Calcified Tissue International

, Volume 78, Issue 4, pp 218–226 | Cite as

Association of Grip Strength Change with Menopausal Bone Loss and Related Fractures: A Population-Based Follow-Up Study

  • J. Sirola
  • T. Rikkonen
  • M. Tuppurainen
  • J. S. Jurvelin
  • H. Kröger


The aim of the present study was to investigate the association between grip strength change and bone health according to menopausal status. A random sample of 971 pre- to postmenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort was measured with dual X-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN) and grip strength with pneumatic squeeze dynamometer at baseline (1989–1991), 5 years (1994–1997), and 10 years (1999–2001). Fractures were recorded based on self-reports and validated from medical records. Women were divided into two groups according to change in grip strength quartile from baseline to 5-year follow-up: not improved (n = 735) and improved (n = 236). In the total population, the greatest bone loss was observed in perimenopausal (beginning of menopause during follow-up, n = 311) women [P < 0.001 vs. premenopausal women (n = 139)], and it declined in postmenopausal (n = 521) women [P < 0.001 by analysis of covariance (ANCOVA)]. The perimenopausal bone loss rate was significantly lower in women in the improved group in comparison to the not improved group (P < 0.01) in contrast to the pre- and postmenopausal groups (P > 0.05). Accordingly, there was a greater decline in perimenopausal LS and FN T-scores in the improved group vs. the not improved group over the first 5-year follow-up interval (P < 0.05 by ANCOVA) and remained unchanged over the 10-year follow-up. In perimenopausal women, there was a trend toward higher fracture-free survival rate in the improved group (82%) vs. the not improved group (88%) after 10 years. Adjustments did not change the results. In conclusion, maintenance of grip strength is associated with menopausal bone loss and future fractures.


Bone loss Dual X-ray absorptiometry Fracture Menopause Muscle strength change Osteoporosis 



This study was financially supported by the Finnish Medical Foundation and the Academy of Finland.


