Predictive value of grip strength for bone mineral density in males: site specific or systemic?

Utilizing nomograms to predict prevalent vertebral fracture risk: An analysis of dysmobility syndrome in a community-dwelling population

BACKGROUND

To determine a reliable method to predict prevalent vertebral fractures (VF) by assessing the association between dysmobility syndrome (DS) and VF in a community-dwelling population.

METHODS

This cross-sectional study enrolled 518 participants from fracture-prevention educational activities held in multiple communities in Taiwan. Assessments included questionnaires, fracture risk assessment tool (FRAX), bone mineral density (BMD) and body composition using dual-energy x-ray absorptiometry (DXA), lateral thoracolumbar spine x-rays (specifically T8-S1), grip strength (GS), walking speed, and fall history.

RESULTS

DS was noted in 257 participants (49.6%) and VF was identified in 196 participants (37.8%). A higher prevalence of VF was noted in those with DS. The prevalence of VF was significantly associated with age, gender, FRAX both with and without BMD, osteoporosis, low GS, and DS. In multivariate models accounting for age and sex, the c-index was greater in those with low GS plus osteoporosis as compared to DS alone. Low GS, osteoporosis, and pre-BMD FRAX all had similar c-indexes. Pre-BMD FRAX plus low GS and osteoporosis was superior in predicting VF compared to pre-BMD FRAX plus low GS or osteoporosis alone. Besides the inclusion of age and gender, the nomogram with pre-BMD FRAX major osteoporosis fracture probability (MOF) plus low GS had improved correlation between the estimated and actual VF probability than those with pre-BMD FRAX MOF plus osteoporosis.

CONCLUSIONS

The constructed nomogram containing pre-BMD FRAX MOF plus low GS may be considered as a first-line prevalent VF screening method. Those with high-risk scores should subsequently undergo vertebral radiography and/or BMD.

Causal associations of hand grip strength with bone mineral density and fracture risk: A mendelian randomization study

BACKGROUND

Muscle strength has been shown to exert positive effects on bone health. The causal relationship between hand grip strength and osteoporosis is an important public health issue but is not fully revealed. The goal of this study was to investigate whether and to what extent hand grip strength affects bone mineral density (BMD) and fracture risk.

METHODS

We conducted a state-of-the-art two-sample Mendelian randomization analysis. Genomewide significant (P<5×10^-8) single nucleotide polymorphisms associated with hand grip strength were obtained. Summary level data of BMD and fractures at different body sites (lumbar spine, heel, forearm and femoral neck) was obtained from a large-scale osteoporosis database. The inverse variance weighted method was the primary method used for analysis, and the weighted-median, MR-Egger were utilized for sensitivity analyses.

RESULTS

The results provided strong evidence that hand grip strength trait was causally and positively associated with lumbar spine BMD (β: 0.288, 95% CI: 0.079 to 0.497; P=0.007), while no causal relationship was found between hand grip strength and BMD at heel (β: -0.081, 95% CI: -0.232 to 0.070; P=0.295), forearm (β: 0.-0.101, 95% CI: -0.451 to 0.248; P=0.571) or femoral neck (β: 0.054, 95% CI: -0.171 to 0.278; P=0.639). In addition, no statistically significant effects were observed for hand grip strength on fracture risks (β: -0.004, 95% CI: -0.019 to 0.012; P=0.662).

CONCLUSIONS

This study showed a positive causal relationship between hand grip strength and lumbar BMD, which is the most common site of osteoporotic fracture, but did not find a causal relationship between hand grip strength and BMD of heel, forearm, or femoral neck. No statistically significant effect of hand grip strength on fracture risk was observed. This study indicates variations in the abilities of hand grip strength trait to causally influence BMD at different skeleton sites. These results should be considered in further studies and public health measures on osteoporosis prevention strategies.

