Abstract
We examined the role of muscle strength, lean tissue distribution, and overall body composition as indicators of osteoporosis (OP) in a pooled sample of 979 Finnish postmenopausal women (mean age 68.1 years) from the Kuopio Osteoporosis Risk Factor and Prevention study. Bone mineral density (BMD) at the femoral neck (FN) and total body composition were assessed by dual-energy X-ray absorptiometry scans. The women (n = 979) were divided into three groups according to WHO criteria, based on FN BMD T score: normal (n = 474), osteopenia (n = 468), and OP (n = 37). Soft tissue proportions, fat mass index (FMI, fat/height²), lean mass index (LMI, lean/height²), and appendicular skeletal muscle mass (ASM, (arms + legs)/height²) were calculated. Handgrip and knee extension strength measurements were made. OP subjects had significantly smaller LMI (p = 0.001), ASM (p = 0.001), grip strength (p < 0.0001), and knee extension strength (p < 0.05) but not FMI (p > 0.05) compared to other subjects. Grip and knee extension strength were 19 and 16 % weaker in OP women compared to others, respectively. The area under the receiver operating characteristic curve was 69 % for grip and 71 % for knee extension strength. In tissue proportions only LMI showed predictive power (63 %, p = 0.016). An overall linear association of LMI (R 2 = 0.007, p = 0.01) and FMI (R 2 = 0.028, p < 0.001) with FN BMD remained significant. In the multivariate model, after adjusting for age, grip strength, leg extension strength, FMI, LMI, number of medications, alcohol consumption, current smoking, dietary calcium intake, and hormone therapy, grip strength (adjusted OR = 0.899, 95 % CI 0.84–0.97, p < 0.01), leg extension strength (OR = 0.998, 95 % CI 0.99–1, p < 0.05), and years of hormone therapy (OR = 0.905, 95 % CI 0.82–1, p < 0.05) remained as significant determinants of OP. Muscle strength tests, especially grip strength, serve as an independent and useful tool for postmenopausal OP risk assessment. In addition, lean mass contributes to OP in this age group. Muscle strength and lean mass should be considered separately since both are independently associated with postmenopausal BMD.
Similar content being viewed by others
References
Grisso J, Kelsey J, Strom B, Ghiu G, Maislin G, O’Brien L, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331
Ensrud K, Ewing S, Taylor B, Fink H, Stone K, Cauley J, Tracy J, Hochberg M, Rodondi N, Cawthon P (2007) Unconventional views of frailty: frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62(7):744–751
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254
Cefalu CA (2004) Is bone mineral density predictive of fracture risk reduction? Curr Med Res Opin 20(3):341–349
Delmas P, Li Z, Cooper C (2004) Relationship between changes in bone mineral density and fracture risk reduction with antiresorptive drugs: some issues with meta-analyses. J Bone Miner Res 19:330–337
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773
Sirola J, Rikkonen T, Tuppurainen M, Jurvelin S, Kröger H (2006) Association of grip strength change with menopausal bone loss and related fractures: a population-based follow-up study. Calcif Tissue Int 78:218–226
Lim S, Joung H, Shin C, Lee H, Kim K, Shin E, Kim H, Lim M, Cho S (2004) Body composition changes with age have gender-specific impacts on bone mineral density. Bone 35(3):792–798
Douchi T, Kosha S, Uto H, Oki T, Nakae M, Yoshimitsu N, Nagata Y (2003) Precedence of bone loss over changes in body composition and body fat distribution within a few years after menopause. Maturitas 46:133–138
Ferretti JL, Capozza RF, Cointry GR (1998) Gender-related differences in the relationship between densitometric values of whole-body mineral content and lean body mass in humans between 2 and 87 years of age. Bone 22:683–690
Baglietto L, English D, Hopper J, MacInnis R, Morris H, Tilley W, Krishnan K, Giles G (2009) Circulating steroid hormone concentrations in postmenopausal women in relation to body size and composition. Breast Cancer Res Treat 115(1):171–179
Lindsay RS, Hanson RL, Roumain J, Ravussin E, Knowler WC, Tataranni PA (2001) Body mass index as a measure of adiposity in children and adolescents: relationship to adiposity by dual energy X-ray absorptiometry and to cardiovascular risk factors. J Clin Endocrinol Metab 86(9):4061–4067
Ijuin M, Douchi T, Matsuo T, Yamamoto S, Uto H, Nagata Y (2002) Difference in the effects of body composition on bone mineral density between pre- and postmenopausal women. Maturitas 43(4):239–244
Wang J, Thornton JC, Heymsfield SB, Pierson RN (2003) The relationship between body mass index and body cell mass in African-American, Asian, and Caucasian adults. Acta Diabetol 40(Suppl 1):S305–S308
Salovaara K, Tuppurainen M, Kärkkäinen M, Rikkonen T, Sandini L, Sirola J, Honkanen R, Alhava E, Kröger H (2010) Effect of vitamin D3 and calcium on fracture risk in 65- to 71-year-old women: a population-based 3-year randomized, controlled trial—the OSTPRE-FPS. J Bone Miner Res 25:1487–1495
Rikkonen T, Salovaara K, Sirola J, Kärkkäinen M, Tuppurainen M, Jurvelin J, Honkanen R, Alhava E, Kröger H (2010) Physical activity slows femoral bone loss but promotes wrist fractures in postmenopausal women: a 15-year follow-up of the OSTPRE study. J Bone Miner Res 25:2332–2340
