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Association between hand-grip strength and site-specific risks of major osteoporotic fracture: Results from the Japanese Population-based Osteoporosis Cohort Study

Published:September 23, 2019DOI:https://doi.org/10.1016/j.maturitas.2019.09.008

      Highlights

      • Low hand-grip strength was independently associated with the risk of vertebral fracture.
      • Hand-grip strength was associated with risk of forearm fracture over a 10-year follow-up.
      • Age adjustment attenuated the association between hand-grip and risk of hip fracture.

      Abstract

      Objectives

      To investigate the association between hand-grip strength and site-specific risks of major osteoporotic fracture.

      Study design

      Prospective cohort study.

      Main Outcome

      Associations between low hand-grip strength and increased risk of fracture at the distal forearm, vertebrae, and hip.

      Measures

      We enrolled 1342 postmenopausal women aged 50 years or more into baseline and follow-up surveys of the Japanese Population-based Osteoporosis Cohort Study in 1996, 1999, 2002, or 2006. Fracture events were ascertained by follow-up surveys until 2011 or 2012. The Cox proportional hazards model was used to estimate hazard ratios (HRs) of hand-grip strength on fracture event.

      Results

      During a median follow-up of 15.2 years, 162 women sustained at least one osteoporotic fracture and 135 of these women sustained at least one major osteoporotic fracture, the larger group including 65, 38, 35, and 8 women with fractures of the distal forearm, vertebrae, hip, and proximal humerus, respectively. In the crude models, the associations between low hand-grip strength and increased risk of fracture at the distal forearm, vertebrae, and hip were significant; the HRs (95% confidence interval) of the lowest tertile of hand-grip strength were 2.02 (1.10–3.71), 11.35 (4.07–31.63), and 4.72 (1.79–12.47), respectively. Age adjustment attenuated the significance of hip fracture risk, and adjusting for bone mineral density attenuated the significance of distal forearm fracture risk. After additional adjustment for body mass index, history of diabetes mellitus, and calcium intake, the HR for vertebral fracture risk was 4.55 (1.56–13.27). When limiting the follow-up period to 5 and 10 years, low hand-grip strength was associated with an increased risk of distal forearm fracture independently of the aforementioned covariates; the HRs were 4.22 (1.12–15.95) and 2.52 (1.03–6.17), respectively.

      Conclusions

      Low hand-grip strength is specifically associated with the risk of distal forearm fractures within 10 years and clinical vertebral fractures within 15 years or more in Japanese postmenopausal women.

      Abbreviations:

      BMD (bone mineral density), BMI (body mass index), CI (confidence interval), HR (hazard ratio), IQR (interquartile range), JPOS (Japanese Population-based Osteoporosis Cohort Study)