Higher Hand Grip Strength Is Associated With Greater Radius Bone Size and Strength in Older Men and Women: The Framingham Osteoporosis Study

Mechanical loading by muscles elicits anabolic responses from bone, thus age‐related declines in muscle strength may contribute to bone fragility in older adults. We used high‐resolution peripheral quantitative computed tomography (HR‐pQCT) to determine the association between grip strength and distal radius bone density, size, morphology, and microarchitecture, as well as bone strength estimated by micro–finite element analysis (μFEA), among older men and women. Participants included 508 men and 651 women participating in the Framingham Offspring Study with grip strength measured in 2011–2014 and HR‐pQCT scanning in 2012–2015. Separately for men and women, analysis of covariance was used to compare HR‐pQCT measures among grip strength quartiles and to test for linear trends, adjusting for age, height, weight, smoking, and physical activity. Mean age was 70 years (range, 50–95 years), and men had higher mean grip strength than the women (37 kg vs. 21 kg). Bone strength estimated by μFEA‐calculated failure load was higher with greater grip strength in both men (p < 0.01) and women (p = 0.04). Higher grip strength was associated with larger cross‐sectional area in both men and women (p < 0.01), with differences in area of 6% and 11% between the lowest to highest grip strength quartiles in men and women, respectively. Cortical thickness was positively associated with grip strength among men only (p = 0.03). Grip strength was not associated with volumetric BMD (vBMD) in men. Conversely, there was a trend for lower total vBMD with higher grip strength among women (p = 0.02), though pairwise comparisons did not reveal any statistically significant differences in total vBMD among grip strength quartiles. Bone microarchitecture (cortical porosity, trabecular thickness, trabecular number) was not associated with grip strength in either men or women. Our findings suggest that the positive association between hand grip strength and distal radius bone strength may be driven primarily by bone size. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Hand grip strength in predicting the risk of osteoporosis in Asian adults

INTRODUCTION

There is a need for a cost-effective method to identify individuals with a high risk of osteoporosis. This study aimed to investigate the suitability of hand grip strength in predicting the risk of osteoporosis in Asian adults.

MATERIALS AND METHODS

In this cross-sectional, hospital-based study of 1007 participants, the bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry according to the 2019 International Society for Clinical Densitometry official positions. Bone microarchitecture was evaluated using the trabecular bone score, and hand grip strength was measured in the dominant hand using a hand digital dynamometer.

RESULTS

Hand grip strength was significantly related to bone density and bone microarchitecture. Moreover, hand grip strength was a significant predictor of osteoporosis in both women and men. For osteoporosis prediction in women, a threshold of 21.9 kg of hand grip strength had a sensitivity of 59%, specificity of 59%, and area under the curve (AUC) of 0.61. In men, a threshold of 28.7 kg had a sensitivity of 66%, specificity of 78%, and AUC of 0.75. The optimal cutoff strengths for osteoporosis depended on age and sex.

CONCLUSION

The measurement of hand grip strength is a simple, cost-effective and an easy assessment method for identifying individuals at a high risk of osteoporosis. The cutoff strength for evaluating osteoporosis in adults is age and sex specific.

Measurement and Interpretation of Handgrip Strength for Research on Sarcopenia and Osteoporosis

Handgrip strength (HGS) is associated with several chronic diseases, cognitive decline, length of hospital-stay, and mortality. More importantly, HGS is one of the diagnostic criteria of sarcopenia and gaining attention because of its relevance to bone mineral density (BMD) and osteoporotic fractures. As the measurement of HGS is widely used in clinical practice as well as in research, its accurate measurement and interpretation are becoming more crucial. This review describes how to use different types of dynamometers accurately, the impact of body and arm positions and anthropometric parameters on HGS, the current reference values of HGS for sarcopenia research, and the updates on the relationship between HGS and BMD and osteoporotic fractures.

Association between grip strength and bone mineral density in general US population of NHANES 2013-2014

Association between strength of nonadjacent muscles and bone mineral density is unclear. We used data from the National Health and Nutrition Examination Survey to convince the effect of grip strength on femoral neck and lumbar spine mineral density in the general US population. This research can broaden the area of muscle-bone interaction.

INTRODUCTION

Grip test measures the maximum isotonic strength of hand and forearm and is often used as an indicator of general muscle strength. Muscle has been shown to exert positive effects on bone health, and studies are needed to test whether grip strength can be associated with bone mineral density of nonadjacent bones. The aim of this study is to assess whether grip strength is an independent predictor for bone mineral density (BMD) of femoral neck and total lumbar spine in the general US population.