Faulkner K (2001) Advanced hip assessment. GE Healthcare. White paper. http://www.gehealthcare.com/gecommunity/lunar/docs/adv_hip_assessment.pdf
Rantanen T, Harris T, Leveille S, Visser M, Foley D, Masaki K, Guralnik J (2000) Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci 55(3):M168–M173
Li S, Wagner R, Holm K, Lehotsky J, Zinaman MJ (2004) Relationship between soft tissue body composition and bone mass in perimenopausal women. Maturitas 47:99–105
Douchi T, Yamamoto S, Oki T, Maruta K, Kuwahata R, Yamasaki H, Nagata Y (2000) The effects of physical exercise on body fat distribution and bone mineral density in postmenopausal women. Maturitas 35:25–30
Martini G, Valenti R, Giovani S, Nuti R (1997) Age-related changes in body composition of healthy and osteoporotic women. Maturitas 27:25–33
Newman AB, Haggerty CL, Goodpaster B, Harris T, Kritchevsky S, Nevitt M, Miles T, Visser M, Health, Aging, and Body Composition Research Group (2003) Strength and muscle quality in a well-functioning cohort of older adults: the health, aging and body composition study. J Am Geriatr Soc 51:323–330
Matsuo T, Douchi T, Nakae M, Uto H, Oki T, Nagata Y (2003) Relationship of upper body fat distribution to higher regional lean mass and bone mineral density. J Bone Miner Metab 21:179–183
Warming L, Ravn P, Christiansen C (2003) Visceral fat is more important than peripheral fat for endometrial thickness and bone mass in healthy postmenopausal women. Am J Obstet Gynecol 188:349–353
Randell KM, Honkanen RJ, Kröger H, Saarikoski S (2002) Does hormone-replacement therapy prevent fractures in early postmenopausal women? J Bone Miner Res 17:528–533
Reid IR (2002) Relationships among body mass, its components, and bone. Bone 31:547–555
Sorensen MB (2002) Changes in body composition at menopause—age, lifestyle or hormone deficiency? J Br Menopause Soc 8:137–140
Gambacciani M, Ciaponi M, Cappagli B, Benussi C, De Simone L, Genazzani AR (1999) Climacteric modifications in body weight and fat tissue distribution. Climacteric 2:37–44
Figueroa A, Going S, Milliken L, Blew R, Sharp S, Teixeira P, Lohman T (2003) Effects of exercise training and hormone replacement therapy on lean and fat mass in postmenopausal women. J Gerontol A Biol Sci Med Sci 58:266–270
Arabi A, Garnero P, Porcher R, Pelissier C, Benhamou CL, Roux C (2003) Changes in body composition during post-menopausal hormone therapy: a 2 year prospective study. Hum Reprod 18:1747–1752
Hagberg JM, Zmuda JM, McCole SD, Rodgers KS, Wilund KR, Moore GE (2000) Determinants of body composition in postmenopausal women. J Gerontol A Biol Sci Med Sci 55:M607–M612
Joakimsen RM, Fønnebø V, Magnus JH, Størmer J, Tollan A, Søgaard AJ (1998) The Tromsø Study: physical activity and the incidence of fractures in a middle-aged population. J Bone Miner Res 13:1149–1157
Yu EW, Thomas BJ, Brown JK, Finkelstein JS (2012) Simulated increases in body fat and errors in bone mineral density measurements by DXA and QCT. J Bone Miner Res 27:119–124
Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Alhava E, Kröger H (2008) Grip strength may facilitate fracture prediction in perimenopausal women with normal BMD: a 15-year population-based study. Calcif Tissue Int 83(2):93–100
Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Kroger H (2006) Association of grip strength change with menopausal bone loss and related fractures: a population-based follow-up study. Calcif Tissue Int 78(4):218–226
Kröger H, Heikkinen J, Laitinen K, Kotaniemi X (1992) Dual-energy X-ray absorptiometry in normal women: a cross-sectional study of 717 Finnish volunteers. Osteoporos Int 22:135–140
World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series. WHO, Geneva
Cruz-Jentoft A, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Finbarr M, Michel J-P, Rolland Y, Schneider S, Topinková E, Vandewoude M, Zamboni M (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in older people. Age Ageing 39(4):412–423
Saarelainen J, Rikkonen T, Honkanen R, Kröger H, Tuppurainen M, Niskanen L, Jurvelin JS (2007) Is discordance in bone measurements affected by body composition or anthropometry? A comparative study between peripheral and central devices. J Clin Densitom 10(3):312–318
Saarelainen J, Kiviniemi V, Kröger H, Tuppurainen M, Niskanen L, Jurvelin J, Honkanen R (2012) Body mass index and bone loss among postmenopausal women: the 10-year follow-up of the OSTPRE cohort. J Bone Miner Metab 30(2):208–216
Acknowledgments
This study was supported by a grant from the Finnish Cultural Foundation, the Eemil Aaltonen Foundation, the Juho Vainio Foundation, the University of Eastern Finland, the Academy of Finland, and the Ministry of Education and Culture as well as an EVO grant from Kuopio University Hospital.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have stated that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Rikkonen, T., Sirola, J., Salovaara, K. et al. Muscle Strength and Body Composition Are Clinical Indicators of Osteoporosis. Calcif Tissue Int 91, 131–138 (2012). https://doi.org/10.1007/s00223-012-9618-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00223-012-9618-1