Skip to main content

Advertisement

SpringerLink
Log in

Grip strength cutpoints for youth based on a clinically relevant bone health outcome

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

The National Academy of Medicine recommends the handgrip for school-based surveillance of muscle strength for bone health. We established grip strength cutpoints that are linked to bone health in both US and European youth. These cutpoints could serve as a potential set of standards for surveillance and clinical applications.

Purpose

The U.S. National Academy of Medicine and experts in Europe recommend the use of grip strength as a valuable and accessible musculoskeletal fitness measure due to its association with bone health. This is the first study to facilitate this recommendation by developing bone health-related grip strength cutpoints for youth based on empirical associations with the well accepted marker of bone development, i.e., height-adjusted total body less head bone mineral content (TBLH_BMC).

Methods

A purposive sample of healthy youth from Midwest USA (n = 433 youth; 14.1 ± 2.3 years; 1998–2004) and a random sample of healthy adolescents from Zaragoza, Spain (n = 355 youth; 14.9 ± 1.2 years; 2006–2007) were used to develop and test cut-points. Participants’ grip strength was measured using a hand-held dynamometer while height-adjusted TBLH_BMC was determined using dual-energy x-ray absorptiometry. Grip strength scores were linked to TBLH_BMC using receiver operator characteristic curves, and grip strength cutpoints were tested based on the area under the curve (AUC), sensitivity (Se), specificity (Sp), and predictive odds ratios. All analyses were conducted in 2016.

Results

The AUC approximated or exceeded 0.80 for grip strength cutpoints, and the associated Se and Sp indices ranged from 53.6 to 92.5%. Sensitivity and Sp remained similar in the validation sample and those not meeting the grip strength cutpoints were five to eight times more likely to have insufficient TBLH_BMC, depending on their sex and cutpoint being considered.

Conclusions

Grip strength is strongly related to TBLH_BMC, and the proposed cutpoints demonstrated acceptable classification accuracy for screening healthy youth and tracking healthy bone development in community settings. The utility of the cutpoints should be further examined in more diverse populations of youth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ortega FB, Silventoinen K, Tynelius P, Rasmussen F (2012) Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ 345:e7279. https://doi.org/10.1136/bmj.e7279bmj.e7279

    Article  PubMed  PubMed Central  Google Scholar 

  2. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Jr., Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S (2015) Prognostic value of grip strength: findings from the prospective urban rural epidemiology (PURE) study. Lancet 386 (9990):266–273. doi:https://doi.org/10.1016/S0140-6736(14)62000-6S0140-6736(14)62000-6 [pii]

  3. World Health Organization (2010) Global recommendations on physical activity for health. World Health Organization, Geneva, Switzerland

    Google Scholar 

  4. Centers for Disease Control and Prevention. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC, 2008

  5. Turner CH, Forwood MR, Rho JY, Yoshikawa T (1994) Mechanical loading thresholds for lamellar and woven bone formation. J Bone Miner Res 9(1):87–97. https://doi.org/10.1002/jbmr.5650090113

    Article  CAS  PubMed  Google Scholar 

  6. Frost HM (1987) The mechanostat: a proposed pathogenic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents. Bone Miner 2(2):73–85

    CAS  PubMed  Google Scholar 

  7. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475. https://doi.org/10.1359/jbmr.061113

    Article  PubMed  Google Scholar 

  8. Cheung CL, Nguyen US, Au E, Tan KC, Kung AW (2013) Association of handgrip strength with chronic diseases and multimorbidity: a cross-sectional study. Age (Dordr) 35(3):929–941. https://doi.org/10.1007/s11357-012-9385-y

    Article  Google Scholar 

  9. Leonard MB, Zemel BS (2002) Current concepts in pediatric bone disease. Pediatr Clin N Am 49(1):143–173

    Article  Google Scholar 

  10. Clark EM, Ness AR, Bishop NJ, Tobias JH (2006) Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res 21(9):1489–1495. https://doi.org/10.1359/jbmr.060601

