Calcified Tissue International

, Volume 83, Issue 2, pp 93–100

Grip Strength May Facilitate Fracture Prediction in Perimenopausal Women with Normal BMD: A 15-Year Population-Based Study

  • Joonas Sirola
  • Toni Rikkonen
  • Marjo Tuppurainen
  • Jukka S. Jurvelin
  • Esko Alhava
  • Heikki Kröger
Article

Abstract

The aim of the present study was to investigate the ability of grip strength measurements to predict fracture risk in perimenopausal women according to bone mineral density (BMD). A random sample of 971 perimenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention study cohort was measured with dual-energy X-ray absorptiometry (DXA) at the femoral neck and grip strength with a pneumatic squeeze dynamometer in 5-year intervals from baseline (1989–1991). Fractures during the 15-year follow-up were recorded based on self-reports and validated from medical records. In the total sample and in osteopenic or osteoporotic women (T score < −1, n = 284) grip strength was not significantly associated with fracture-free survival rate (P = nonsignificant in Cox regression). In women with normal baseline BMD (N-BMD, T score > −1, n = 687) the lowest grip strength quartile had a significantly lower fracture-free survival rate in the Cox proportional hazard model (P = 0.005, hazard ratio [HR] = 2.0). In the multivariate Cox regression model, T score and grip strength were the only significant predictors of 15-year fracture-free survival in the N-BMD group and a risk index (RI) was formed according to HRs of these two variables. High RI (0–5 points) was associated with significantly lower 15-year fracture-free survival rate (P = 0.001, HR = 0.137) in the N-BMD group. In contrast, 5-year T score was no better a predictor of fractures in the baseline N-BMD group (P = 0.04, HR = 0.36). In conclusion, grip strength predicts 15-year fracture-free survival in perimenopausal women with N-BMD, while 5-year DXA does not seem to be any better a predictor of fracture risk. DXA measurements could be coupled with simple and cost-effective grip strength measurements. Controlling BMD in women with N-BMD could be abandoned.

Keywords

Dual-energy X-ray absorptiometry Fracture risk Grip strength Osteoporosis Population-based study Postmenopause 

References

  1. 1.
    Dennison E, Cole Z, Cooper C (2005) Diagnosis and epidemiology of osteoporosis. Curr Opin Rheumatol 17:456–461PubMedCrossRefGoogle Scholar
  2. 2.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767PubMedCrossRefGoogle Scholar
  3. 3.
    National Osteoporosis Foundation (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and costeffectiveness analysis. Status report developed by the National Osteoporosis Foundation. Osteoporos Int 8(Suppl 4):S1–S88Google Scholar
  4. 4.
    Seeman E, Delmas PD (2006) Bone quality—the material and structural basis of bone strength and fragility. N Engl J Med 354:2250–2261PubMedCrossRefGoogle Scholar
  5. 5.
    Widgerowitz C, Paterson C, Dashti H, McGurty D, Rowley D (2000) Prediction of bone strength from cancellous structure of the distal radius: can we improve DXA? Osteoporos Int 11:840–846CrossRefGoogle Scholar
  6. 6.
    Cadarette SM, Jaglal SB, Murray TM et al (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy X-ray absorptiometry. JAMA 286:57–63PubMedCrossRefGoogle Scholar
  7. 7.
    Black DM, Steinbuch M, Palermo L et al (2001) An assessment tool for prediction fracture risk in postmenopausal women. Osteoporos Int 12:519–528PubMedCrossRefGoogle Scholar
  8. 8.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX TM and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRefGoogle Scholar
  9. 9.
    Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 17:1404–1409PubMedCrossRefGoogle Scholar
  10. 10.
    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 13:1458–1467PubMedCrossRefGoogle Scholar
  11. 11.
    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 67:10–18PubMedCrossRefGoogle Scholar
  12. 12.
    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 32:78–85PubMedCrossRefGoogle Scholar
  13. 13.
    Honkanen R, Tuppurainen M, Alhava E, Saarikoski S (1991) Kuopio Osteoporosis Risk Factor, Prevention Study. Baseline postal inquiry in 1989. University of Kuopio, Community Health, Statistics and Reviews, KuopioGoogle 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 55:1–7PubMedCrossRefGoogle Scholar
  15. 15.
    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 31:45–54PubMedCrossRefGoogle Scholar
  16. 16.
    WHO Scientific Group (1996) Research on the menopause in the 1990’s. A report of the WHO Scientific Group. WHO Technical Report Series 866. World Health Organisation, Geneva, pp 1–79Google Scholar
  17. 17.
    Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Kröger H (2006) Association of grip strength change with menopausal bone loss and related fractures: a population-based follow-up study. Calcif Tissue Int 78:218–226PubMedCrossRefGoogle Scholar
  18. 18.
    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
  19. 19.
    Sirola J, Kröger H, Honkanen R, Sandini L, Tuppurainen M, Jurvelin JS, Saarikoski S (2003) Risk factors associated with peri- and postmenopausal bone loss—does HRT prevent weight loss–related bone loss? Osteoporos Int 14:27–33PubMedCrossRefGoogle Scholar
  20. 20.
    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 2:135–140PubMedCrossRefGoogle Scholar
  21. 21.
    Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2003) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 12:1289–1295Google Scholar
  22. 22.
    Haidar SG, Kumar D, Bassi RS, Deshmukh SC (2004) Average versus maximum grip strength: which is more consistent? J Hand Surg 29:82–84Google Scholar
  23. 23.
    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
  24. 24.
    Kerr D, Morton A, Dick I, Prince R (1996) Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res 11:218–225PubMedCrossRefGoogle Scholar
  25. 25.
    Blain H, Vuillemin A, Teissier A, Hanesse B, Guillemin F, Jeandel C (2001) Influence of muscle strength and body weight and composition on regional bone mineral density in healthy women aged 60 and older. Gerontology 47:207–212PubMedCrossRefGoogle 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 populationbased study. Eur J Appl Physiol 93:102–107PubMedCrossRefGoogle Scholar
  27. 27.
    Seeman E, Delmas PD (2006) Bone quality—the material and structural basis of bone strength and fragility. N Engl J Med 354:2250–2261PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Joonas Sirola
    • 1
    • 2
  • Toni Rikkonen
    • 1
  • Marjo Tuppurainen
    • 1
    • 3
  • Jukka S. Jurvelin
    • 4
  • Esko Alhava
    • 5
  • Heikki Kröger
    • 1
    • 2
  1. 1.Bone and Cartilage Research UnitUniversity of KuopioKuopioFinland
  2. 2.Department of Orthopedics and TraumatologyKuopio University HospitalKuopioFinland
  3. 3.Department of Obstetrics and GynecologyKuopio University HospitalKuopioFinland
  4. 4.Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
  5. 5.Department of SurgeryKuopio University HospitalKuopioFinland

Personalised recommendations