Benign Paroxysmal Positional Vertigo in Patients with Low Bone Mineral Density: Association with Serum Calcium, Vitamin D, and Dizziness-related Disability – A Prospective Cross-sectional Study

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Background: Benign paroxysmal positional vertigo (BPPV) is the commonest peripheral vestibular disorder.Because its otoconia are calcium carbonate and depend on calcium homeostasis to stay intact, clinicians have wondered whether low bone mineral density (BMD) and disturbed calcium metabolism make the condition more likely.Objectives: To estimate the prevalence of BPPV in patients with low BMD, describe their calcium and vitamin D status, compare the osteopenia and osteoporosis subgroups, and explore predictors of dizziness-related disability and of BPPV.Materials and methods: We prospectively studied 53 patients older than 40 years with osteopenia or osteoporosis on calcaneal dual-energy X-ray absorptiometry (DEXA) over an 11 months period (February-December 2025) at a tertiary center in Tumkur, Karnataka.All underwent vestibular testing, measurement of serum total calcium and 25-hydroxyvitamin D, and dizziness handicap inventory (DHI) scoring.Groups were compared with the independent-samples t-test and the Chi-square or Fisher exact test; associations were examined with Pearson correlation, multiple linear regression, and logistic regression.Results: Mean age was 58.8 ± 7.1 years and 75.5% were women.Benign paroxysmal positional vertigo was found in 19 of 53 patients [35.8%; 95% confidence interval (CI): 24.3-49.3%].Its frequency rose sharply with bone loss, from 17.9% in osteopenia to 85.7% in osteoporosis (p < 0.001).Patients with BPPV had lower serum calcium than those without (7.89± 0.83 vs 8.88 ± 0.75 mg/dL; Cohen d = 1.3; p < 0.001) and lower BMD T-scores (-2.37 ± 0.55 vs -1.77 ± 0.58; d = 1.1; p < 0.001).Their DHI scores were also much higher (63.8 ± 12.2 vs 37.0 ± 13.2; d = 2.1; p < 0.001).Vitamin D was lower in cases, but the difference was not significant (20.7 ± 6.5 vs 24.2 ± 7.3 ng/mL; p = 0.07).Hypocalcemia carried nearly eight-fold higher odds of BPPV [73.7 vs 26.5%; odds ratio (OR): 7.78, 95% CI: 2.18-27.81;p = 0.001].In logistic regression, lower calcium and lower BMD T-score were each independent predictors of BPPV.Disability behaved differently.Once BPPV status was entered into the linear model, it dominated (standardized β = 1.24; p < 0.001); the model accounted for 58% of the variance in DHI, and calcium added nothing further.Conclusion: In this low-BMD cohort, BPPV was linked to lower serum calcium and greater bone-loss severity, with a steep rise in prevalence from osteopenia to osteoporosis.Disability was driven mainly by whether BPPV was present, not by bone density or calcium on their own.The design is cross-sectional and cannot prove causation, but the findings make a case for checking serum calcium, vitamin D, and bone density in older patients who present with positional vertigo.Keywords: Benign paroxysmal positional vertigo, Bone mineral density, Dizziness handicap inventory, Hypocalcemia, Vitamin D. Take-home message: In patients with low BMD, BPPV was associated with lower serum calcium and more severe bone loss.Serum calcium, vitamin D and bone densitometry are worth checking in older patients with positional vertigo, although this cross-sectional study cannot show whether correcting these deficiencies prevents the disorder.