    Article  PubMed  Google Scholar 

  11. Rizzoli R, Bianchi ML, Garabedian M, McKay HA, Moreno LA (2010) Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone 46(2):294–305. https://doi.org/10.1016/j.bone.2009.10.005S8756-3282(09)01971-1

    Article  PubMed  Google Scholar 

  12. Bachrach LK, Sills IN (2011) Clinical report-bone densitometry in children and adolescents. Pediatrics 127(1):189–194. https://doi.org/10.1542/peds.2010-2961peds.2010-2961

    Article  PubMed  Google Scholar 

  13. Artero EG, Espana-Romero V, Castro-Pinero J, Ruiz J, Jimenez-Pavon D, Aparicio V, Gatto-Cardia M, Baena P, Vicente-Rodriguez G, Castillo MJ, Ortega FB (2012) Criterion-related validity of field-based muscular fitness tests in youth. J Sports Med Phys Fitness 52 (3):263–272. doi: R40123544

  14. Institute of Medicine (2012) Fitness measures and health outcomes in youth. In: The National Academies Press; Washington DC

    Google Scholar 

  15. Castro-Pinero J, Artero EG, Espana-Romero V, Ortega FB, Sjostrom M, Suni J, Ruiz JR (2010) Criterion-related validity of field-based fitness tests in youth: a systematic review. Br J Sports Med 44(13):934–943. https://doi.org/10.1136/bjsm.2009.058321bjsm.2009.058321

    Article  CAS  PubMed  Google Scholar 

  16. Ortega FB, Ruiz J (2015) Fitness in youth: methodological issues and understanding of its clinical value. Am J Lifestyle Med 9(6):403–408

    Article  Google Scholar 

  17. Ruiz JR, Castro-Pinero J, Artero EG, Ortega FB, Sjostrom M, Suni J, Castillo MJ (2009) Predictive validity of health-related fitness in youth: a systematic review. Br J Sports Med 43(12):909–923. https://doi.org/10.1136/bjsm.2008.056499bjsm.2008.056499

    Article  CAS  PubMed  Google Scholar 

  18. Ruiz JR, Castro-Pinero J, Espana-Romero V, Artero EG, Ortega FB, Cuenca MM, Jimenez-Pavon D, Chillon P, Girela-Rejon MJ, Mora J, Gutierrez A, Suni J, Sjostrom M, Castillo MJ (2011) Field-based fitness assessment in young people: the ALPHA health-related fitness test battery for children and adolescents. Br J Sports Med 45(6):518–524. https://doi.org/10.1136/bjsm.2010.075341bjsm.2010.075341

    Article  PubMed  Google Scholar 

  19. Artero EG, Espana-Romero V, Castro-Pinero J, Ortega FB, Suni J, Castillo-Garzon MJ, Ruiz JR (2011) Reliability of field-based fitness tests in youth. Int J Sports Med 32(3):159–169. https://doi.org/10.1055/s-0030-1268488

    Article  CAS  PubMed  Google Scholar 

  20. De Miguel-Etayo P, Gracia-Marco L, Ortega FB, Intemann T, Foraita R, Lissner L, Oja L, Barba G, Michels N, Tornaritis M, Molnar D, Pitsiladis Y, Ahrens W, Moreno LA (2014) Physical fitness reference standards in European children: the IDEFICS study. Int J Obes (Lond) 38(Suppl 2):S57–S66. https://doi.org/10.1038/ijo.2014.136ijo2014136

    Article  Google Scholar 

  21. Ortega FB, Artero EG, Ruiz JR, Espana-Romero V, Jimenez-Pavon D, Vicente-Rodriguez G, Moreno LA, Manios Y, Beghin L, Ottevaere C, Ciarapica D, Sarri K, Dietrich S, Blair SN, Kersting M, Molnar D, Gonzalez-Gross M, Gutierrez A, Sjostrom M, Castillo MJ (2011) Physical fitness levels among European adolescents: the HELENA study. Br J Sports Med 45(1):20–29. https://doi.org/10.1136/bjsm.2009.062679bjsm.2009.062679