METHODS

We used the data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014, and 1850 participants aged from 40 to 80 years old were included in the analysis. Grip strength was recorded as the largest reading of three efforts of one's dominant hand using a handgrip dynamometer. Femoral neck and lumbar spine BMDs were measured through Dual-energy X-ray absorptiometry (DXA) scan. Univariate and multivariate linear regression analyses were done to examine the association between grip strength and BMDs.

RESULTS

After adjusting for age, ethnicity, body mass index (BMI), use of female hormones, smoking habit, drinking habit, family history of osteoporosis, use of calcium and vitamin D supplements, physical activity, serum calcium, and phosphorus levels, grip strength is associated with increased femoral neck and total lumbar spine BMDs in men (P < 0.001, P = 0.005), premenopausal women (P = 0.040, P = 0.014), and postmenopausal women (P = 0.016, P = 0.012).

CONCLUSIONS

Our results suggest that (1) grip strength can be associated with BMD of nonadjacent bones, and (2) grip strength of dominant hand can be an indicator of BMD in the general US population across genders and menopausal status.

Occupational Activities: Factors That Tip the Balance From Bone Accrual to Bone Loss

Bone adaptation to persistent overloading can be counteracted by superimposed inflammatory and loading-induced damage that can tip the balance from bone accrual to loss.

Supplemental digital content is available in the text.

It is commonly assumed that beneficial adaptations in bone occur with vigorous exercise, yet any adaptive re/modeling in bone undergoing persistent overloading can be counteracted by superimposed inflammatory, compressive, and tensile loading–induced damage responses above thresholds of tissue fatigue failure and repair. This leads to a tenuous balance between achieving bone accrual and loss.

Bone mineral density and trabecular bone score in Chinese subjects with sarcopenia

Background

As the general population is aging worldwide, the incidence of sarcopenia and osteoporosis is also rapidly increasing. Studies have found the link between sarcopenia and osteoporosis, but the relationship between sarcopenia and osteoporosis, especially bone microarchitecture, remains unclear.

Aims

To investigate the relationship between components of sarcopenia (muscle mass, handgrip strength, and gait speed) and components of osteoporosis [bone mass measured by bone mineral density (BMD) and bone microarchitecture measured by trabecular bone score (TBS)] in Chinese subjects.

Methods

318 Chinese men and 203 Chinese women were included in our study. Muscle mass and BMD were measured by dual-energy X-ray absorptiometry (DXA). TBS iNsight^® software was used for TBS. Jamar hydraulic hand dynamometer was used to assess muscle strength, and gait speed was used to assess physical performance.

Results

We found that the relative appendicular skeletal muscle mass (RASM) in both genders and handgrip strength in women correlated positively with TBS, RASM in men and handgrip strength in women correlated positively with BMDs. In the multiple linear regression model, RASM was positively associated with TBS in both genders, but no significant association was observed between RASM and BMDs. Interestingly, handgrip strength showed positive association with all evaluated BMDs and TBS in women, but not in men. Women with sarcopenia had lower TBS and BMDs at all evaluated sites. Men with sarcopenia had lower BMDs only at femur neck and total hip.

Conclusions

The reduction of muscle mass and strength was significantly associated with decreased bone mass and deteriorated bone microarchitecture. More importantly, low muscle mass is an independent risk factor for bone microarchitecture in Chinese subjects.

Predictors of Bone Status by Quantitative Ultrasound Measurements in a Mountain Village in Japan

Background:

It seems to be important to recognize predictors of bone health condition in Japanese super-aged society. The purpose of this study was to investigate predictors of the speed of sound (SOS) of calcaneus by quantitative ultrasound measurements of mountain village residents.

Materials and Methods:

Medical examinations were conducted on 214 participants (69 men, 145 women; average age of 63.6 years). Each had completed a self-administered questionnaire including items such as gender, dominant hand, occupation, and history of smoking and drinking alcohol, experience of falls, and the EuroQol-5-dimensions-3-level Japanese version and a 25-question geriatric locomotive function scale proposed by the Japanese Orthopaedic Association. Bilateral grip and key pinch strength were measured. The SOS of calcaneus was assessed using ultrasound bone densitometry. Body composition was measured using a multi-frequency segmental body composition analyzer. Spearman's rank correlation coefficient was calculated to elucidate the relation between SOS and evaluation items. Stepwise logistic regression was used to identify predictors of SOS using the investigated factors as explanatory variables. P values of < .05 were regarded as statistically significant.