      Keywords

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      References

        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • Boirie Y.
        • Bruyère O.
        • Cederholm T.
        • et al.
        Sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 412-423https://doi.org/10.1093/ageing/afy169
        • Jenkins N.D.M.
        • Buckner S.L.
        • Bergstrom H.C.
        • Cochrane K.C.
        • Goldsmith J.A.
        • Housh T.J.
        • et al.
        Reliability and relationships among handgrip strength, leg extensor strength and power, and balance in older men.
        Exp. Gerontol. 2014; 58: 47-50https://doi.org/10.1016/j.exger.2014.07.007
        • Bohannon R.W.
        Hand-grip dynamometry predicts future outcomes in aging adults.
        J. Geriatr. Phys. Ther. 2008; 31: 3-10https://doi.org/10.1519/00139143-200831010-00002
        • Stel V.S.
        • Pluijm S.M.F.
        • Deeg D.J.H.
        • Smit J.H.
        • Bouter L.M.
        • Lips P.
        Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons.
        Osteoporos. Int. 2004; 15: 742-750https://doi.org/10.1007/s00198-004-1604-7
        • Di Monaco M.
        • Di Monaco R.
        • Manca M.
        • Cavanna A.
        Handgrip strength is an independent predictor of distal radius bone mineral density in postmenopausal women.
        Clin. Rheumatol. 2000; 19: 473-476https://doi.org/10.1007/s100670070009
        • Zehnacker C.H.
        • Bemis-Dougherty A.
        Effect of weighted exercises on bone mineral density in post menopausal women. A systematic review.
        J. Geriatr. Phys. Ther. 2007; 30: 79-88https://doi.org/10.1519/00139143-200512000-00026
        • Sirola J.
        • Tuppurainen M.
        • Honkanen R.
        • Jurvelin J.S.
        • Kröger H.
        Associations between grip strength change and axial postmenopausal bone loss–a 10-year population-based follow-up study.
        Osteoporos. Int. 2005; 16: 1841-1848https://doi.org/10.1007/s00198-005-1944-y
        • Hamrick M.W.
        • McNeil P.L.
        • Patterson S.L.
        Role of muscle-derived growth factors in bone formation.
        J. Musculoskelet. Neuronal Interact. 2010; 10: 64-70
        • Foo L.H.
        • Zhang Q.
        • Zhu K.
        • Ma G.
        • Hu X.
        • Greenfield H.
        • et al.
        Low vitamin D status has an adverse influence on bone mass, bone turnover, and muscle strength in Chinese adolescent girls.
        J. Nutr. 2009; 139: 1002-1007https://doi.org/10.3945/jn.108.102053
        • Snow-Harter C.
        • Bouxsein M.
        • Lewis B.
        • Charette S.
        • Weinstein P.
        • Marcus R.
        Muscle strength as a predictor of bone mineral density in young women.
        J. Bone Miner. Res. 1990; 5: 589-595https://doi.org/10.1002/jbmr.5650050608
        • Kärkkäinen M.
        • Rikkonen T.
        • Kröger H.
        • Sirola J.
        • Tuppurainen M.
        • Salovaara K.
        • et al.
        Association between functional capacity tests and fractures: an eight-year prospective population-based cohort study.
        Osteoporos. Int. 2008; 19: 1203-1210https://doi.org/10.1007/s00198-008-0561-y
        • Dixon W.G.
        • Lunt M.
        • Pye S.R.
        • Reeve J.
        • Felsenberg D.
        • Silman A.J.
        • et al.
        Low grip strength is associated with bone mineral density and vertebral fracture in women.
        Rheumatology (Oxford). 2005; 44: 642-646https://doi.org/10.1093/rheumatology/keh569
        • Samelson E.J.
        • Hannan M.T.
        • Zhang Y.
        • Genant H.K.
        • Felson D.T.
        • Kiel D.P.
        Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study.
        J. Bone Miner. Res. 2006; 21: 1207-1214https://doi.org/10.1359/jbmr.060513
        • Cawthon P.M.
        • Blackwell T.L.
        • Marshall L.M.
        • Fink H.A.
        • Kado D.M.
        • Ensrud K.E.
        • et al.
        Physical performance and radiographic and clinical vertebral fractures in older men.
        J. Bone Miner. Res. 2014; 29: 2101-2108https://doi.org/10.1359/jbmr.080227
        • Cummings S.R.
        • Nevitt M.C.
        • Browner W.S.
        • Stone K.
        • Fox K.M.
        • Ensrud K.E.
        • et al.
        Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group.
        N. Engl. J. Med. 1995; 332: 767-773https://doi.org/10.1056/NEJM199503233321202
        • Dargent-Molina P.
        • Favier F.
        • Grandjean H.
        • Baudoin C.
        • Schott A.M.
        • Hausherr E.
        • et al.
        Fall-related factors and risk of hip fracture: the EPIDOS prospective study.
        Lancet (London, England). 1996; 348: 145-149https://doi.org/10.1016/S0140-6736(96)01440-7
        • Kelsey J.L.
        • Samelson E.J.
        Variation in risk factors for fractures at different sites.
        Curr. Osteoporos. Rep. 2009; 7: 127-133https://doi.org/10.1007/s11914-009-0022-3
        • Iki M.