    Article  CAS  PubMed  Google Scholar 

  22. Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, Der G, Gale CR, Inskip HM, Jagger C, Kirkwood TB, Lawlor DA, Robinson SM, Starr JM, Steptoe A, Tilling K, Kuh D, Cooper C, Sayer AA (2014) Grip strength across the life course: normative data from twelve British studies. PLoS One 9(12):e113637. https://doi.org/10.1371/journal.pone.0113637PONE-D-14-38921

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ploegmakers JJ, Hepping AM, Geertzen JH, Bulstra SK, Stevens M (2013) Grip strength is strongly associated with height, weight and gender in childhood: a cross sectional study of 2241 children and adolescents providing reference values. J Physiother 59(4):255–261. https://doi.org/10.1016/S1836-9553(13)70202-9S1836-9553(13)70202-9

    Article  PubMed  Google Scholar 

  24. Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O'Karma M, Wallace TC, Zemel BS (2016) The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27(4):1281–1386. https://doi.org/10.1007/s00198-015-3440-310.1007/s00198-015-3440-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Welk GJ, Going SB, Morrow JR Jr, Meredith MD (2011) Development of new criterion-referenced fitness standards in the FITNESSGRAM (R) program: rationale and conceptual overview. Am J Prev Med 41(4 Suppl 2):S63–S67. https://doi.org/10.1016/j.amepre.2011.07.012S0749-3797(11)00513-7

    Article  PubMed  Google Scholar 

  26. Janz KF, Letuchy EM, Burns TL, Eichenberger Gilmore JM, Torner JC, Levy SM (2014) Objectively measured physical activity trajectories predict adolescent bone strength: Iowa bone development study. Br J Sports Med 48(13):1032–1036. https://doi.org/10.1136/bjsports-2014-093574bjsports-2014-093574

    Article  PubMed  Google Scholar 

  27. Janz KF, Burns TL, Torner JC, Levy SM, Paulos R, Willing MC, Warren JJ (2001) Physical activity and bone measures in young children: the Iowa bone development study. Pediatrics 107(6):1387–1393

    Article  CAS  PubMed  Google Scholar 

  28. Ortega FB, Artero EG, Ruiz JR, Vicente-Rodriguez G, Bergman P, Hagstromer M, Ottevaere C, Nagy E, Konsta O, Rey-Lopez JP, Polito A, Dietrich S, Plada M, Beghin L, Manios Y, Sjostrom M, Castillo MJ (2008) Reliability of health-related physical fitness tests in European adolescents. The HELENA study. Int J Obes (Lond) 32 Suppl 5:S49–S57. doi:https://doi.org/10.1038/ijo.2008.183ijo2008183

  29. Moreno LA, De Henauw S, Gonzalez-Gross M, Kersting M, Molnar D, Gottrand F, Barrios L, Sjostrom M, Manios Y, Gilbert CC, Leclercq C, Widhalm K, Kafatos A, Marcos A (2008) Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes (Lond) 32 Suppl 5:S4–11. doi:https://doi.org/10.1038/ijo.2008.177ijo2008177

  30. Armstrong N, Welsman JR (2007) Aerobic fitness: what are we measuring? Med Sport Sci 50:5–25

    Article  PubMed  Google Scholar 

  31. Zemel BS, Kalkwarf HJ, Gilsanz V, Lappe JM, Oberfield S, Shepherd JA, Frederick MM, Huang X, Lu M, Mahboubi S, Hangartner T, Winer KK (2011) Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: results of the bone mineral density in childhood study. J Clin Endocrinol Metab 96(10):3160–3169. https://doi.org/10.1210/jc.2011-1111jc.2011-1111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW (1989) Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA 262(17):2395–2401

