Osteoporosis International

, Volume 3, Issue 2, pp 66–70

Low bone mineral density, grip strength and skinfold thickness are important risk factors for hip fracture in Hong Kong Chinese

  • E. M. C. Lau
  • J. Woo
  • P. C. Leung
  • R. Swaminthan
Original Article


The purpose of the study was to compare the bone mineral density (BMD) at the hip and spine, the grip strength and the skinfold thickness in Chinese hip fracture patients and controls, and to document the relative risk of hip fracture associated with different levels of these risk factors. The study was conducted on 163 elderly patients with hip fracture (32 men and 131 women) and 317 controls (104 men and 213 women). BMD at the hip and spine was measured by dual-energy X-ray densitometry (Norland NR26). The mean grip strength was measured in both hands by a hand dynamometer; and bicep, tricep and iliac skinfold thicknesses were measured by a caliper (Holstain). Student'st-test was used to compare the mean bone densities, recalled body weight, grip strength and skinfold thickness; and multiple logistic regression was used to calculate the relative risk and 95% confidence intervals in quartiles of bone density, grip strength and skinfold thickness. In women, the mean BMD and anthropometric measurements were significantly lower in patients than controls. However, in men the mean recalled body weight and measured skinfold thickness were not significantly different between patients and controls. In both men and women the relative risk of hip fracture increased significantly with diminishing bone density at the spine, femoral neck and intertrochanteric area, but not at the Ward's triangle. In women the relative risk of hip fracture also increased significantly with a low recalled body weight, grip strength and skinfold thickness. The relative risk of hip fracture in the lowest quartiles compared with the highest quartiles was 4.3 (95% CI 2.3–9.0) for BMD at the femoral neck, 9.7 (95% CI 4.6–20.6) for iliac skinfold thickness and 2.0 (95% CI 4.6–20.6) for grip strength. The results of multiple logistic regression shows that a low iliac skin fold thickness was associated with a higher risk of hip fracture than grip strength and BMD in women, but not in men. It is concluded that low BMD is a significant risk factor for hip fracture in elderly Chinese living in Hong Kong; however, poor muscle strength and lack of subcutaneous fat are as important.


Bone mineral density Chinese Grip strength Hip fracture Skinfold thickness 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lau EMC, Cooper C, Wickham C, et al. Hip fracture in Hong Kong and Britain. Int J Epidemiol 1990;9:1119–21.Google Scholar
  2. 2.
    Cummings SR. Are patients with hip fractures more osteoporotic? Am J Med 1985;78:487–94.Google Scholar
  3. 3.
    Mautalen C, Vega E, Ghiringhelli G, et al. Bone diminution of osteoporotic females at different skeletal sites. Calcif Tissue Int 1990;46:217–21.Google Scholar
  4. 4.
    Boden SD, Labropoulos P, Saunders R. Hip fractures in young patients: is this early osteoporosis? Calcif Tissue Int 1990;46:65–72.Google Scholar
  5. 5.
    Melton LJ III, Wahner HW, Richelson LS, et al. Osteoporosis and the risk of hip fracture. Am J Epidemiol 1986;124:254–61.Google Scholar
  6. 6.
    Cummings SR, Black DM, Nevitt MC, et al. Appendicular bone density and age predict hip fracture in women. JAMA 1990;263:665–8.Google Scholar
  7. 7.
    Schlesselman JJ. Case-control studies: design, conduct and analysis. New York: Oxford University Press, 1982:58.Google Scholar
  8. 8.
    Cooper C, Barker DJP, Wickham C. Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. BMJ 1988;297:1443–5.Google Scholar
  9. 9.
    Cummings SR, Nevitt MC. A hypothesis: the causes of hip fractures. J Gerontol Med Sci 1989;44(4):107–11.Google Scholar

Copyright information

© European Foundation for Osteoporosis 1993

Authors and Affiliations

  • E. M. C. Lau
    • 1
  • J. Woo
    • 2
  • P. C. Leung
    • 3
  • R. Swaminthan
    • 4
  1. 1.Department of Community and Family Medicinethe Chinese University of Hong KongChina
  2. 2.Department of Medicinethe Chinese University of Hong KongChina
  3. 3.Department of Orthopaedics and Traumatologythe Chinese University of Hong KongChina
  4. 4.Department of Chemical Pathologythe Chinese University of Hong KongChina
  5. 5.Centre for Clinical Epidemiology and Biostatistics, David Maddison Clinical Sciences BuildingRoyal Newcastle HospitalNewcastleAustralia

Personalised recommendations