Archives of Osteoporosis

, 13:71 | Cite as

Low physical performance determined by chair rising test muscle mechanography is associated with prevalent fragility fractures

  • Tobias Rupp
  • Sebastian Butscheidt
  • Katharina Jähn
  • Maciej JK Simon
  • Haider Mussawy
  • Ralf Oheim
  • Florian Barvencik
  • Michael Amling
  • Tim RolvienEmail author
Original Article



This study examined associations between physical performance assessed by chair rising test muscle mechanography and DXA T-score as well as body composition in a large patient cohort. Next to various significant interrelationships between these muscle and bone parameters, lower physical performance was associated with prevalent fragility fractures.


Although the interaction between muscle and bone has been demonstrated in various aspects, the clinical focus in the diagnosis of musculoskeletal disorders mainly lies on the skeletal assessments. Accordingly, the association between muscle function, bone mineral density (BMD), and fragility fractures remains to be further elucidated with a feasible muscle assessment in a clinical setting.


Patient data (2076 patients, 1538 women, 538 men) were evaluated retrospectively from a large dual energy X-ray absorptiometry (DXA) database as well as from chair rising test (CRT) that was performed on a muscle mechanograph. To determine potential predictors of the CRT time and maximum force, a multivariate regression analysis was performed including age, DXA T-score, and body composition indices. Furthermore, CRT results were compared between non-fracture and fracture cases.


We determined independent predictors for CRT time such as age, femoral DXA T-score, and total fat mass, whereas CRT force was only influenced by total lean mass. Both women and men with previous fragility fractures displayed a longer CRT time (women p = 0.009, men p = 0.001) and lower CRT force (women p < 0.001, men p < 0.001) than those with no fractures, while no clear differences in CRT results could be detected between normal BMD, osteopenia, and osteoporosis based on DXA T-scores.


Our study demonstrates that in addition to the associations between chair rising time and femoral T-score assessed by DXA, low muscle strength is associated with previous fragility fractures.


DXA Muscle force Osteoporosis Bone-muscle crosstalk 


Authors’ roles

Study design: MA and T Rolvien. Study conduct: T Rupp, SB, MJKS, HM, RO, FB, MA, and T Rolvien. Data analysis: T Rupp, SB, KJ, MJKS, HM, RO, FB, MA, and T Rolvien. Drafting manuscript: T Rupp and T Rolvien. Revising manuscript: T Rupp, SB, KJ, MJKS, HM, RO, FB, MA, and T Rolvien. T Rupp and T Rolvien take responsibility for the integrity of the data analysis.

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

This study was approved by the local ethics committee (PV3874).

Conflicts of interest


Supplementary material

11657_2018_490_MOESM1_ESM.docx (67 kb)
ESM 1 (DOCX 66 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Tobias Rupp
    • 1
  • Sebastian Butscheidt
    • 1
  • Katharina Jähn
    • 1
  • Maciej JK Simon
    • 1
    • 2
  • Haider Mussawy
    • 1
    • 2
  • Ralf Oheim
    • 1
  • Florian Barvencik
    • 1
  • Michael Amling
    • 1
  • Tim Rolvien
    • 1
    • 2
    Email author
  1. 1.Department of Osteology and BiomechanicsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of OrthopedicsUniversity Medical Center Hamburg-EppendorfHamburgGermany

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