    Article  CAS  PubMed  Google Scholar 

  33. Lakoski SG, Willis BL, Barlow CE, Leonard D, Gao A, Radford NB, Farrell SW, Douglas PS, Berry JD, DeFina LF, Jones LW (2015) Midlife cardiorespiratory fitness, incident cancer, and survival after cancer in men: the Cooper Center Longitudinal Study. JAMA Oncol 1(2):231–237. https://doi.org/10.1001/jamaoncol.2015.02262203829

    Article  PubMed  PubMed Central  Google Scholar 

  34. Farrell SW, Finley CE, Haskell WL, Grundy SM (2015) Is there a gradient of mortality risk among men with low cardiorespiratory fitness? Med Sci Sports Exerc 47(9):1825–1832. https://doi.org/10.1249/MSS.0000000000000608

    Article  PubMed  Google Scholar 

  35. Cawsey S, Padwal R, Sharma AM, Wang X, Li S, Siminoski K (2015) Women with severe obesity and relatively low bone mineral density have increased fracture risk. Osteoporos Int 26(1):103–111. https://doi.org/10.1007/s00198-014-2833-z

    Article  CAS  PubMed  Google Scholar 

  36. Hongsdusit N, von Muhlen D, Barrett-Connor E (2006) A comparison between peripheral BMD and central BMD measurements in the prediction of spine fractures in men. Osteoporos Int 17(6):872–877. https://doi.org/10.1007/s00198-005-0061-2

    Article  CAS  PubMed  Google Scholar 

  37. Gordon CM, Bachrach LK, Carpenter TO, Crabtree N, El-Hajj Fuleihan G, Kutilek S, Lorenc RS, Tosi LL, Ward KA, Ward LM, Kalkwarf HJ (2008) Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD pediatric official positions. J Clin Densitom 11(1):43–58. https://doi.org/10.1016/j.jocd.2007.12.005S1094-6950(07)00253-3

    Article  PubMed  Google Scholar 

  38. Metz CE (1978) Basic principles of ROC analysis. Semin Nucl Med 8(4):283–298

    Article  CAS  PubMed  Google Scholar 

  39. Laurson KR, Eisenmann JC, Welk GJ (2011) Development of youth percent body fat standards using receiver operating characteristic curves. Am J Prev Med 41(4 Suppl 2):S93–S99. https://doi.org/10.1016/j.amepre.2011.07.003S0749-3797(11)00489-2

    Article  PubMed  Google Scholar 

  40. Welk GJ, Laurson KR, Eisenmann JC, Cureton KJ (2011) Development of youth aerobic-capacity standards using receiver operating characteristic curves. Am J Prev Med 41(4 Suppl 2):S111–S116. https://doi.org/10.1016/j.amepre.2011.07.007S0749-3797(11)00493-4

    Article  PubMed  Google Scholar 

  41. Bai Y, Saint-Maurice PF, Welk GJ, Allums-Featherston K, Candelaria N, Anderson K (2015) Prevalence of youth fitness in the United States: baseline results from the NFL PLAY 60 FITNESSGRAM partnership project. J Pediatr 167(3):662–668. https://doi.org/10.1016/j.jpeds.2015.05.035S0022-3476(15)00542-9

    Article  PubMed  Google Scholar 

  42. Prentice A, Parsons TJ, Cole TJ (1994) Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr 60(6):837–842

    Article  CAS  PubMed  Google Scholar 

  43. Baxter-Jones AD, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA (2011) Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 26(8):1729–1739. https://doi.org/10.1002/jbmr.412

    Article  PubMed  Google Scholar 

  44. Heaney RP (2003) Bone mineral content, not bone mineral density, is the correct bone measure for growth studies. Am J Clin Nutr 78(2):350–351 author reply 351-352

    Article  CAS  PubMed  Google Scholar 

  45. Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S (2008) International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone 43(6):1115–1121. https://doi.org/10.1016/j.bone.2008.08.106S8756-3282(08)00712-6