Results:

Significant positive correlation was found between the SOS and dominant and non-dominant grip and key pinch strength and Euro index and QOL VAS in all participants. In stepwise logistic regression, non-dominant key pinch (β coefficient= 0.27, p= .022) and Euro QOL VAS (β coefficient= 0.24, p= .0001) were predictors of calcaneal SOS for all participants.

Conclusion:

Key pinch strength and Euro QOL VAS assessment might be useful to predict calcaneal SOS in the general population.

Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men

OBJECTIVE

Analyze the influence of sarcopenia in bone health of elderly men.

SUBJECTS AND METHODS

This cross-sectional study evaluated 198 men aged over 60 years. Body composition was measured by dual energy X-ray absorptiometry. The BMD was measured at the femoral neck, total hip, lumbar spine and 33% radius. The diagnosis of abnormal BMD was defined for men who presented densitometric diagnosis of osteopenia or osteoporosis defined by T-score of femoral neck, total hip and lumbar spine. The pre-sarcopenia and sarcopenia were defined according to the European Working Group on Sarcopenia in Older People.

RESULTS

The group diagnosed with normal BMD, compared to the group of abnormal BMD, have significantly higher body weight, body mass index, grip strength, lean mass, fat mass, and relative appendicular skeletal muscle mass (RASM). However, after multiple linear regression analysis, we found that only the RASM, lean mass, and handgrip strength in the dominant hand influenced the variability of the BMD after adjustment for age and weight. Regression analyzes showed a positive association between greater appendicular lean mass and a smaller number of elderly patients with abnormal BMD diagnostic. The regression analyzes showed that elderly men diagnosed with pre-sarcopenia and sarcopenia had more abnormal BMD than non-sarcopenic elderly men.

CONCLUSION

We concluded that pre-sarcopenia and sarcopenia were associated with abnormal BMD. The lean mass, compared to fat mass, has a greater positive influence on the BMD of elderly men. This result suggests the importance of the increase in lean mass for the bone health of elderly men.

Grip strength is a predictor of bone mineral density among adolescent combat sport athletes

The aim of this study was firstly to investigate the correlation between bone parameters and grip strength (GS) in hands, explosive legs power (ELP), and hormonal parameters; second, to identify the most determinant variables of bone mineral density (BMD) among adolescent combat sport athletes. Fifty combat sport athletes aged 17.1 ± 0.2 year were compared with 30 sedentary subjects matched for age, height, and pubertal stage. For all subjects, the BMD in deferent sites associated with anthropometric parameters were measured by dual-energy X-ray absorptiometry. The growth hormone (GH) and testosterone (TESTO) concentrations were tested. The GS in dominant (GSDA) and nondominant arms (GSNDA) and ELP were evaluated. All BMD measured were greater in athletes than in sedentary group (p<0.01). The GS and ELP showed higher values in athletes than in sedentary group (p<0.01). The BMD in all sites were correlated with weight, but without correlation with height. The GSNDA and ELP were significantly correlated with BMD of both spine and legs. The GH was correlated with the BMD of whole body and spine (p<0.05). The TESTO was only correlated with BMD of the arms (p<0.01). The best predictor of BMD measurements is GSNDA. This study has proved the osteogenic effect of combat sports practice, especially judo and karate kyokushinkai. Therefore, children and adolescent should be encouraged to participate in combat sport. Moreover, it suggested that the best model predicting BMD in different sites among adolescent combat sports athletes was the GSNDA.

Impaired bone microarchitecture at the distal radius in older men with low muscle mass and grip strength: the STRAMBO study

