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

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.