  1. 1.
    Lindsay R (1992) The growing problem of osteoporosis. Osteoporosis Int 2:267–268Google Scholar
  2. 2.
    Melton LJ III (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14:S1–S8CrossRefPubMedGoogle Scholar
  3. 3.
    Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. Lancet 341:72–75CrossRefPubMedGoogle Scholar
  4. 4.
    Kröger H, Huopio J, Honkanen R, Tuppurainen M, Puntila E, Alhava E, Saarikoski S (1995) Prediction of fracture risk using axial bone mineral density in perimenopausal population: a prospective study. J Bone Miner Res 10:302–306PubMedGoogle Scholar
  5. 5.
    Honkanen R, Kroger H, Tuppurainen M, Alhava E, Saarikoski S (1995) Fractures and low axial bone density in perimenopausal women. J Clin Epidemiol 48:881–888CrossRefPubMedGoogle Scholar
  6. 6.
    Huopio J, Kröger H, Honkanen R, Saarikoski S, Alhava E (2000) Risk factors for perimenopausal fractures: a prospective study. Osteoporos Int 11:219–227CrossRefPubMedGoogle Scholar
  7. 7.
    Riis BJ, Hansen MA, Jensen AM, Overgaard K, Christiansen C (1996) Low bone mass and fast rate of bone loss at menopause: equal risk factors for future fracture: a 15 year follow-up study. Bone 19:9–12CrossRefPubMedGoogle Scholar
  8. 8.
    Pouilles JM, Tremollieres F, Ribot C (1995) Effect of menopause on femoral and vertebral bone loss. J Bone Miner Res 10:1531–1536PubMedGoogle Scholar
  9. 9.
    Sirola J, Kröger H, Honkanen R, Jurvelin JS, Sandini L, Tuppurainen M, Saarikoski S (2003a) Factors affecting bone loss around menopause in women without HRT: a prospective population based cohort study. Maturitas 3:159–167Google Scholar
  10. 10.
    Harris S, Dawson-Hughes B (1992) Rates of change in bone mineral density of spine, heel, femoral neck and radius in healthy postmenopausal women. J Bone Miner Res 17:87–95Google Scholar
  11. 11.
    Pouilles JM, Tremollieres F, Ribot C (1993) The effects of menopause on longitudinal bone loss from spine. Calcif Tissue Int 52:340–343PubMedGoogle Scholar
  12. 12.
    Samson MM, Meeuwsen IB, Crowe A, Dessens JA, Duursma SA, Veerhaar HJ (2000) Relationships between physical performance measures, age, height and body weight in healthy adults. Age Aging 29:235–242Google Scholar
  13. 13.
    Sirola J, Rikkonen T (2005) Muscle performance after the menopause - review. J Br Menopause Soc 11:45–50CrossRefPubMedGoogle Scholar
  14. 14.
    Kröger H, Tuppurainen M, Honkanen R, Alhava E, Saarikoski S (1994) Bone mineral density and risk factors for osteoporosis - a population based study of 1600 perimenopausal women. Calcif Tissue Int 55:1–7CrossRefPubMedGoogle Scholar
  15. 15.
    Nguyen TV, Sambrook PN, Eisman JA (1998) Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 13:1458–1460PubMedGoogle Scholar
  16. 16.
    Wallace BA, Cumming RG (2000) Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif Tissue Int 67:10–18CrossRefPubMedGoogle Scholar
  17. 17.
    Sirola J, Tuppurainen M, Honkanen R, Jurvelin JS, Kröger H (2005) Associations between grip strength change and axial postmenopausal bone loss – a 10-year population-based follow-up study. Osteoporos Int 16:1841–1848CrossRefPubMedGoogle Scholar
  18. 18.
    Albrand G, Munoz F, Sornay-Rendu E, Du Boeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 32:78–85CrossRefPubMedGoogle Scholar
  19. 19.
    Honkanen R, Tuppurainen M, Alhava E, Saarikoski S (1991) Kuopio Osteoporosis Risk Factor and Prevention Study. Baseline postal inquiry in 1989. University of Kuopio, Community Health, Statistics and Reviews, KuopioGoogle Scholar
  20. 20.
    WHO Scientific Group (1996) Research on the menopause in the 1990’s. A report of the WHO Scientific Group, 866. World Health Organisation, GenevaGoogle Scholar
  21. 21.
    Honkanen K, Honkanen R, Heikkinen L, Kröger H, Saarikoski S (1999) The validity of self-reports of fractures in perimenopausal women. Am J Epidemiol 150:511–516PubMedGoogle Scholar
  22. 22.
    Sirola J, Kröger H, Honkanen R, Sandini L, Tuppurainen M, Jurvelin JS, Saarikoski S (2003b) Risk factors associated with peri- and postmenopausal bone loss - does HRT prevent weight loss-related bone loss? Osteoporosis Int 14:27–33CrossRefGoogle Scholar
  23. 23.
    Kröger H, Heikkinen J, Laitinen K, Kotaniemi A (1992) Dual-energy X-ray absorptiometry in normal women: a cross-sectional study of 717 Finnish volunteers. Osteoporos Int 2:135–140CrossRefPubMedGoogle Scholar
  24. 24.
    Komulainen MH, Kröger H, Tuppurainen MT, Heikkinen A-M, Alhava E, Honkanen R, Saarikoski S (1998) HRT and vit D in prevention of non-vertebral fractures in postmenopausal women: a 5 year randomised trial. Maturitas 31:45–54CrossRefPubMedGoogle Scholar
  25. 25.
    Dennerstein L, Smith AMA, Morse C, Burger H, Green A, Hopper J, Ryan M (1993) Menopausal symptoms in Australian women. Med J Aust 159:232–236PubMedGoogle Scholar
  26. 26.
    Sirola J, Rikkonen T, Kröger H, Honkanen R, Tuppurainen M, Airaksinen O, Saarikoski S (2004) Factors related to postmenopausal muscle performance: a cross-sectional population-based study. Eur J Appl Physiol 93:102–107PubMedGoogle Scholar
  27. 27.
    Prior JC, (1998) Perimenopause: the complex endocrinology of the menopausal transition. Endocr Res 19:397–428Google Scholar
  28. 28.
    Ito M, Nakamura T, Tsurusaki K, Uetani M, Hayashi K (1999) Effects of menopause on age-dependent bone loss in the axial and appendicular skeletons in healthy Japanese women. Osteoporos Int 19:377–383Google Scholar
  29. 29.
    Hansen MA, Overgaard K, Christiansen C (1995) Spontaneous postmenopausal bone loss in different skeletal areas followed up for 15 years. J Bone Miner Res 10:205–210PubMedGoogle Scholar
  30. 30.
    Luckey MM, Wallenstein S, Lapinski R, Meier DE (1996) A prospective study of bone loss in African-American and white women - a clinical research centre study. J Clin Endocrinol Metab 81:2948–2956CrossRefPubMedGoogle Scholar
  31. 31.
    Young R, May H, Murphy S, Grey C, Compston E (1996) Rates of bone loss in peri- and postmenopausal women: a 4 year, prospective, population-based study. Clin Sci (Colch) 91:307–312Google Scholar
  32. 32.
    Bolotin HH, Sievänen H, Grashuis JL, Kuiper JW, Jarvinen TL (2001) Inaccuracies inherent in patient-specific dual-energy X-ray absorptiometry bone mineral density measurements: comprehensive phantom-based evaluation. J Bone Miner Res 16:417–426PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • J. Sirola
    • 1
    • 5
  • T. Rikkonen
    • 1
  • M. Tuppurainen
    • 1
    • 2
  • J. S. Jurvelin
    • 3
  • H. Kröger
    • 1
    • 4
  1. 1.Bone and Cartilage Research UnitUniversity of KuopioKuopioFinland
  2. 2.Department of Obstetrics and GynecologyKuopio University HospitalKuopioFinland
  3. 3.Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
  4. 4.Department of SurgeryKuopio University HospitalKuopioFinland
  5. 5.Department of SurgeryMikkeli Central HospitalMikkeliFinland

Personalised recommendations