Kinesiophobia phenotypes and fall history in older adults with osteoporosis: a cross-sectional study using latent profile analysis.

OBJECTIVE: Falls are a leading cause of morbidity among older adults with osteoporosis. While traditional risk assessment focuses on biological factors such as bone mineral density (BMD), psychological factors-particularly kinesiophobia-have received increasing attention. However, most studies conceptualize kinesiophobia as a continuous construct, potentially overlooking clinically meaningful heterogeneity. This study aimed to identify kinesiophobia phenotypes and examine their association with fall history in older adults with osteoporosis. METHODS: This cross-sectional study included 306 older adults with osteoporosis recruited from a tertiary hospital. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK-17) and the Kinesiophobia Causes Scale (KCS). Latent profile analysis (LPA) was performed to identify distinct kinesiophobia phenotypes based on standardized KCS scores. Multivariable logistic regression was used to evaluate the association between phenotypes and fall history, adjusting for age, body mass index (BMI), BMD, prognostic nutritional index (PNI), and the log-transformed systemic immune-inflammation index (log-SII). Model performance was assessed using the area under the receiver operating characteristic curve (AUC) with bootstrap validation. RESULTS: Among 306 participants (mean age, 74.9 years; 77.1% women), 232 (75.8%) exhibited kinesiophobia and were included in the LPA. Three phenotypes were identified: sensitized, resilient, and frail. The frail phenotype was independently associated with a significantly higher odds of prevalent falls (OR, 2.93; 95% CI, 1.44-5.96; P = .003), whereas the sensitized phenotype was not. Notably, bone mineral density was not independently associated with fall history after adjustment (P = .735). The predictive model demonstrated moderate discrimination (AUC = 0.693; bootstrap AUC = 0.692), with improved performance after inclusion of kinesiophobia phenotypes. CONCLUSION: Kinesiophobia is a heterogeneous construct in older adults with osteoporosis. The frail kinesiophobia phenotype is associated with a substantially higher odds of prevalent falls, independent of traditional biological markers. These findings suggest that psychological and behavioral phenotyping may enhance fall history stratification and support more targeted prevention strategies in geriatric populations.