The aim was to study the association between bone microarchitecture and muscle mass and strength in older men. Volumetric bone mineral density (vBMD) and bone microarchitecture were assessed in 810 men aged ≥60 years at the distal radius by high-resolution peripheral computed tomography (HR-pQCT). Areal bone mineral density (aBMD) and appendicular muscle mass (ASM) were assessed by dual-energy X-ray absorptiometry (DXA). Relative ASM of the upper limbs (RASM-u.l.) was calculated as ASM of the upper limbs/(height)(2). Grip strength was measured by dynanometry. In multivariable models, men in the lowest RASM-u.l. quartile had lower cross-sectional area (CSA), cortical area (Ct.Ar), cortical thickness (Ct.Th), and trabecular area (Tb.Ar) at distal radius compared with men in the highest quartile. The trends remained significant after adjustment for grip strength. Men in the lowest quartile of the normalized grip strength (grip strength/[height](2)) had lower aBMD, total vBMD, Ct.Ar, Ct.Th, Tb.vBMD, and Tb.N, and higher Tb.Sp and Tb.Sp.SD. The associations for Ct.Ar, total vBMD, Ct.Th, Tb.vBMD, and Tb.Sp remained significant after adjustment for RASM-u.l. In the models including RASM-u.l. and normalized grip strength, CSA and Tb.Ar were associated with RASM-u.l. but not with the strength. Lower Ct.Th, Tb.vBMD, and Tb.N were associated with lower grip strength but not with RASM-u.l. Lower Ct.Ar was associated with lower grip strength and with lower RASM-u.l. In conclusion, in older men, low RASM-u.l. and low grip strength are associated with poor cortical and trabecular microarchitecture partly independently of each other, after adjustment for confounders.

Low handgrip strength is a predictor of osteoporotic fractures: cross-sectional and prospective evidence from the Hong Kong Osteoporosis Study

Handgrip strength (HGS) is a potentially useful objective parameter to predict fracture since it is an indicator of general muscle strength and is associated with fragility and propensity to fall. Our objective was to examine the association of HGS with fracture, to evaluate the accuracy of HGS in predicting incident fracture, and to identify subjects at risk of fracture. We analyzed a cross-sectional cohort with 2,793 subjects (1,217 men and 1,576 women aged 50-101 years) and a subset of 1,702 subjects which were followed for a total of 4,855 person-years. The primary outcome measures were prevalent fractures and incident major fragility fractures. Each standard deviation (SD) reduction in HGS was associated with a 1.24-fold increased odds for major clinical fractures even after adjustment for other clinical factors. A similar result was obtained in the prospective cohort with each SD reduction in HGS being associated with a 1.57-fold increased hazard ratio of fracture even after adjustment for clinical factors. A combination of HGS and femoral neck bone mineral density (FN BMD) T-score values (combined T-score), together with other clinical factors, had a better predictive power of incident fractures than FN BMD or HGS T-score alone with clinical factors. In addition, combined T-score has better sensitivity and specificity in predicting incidence fractures than FN BMD alone. This study is the first study to compare the predictive ability of HGS and BMD. We showed that HGS is an independent risk factor for major clinical fractures. Compared with using FN BMD T-score of -2.5 alone, HGS alone has a comparable predictive power to BMD, and the combined T-score may be useful to identify extra subjects at risk of clinical fractures with improved specificity.

Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis

The implications of having multiple sclerosis (MS) for bone health are incompletely understood. The aim of this population-based study is to identify past and current exposures that are associated with bone mass in fully ambulatory persons with MS up to age 50 years and to determine the prevalence of low bone mineral density (BMD) in this group. We measured BMD (hips, lumbar spine, forearms), physical function, BMI, and serum 25(OH) vitamin D in 55 women and 25 men with MS. Patients provided information on demographic variables and medical history, as well as past and current vitamin D and calcium intake, physical activity, and lifestyle habits. In regression analyses, BMD levels were adjusted for age, sex, and BMI. At the femoral neck, strong associations were found for walking distance (beta = 0.152; P < 0.001) and age (beta = -0.004; P = 0.003), and less certain associations for male sex (beta = 0.055; P = 0.014) and 10-foot timed tandem walk (-0.008; P = 0.013). At the lumbar spine, walking distance (beta = 0.013; P = 0.006) and possibly physical activity growing up (beta = 0.035; P = 0.028) and male sex (beta = -0.057; P = 0.042), were associated with BMD. At the ultradistal radius, strength of grip (beta = 0.001; P = 0.002), and, less certainly, summer outdoor activities age 16-20 (beta = 0.021; P = 0.009), and age at MS onset (beta = 0.002; P = 0.036) were associated with BMD. Low BMD (z score < or = -2) was present in 19 out of 80 patients. This study shows that MS-related variables as well as past exposures differentially affect BMD at three clinically important skeletal sites. Low BMD is prevalent in these young patients. Bone health should receive attention in care for persons with MS.