    Article  PubMed  Google Scholar 

  46. Espana-Romero V, Ortega FB, Vicente-Rodriguez G, Artero EG, Rey JP, Ruiz JR (2010) Elbow position affects handgrip strength in adolescents: validity and reliability of Jamar, DynEx, and TKK dynamometers. J Strength Cond Res 24(1):272–277. https://doi.org/10.1519/JSC.0b013e3181b296a5

    Article  PubMed  Google Scholar 

  47. Hager-Ross C, Rosblad B (2002) Norms for grip strength in children aged 4-16 years. Acta Paediatr 91(6):617–625

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The Iowa Bone Development study was supported by NIDCR (R01-DE09551 and DE12101), GCRCP (M01-RR00059), and NCRR (UL1TR000442). The HELENA Study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). This study was funded by The Cooper Institute, Dallas, Texas under an individual grant attributed to Pedro F. Saint-Maurice.

Author information

Author notes

  1. Pedro F. Saint-Maurice

    Present address: Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, HHS, 9609 Medical Center Drive, Room 6E-572, Rockville, MD, 20850, USA

Authors and Affiliations

  1. Department of Kinesiology, Iowa State University, 283 Forker Building, Ames, IA, 50011, USA

    Pedro F. Saint-Maurice

  2. School of Kinesiology and Recreation, Illinois State University, McCormick Hall, Normal, IL, 61790, USA

    Kelly Laurson

  3. Department of Kinesiology, Iowa State University, 257 Forker Building, Ames, IA, 50011, USA

    Gregory J. Welk

  4. College of Osteopathic Medicine, Michigan State University, East Fee Hall, 965 Fee Rd, East Lansing, MI, 48825, USA

    Joe Eisenmann

  5. Children’s Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU, UK

    Luis Gracia-Marco

  6. University of Zaragoza, Zaragoza, Spain

    Luis Gracia-Marco, Luis A. Moreno & German Vicente-Rodriguez

  7. SPORT Research Group (CTS-1024), University of Almería, 04120, Almería, Spain

    Enrique G. Artero

  8. School of Sport Sciences, University of Granada, 18071, Granada, Spain

    Francisco Ortega

  9. University of Granada, Granada, Spain

    Jonatan R. Ruiz

  10. Department of Physical Education and Sport, Faculty of Sport Sciences, 18071, Granada, Spain

    Jonatan R. Ruiz

  11. Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain

    Luis A. Moreno

  12. Instituto Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Zaragoza, Spain

    Luis A. Moreno

  13. Department of Physiatry and Nursing, Faculty of Health and Sport Sciences, Pza. Universidad 3, 22002, Huesca (España), Zaragoza, Spain

    German Vicente-Rodriguez

  14. Instituto Agroalimentario de Aragón (IA2), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Zaragoza, Spain

    German Vicente-Rodriguez

  15. Department of Health and Human Physiology, University of Iowa, 130 E FH, Iowa City, IA, 52242, USA

    Kathleen F. Janz

Authors
  1. Pedro F. Saint-Maurice
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelly Laurson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory J. Welk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joe Eisenmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luis Gracia-Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Enrique G. Artero
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francisco Ortega
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jonatan R. Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luis A. Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. German Vicente-Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kathleen F. Janz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pedro F. Saint-Maurice.

Ethics declarations

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Jonatan R. Ruiz is part of PROmoting FITness and Health through physical activity (PROFITH) research group.

Luis A. Moreno and German Vicente-Rodriguez are part of Growth, Exercise, Nutrition and Development (GENUD) research group.

Electronic supplementary material

ESM 1

(DOCX 37 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saint-Maurice, P.F., Laurson, K., Welk, G.J. et al. Grip strength cutpoints for youth based on a clinically relevant bone health outcome. Arch Osteoporos 13, 92 (2018). https://doi.org/10.1007/s11657-018-0502-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-018-0502-0

Keywords

Search

Navigation