        • Tamaki J.
        • Sato Y.
        • Morita A.
        • Ikeda Y.
        • Kajita E.
        • et al.
        Cohort profile: the Japanese Population-based Osteoporosis (JPOS) Cohort Study.
        Int. J. Epidemiol. 2015; 44: 405-414https://doi.org/10.1093/ije/dyu084
        • Kanis J.A.
        • on behalf of the World Health Organization Scientific Group
        Assessment of Osteoporosis at the Primary Healthcare Level. Technical Report.
        (Available from:) World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK [Internet]2007
        • Huang C.
        • Niu K.
        • Kobayashi Y.
        • Guan L.
        • Momma H.
        • Cui Y.
        • et al.
        An inverted J-shaped association of serum uric acid with muscle strength among Japanese adult men: a cross-sectional study.
        BMC Musculoskelet. Disord. 2013; 14: 258https://doi.org/10.1186/1471-2474-14-258
        • Lewiecki E.M.
        • Gordon C.M.
        • Baim S.
        • Leonard M.B.
        • Bishop N.J.
        • Bianchi M.L.
        • et al.
        International society for clinical densitometry 2007 adult and pediatric official positions.
        Bone. 2008; 43: 1115-1121https://doi.org/10.1016/j.bone.2008.08.106
        • Iki M.
        • Kagamimori S.
        • Kagawa Y.
        • Matsuzaki T.
        • Yoneshima H.
        • Marumo F.
        Bone mineral density of the spine, hip and distal forearm in representative samples of the Japanese female population: Japanese Population-based Osteoporosis (JPOS) Study.
        Osteoporos. Int. 2001; 12: 529-537https://doi.org/10.1007/s001980170073
        • Sato Y.
        • Tamaki J.
        • Kitayama F.
        • Kusaka Y.
        • Kodera Y.
        • Koutani A.
        • et al.
        Development of a food-frequency questionnaire to measure the dietary calcium intake of adult Japanese women.
        Tohoku J. Exp. Med. 2005; 207: 217-222https://doi.org/10.1620/tjem.207.217
        • Wang M.
        • Leger A.B.
        • Dumas G.A.
        Prediction of back strength using anthropometric and strength measurements in healthy females.
        Clin. Biomech. (Bristol, Avon). 2005; 20: 685-692https://doi.org/10.1016/j.clinbiomech.2005.03.003
        • Pfeifer M.
        • Begerow B.
        • Minne H.W.
        • Schlotthauer T.
        • Pospeschill M.
        • Scholz M.
        • et al.
        Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis.
        Exp. Clin. Endocrinol. Diabetes. 2001; 109: 87-92https://doi.org/10.1055/s-2001-14831
        • Sinaki M.
        • Itoi E.
        • Wahner H.W.
        • Wollan P.
        • Gelzcer R.
        • Mullan B.P.
        • et al.
        Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.
        Bone. 2002; 30: 836-841https://doi.org/10.1016/S8756-3282(02)00739-1
        • Sinaki M.
        • McPhee M.C.
        • Hodgson S.F.
        • Merritt J.M.
        • Offord K.P.
        Relationship between bone mineral density of spine and strength of back extensors in healthy postmenopausal women.
        Mayo Clin. Proc. 1986; 61: 116-122https://doi.org/10.1016/S0025-6196(12)65197-0
        • Ikezoe T.
        • Mori N.
        • Nakamura M.
        • Ichihashi N.
        Effects of age and inactivity due to prolonged bed rest on atrophy of trunk muscles.
        Eur. J. Appl. Physiol. 2012; 112: 43-48https://doi.org/10.1007/s00421-011-1952-x
        • Szulc P.
        • Blaizot A.
        • Boutroy S.
        • Vilayphiou N.
        • Boonen S.
        • Chapurlat R.
        Impaired bone microarchitecture at the distal radius in older men with low muscle mass and grip strength: the STRAMBO study.
        J. Bone Miner. Res. 2013; 28: 169-178https://doi.org/10.1002/jbmr.1726
        • Yu R.
        • Leung J.
        • Woo J.
        Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study.
        J. Am. Med. Dir. Assoc. 2014; 15: 551-558https://doi.org/10.1016/j.jamda.2014.02.005
        • Felicio D.C.
        • Pereira D.S.
        • Assumpção A.M.
        • de Jesus-Moraleida F.R.
        • de Queiroz B.Z.
        • da Silva J.P.
        • et al.
        Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women.
        Geriatr. Gerontol. Int. 2014; 14: 185-189https://doi.org/10.1186/1471-2474-14-258
        • Siggeirsdottir K.
        • Aspelund T.
        • Sigurdsson G.
        • Mogensen B.
        • Chang M.
        • Jonsdottir B.
        • et al.
        Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry.
        Eur. J. Epidemiol. 2007; 22: 631-639https://doi.org/10.1007/s10654-007-9163-9
        • Kadowaki E.
        • Tamaki J.
        • Iki M.
        • Sato Y.
        • Chiba Y.
        • Kajita E.
        • et al.
        Prevalent vertebral deformity independently increases incident vertebral fracture risk in middle-aged and elderly Japanese women: the Japanese Population-based Osteoporosis (JPOS) Cohort Study.
        Osteoporos. Int. 2010; 21: 1513-1522https://doi.org/10.1007/s00198-009-1113-9