis (OP) patients, 40 postmenopausal osteopenia (OPN) patients and 40 postmenopausal women with normal bone mineral density who applied to the Physical Medicine and Rehabilitation outpatient clinic of Adıyaman Training and Research Hospital were included. The sociodemographic characteristics of the participants were recorded. Bone mineral density (BMD) values were evaluated according to Dual energy x-ray absorptiometry (DEXA) measurement results made within the last year. In the evaluation, Tampa kinesiophobia scale (TKS) for kinesiophobia, Falls Efficacy Scale International (FES-I) for fear of falling, Berg balance scale (BBS) and Timed up and go test (TUG) for balance, Beck depression inventory (BDI) for depression, Visual analog scale (VAS) for pain and Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) for quality of life were used. In our study, TKS scores in the OP and OPN groups were statistically significantly higher than the control group (p<0.001), but no statistically significant difference was found between the OP and OPN groups (p>0.05). It was found that the mean of VAS in the OP group was statistically significantly higher than the control (p<0.001) and OPN (p=0.018) groups. The QUALEFFO-Total and all subscale scores in the OP group were statistically significantly higher than the control group (p<0.001). It was found that the mean BDI scores of the cases in the OP group were statistically significantly lower than the OPN (p=0.011) and control groups (p<0.001). It was determined that TUG mean scores in OP and OPN groups did not differ statistically significantly (p>0.05). The mean FES-I in the OP group were statistically significantly higher than the control group (p<0.001). It was determined that the BDI averages did not differ statistically significantly between the three groups and in the double-group analyzes (p>0.05). According to the correlation analysis of the osteopenia group, statistically significant positive correlation between VAS and Q-Pain (p<0.001), Q-GS (p=0.020), Q-Z (p=0.036) and Q-Total (p=0.005) scores; statistically significant positive correlation between TKS and FES-I (p=0.001) and TUG (p=0.048) scores, and statistically significant negative correlation between TKS and BBS scores (p=0.036); statistically significant negative correlation between BBS and FES-I (p=0.034) and TUG (p<0.001) scores; statistically significant positive correlation between FES-I and TUG scores (p<0.001) were found. According to the correlation analyzes of the osteoporosis group, statistically significant positive correlation between VAS and Q-Pain (p=0.015), Q-S (p=0.048) and Q-Total (p=0.013) scores; statistically significant positive correlation between Q-Total and TKS (p=0.014) and BDI (p=0.008) scores; statistically significant negative correlation between TKS and BBS scores (p=0.012); statistically significant negative correlation between BBS and TUG scores (p<0.001) were found. In conclusion, the association of kinesiophobia should be considered in postmenopausal osteoporotic and osteopenic patients. Because physical activity is essential for bone health and overall health, postmenopausal women with OP and OPN should be educated about the importance of physical activity to overcome kinesiophobia. The negative effects of kinesiophobia on fear of falling, balance disorder, quality of life, depression and pain should be prevented. Keywords: Postmenopausal osteoporosis, kinesiophobia, balance, fear of falling