# Association of Sarcopenia and Lower Bone Density With Positional Vertigo in the Morning: Insights From a Nationwide Survey

## TL;DR

This study found that muscle loss and low bone density are linked to morning dizziness in older adults, especially when there is inner ear dysfunction.

## Contribution

The study reveals a novel connection between sarcopenia, bone density, and positional vertigo in the context of vestibular dysfunction.

## Key findings

- Sarcopenia independently predicts vestibular-impaired morning positional vertigo.
- Lower bone mineral density is inversely associated with vestibular dysfunction.
- Morning positional vertigo is more common in older adults with systemic frailty markers.

## Abstract

This study aimed to identify associations of sarcopenia, obesity and low bone mineral density (BMD) with morning positional vertigo (PV) and to examine whether these associations differ according to vestibular function status in a nationally representative sample of Korean adults.

We analysed data from 8512 adults aged ≥ 40 years (50.03% women, mean ± standard error [SE] = 54.06 ± 0.19) who participated in the Korean National Health and Nutrition Examination Survey 2008–2010. Morning PV was defined as severe vertigo when turning in bed or rising in the morning within the past year. Vestibular impairment was assessed using the modified Romberg test (eyes closed, standing on a compliant foam surface). Participants were classified into three groups: controls (no dizziness), morning PV with normal Romberg test results and morning PV with abnormal Romberg test results (suggesting vestibular dysfunction). Body composition—including appendicular skeletal muscle mass, fat mass and BMD—was measured. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria, and abnormal BMD was defined as T‐score < 1.0. Weighted multinomial logistic regression analyses were adjusted for age, sex, income, comorbidities, lifestyle and psychosocial variables.

The weighted 1‐year prevalence of morning PV was 12.58% (95% confidence interval [CI], 11.38–13.89). Abnormal Romberg performance, indicating vestibular dysfunction, was present in 0.96% of all survey respondents and in 7.66% of those with morning PV. Participants with vestibular‐impaired morning PV were older (mean age ± SE = 66.47 ± 1.49), predominantly women, and had higher rates of sarcopenia (38.33%) and low BMD (86.39%) than controls. In adjusted models, sarcopenia independently predicted vestibular‐impaired morning PV (odds ratio [OR], 1.94; 95% CI, 1.14–3.29; p = 0.014). Sensitivity analysis restricted to current morning PV confirmed the association between sarcopenia and vestibular impairment (OR, 2.97; 95% CI, 1.08–8.12; p = 0.035) and demonstrated that lower BMD (minimum T‐score) was inversely associated with vestibular dysfunction (OR, 0.49; 95% CI, 0.25–0.99; p = 0.046).

Morning PV is common among middle‐aged and older adults and is associated with systemic frailty markers, particularly sarcopenia and bone loss, in the presence of vestibular dysfunction. These associations were more pronounced in older adults, suggesting a vestibulo‐musculoskeletal interaction that may contribute to balance impairment and functional decline with aging. Screening for sarcopenia and bone health, along with vestibular and lifestyle interventions, may help reduce recurrent vertigo and improve functional aging.