Associations of muscle function with recurrent and injurious falls in adults aged 50 years and older: A systematic review

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.