Associations of muscle function with recurrent and injurious falls in adults aged 50 years and older: A systematic review - 06/11/26

Doi : 10.1016/j.tjfa.2026.100219

Nina Z. Heilmann ^a, Hajin Jang ^b, Paolo Caserotti ^c, Peggy M. Cawthon ^d,^e, Ashley A. Weaver ^f, Kristen M. Beavers ^a, Kristine M. Ruppert ^b, Bradley C. Nindl ^g, Jane A. Cauley ^b, Elsa S. Strotmeyer ^b,^⁎

^a Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

^b Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

^c Department of Sports Science and Clinical Biomechanics and the Center for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark

^d San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA

^e Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

^f Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA

^g Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA

^⁎ Corresponding author at: 130 De Soto St, 5th floor, Pittsburgh, PA, USA. 130 De Soto St, 5th floor Pittsburgh PA USA

Highlights

•	Falls are a leading cause of injury and injury-related death in older adults.
•	Higher grip strength is associated with lower recurrent and injurious falls risk.
•	Higher leg power may protect against injurious falls, but evidence is limited.
•	Lower-extremity muscle function is understudied in fall risk.
•	Standardized fall outcome definitions and sex-specific analyses are needed.

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Abstract

Purpose

Falls are the leading cause of injury and injury-related mortality among older adults in the U.S. and a major contributor to fracture risk. Muscle function (strength and power) has been associated with risk of recurrent and injurious falls, yet studies vary by measurement methods and anatomical locations. This review synthesizes evidence on associations between muscle function and fall outcomes, identifies methodological limitations, and suggests directions for future research.

Methods

PubMed and Embase were searched for peer-reviewed articles published between 2000 and September 16, 2026 examining associations of muscle function with recurrent or injurious falls among adults aged ≥50 years. Performance-based measures of muscle function (e.g., chair stands) were excluded to focus on direct strength and power assessments. Two reviewers screened abstracts and full texts, one extracted study characteristics, and one performed a risk-of-bias assessment.

Results

Seventeen studies were included, with eight rated ‘good’ and nine rated ‘fair’ quality. Most found that higher grip strength was associated with lower odds of recurrent and injurious falls, though sex-specific associations remain underexplored. Leg strength was evaluated in only one study, and leg power in two studies. Both reported associations of higher leg power with lower odds of injurious falls that were similar in magnitude to grip strength associations, but only one was statistically significant.

Conclusion

Reduced upper-extremity strength may be a risk factor for recurrent and injurious falls, whereas evidence for lower-extremity power remains limited and inconsistent. Future research should incorporate multiple muscle function measures, standardize injury definitions, and examine sex-specific associations.

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Keywords : Strength, Power, Fall injury, Recurrent falls, Community-dwelling

Abbreviations : aBMD, ADL, BMI, CHF, COPD, HR, MMSE, OR, RR, SPPB