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Chronic joint pain and handgrip strength correlates with osteoporosis in mid-life women: a Singaporean cohort

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Abstract

Summary

This study aimed to identify novel correlates which may relate to low bone mass at lumbar spine in mid-life Asian women. The possibility of developing a prediction model for osteoporosis (OP) was explored which resulted in a risk assessment tool that performed better than currently available tools.

Introduction

In order to identify novel correlates associated with low spinal bone mineral density (BMD) in mid-life women, we examined a large number of lifestyle and medical and performance measurements and developed a prediction model for triage to BMD scanning.

Methods

Women (n = 512) aged 45–69 years (mean 57.0 ± 6.3) attending gynecology clinics for “well woman” visits were recruited for this cross-sectional study from 2014 to 2015. We assessed symptoms, medical history, anthropometry, and physical performance. Stepwise multinomial logistic regressions were performed to examine significant associated covariates for pre-specified outcomes (normal [T-score ≥ −1.0], low bone mass [T-score between −1 and −2.5], and OP [T-score ≤ −2.5] at the lumbar spine). A new screening model was developed, and its performance was compared with the OP Screening Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX®).

Results

Spinal OP was found in 6.8%. Multivariate analysis indicated that chronic joint pain, the most common symptom reported by 37.5% of the women, was significantly associated with OP. Only age (Relative Risk Ratio [RRR] 1.63; 95%CI, 1.03–2.60), weight (RRR 0.14; 95% CI, 0.07–0.27), postmenopausal status (RRR 11.59, 95%CI, 1.15–116.73), chronic joint pain (RRR, 4.12; 95% CI, 1.53–11.07), and right handgrip strength (RRR 0.50; 95% CI, 0.31–0.80) were independently associated with spinal OP. Combining these five variables, our final model’s area under curve (AUC) was significantly higher at 84% than both the OSTA [AUC; 79% (p value < 0.0231 ‘c’ statistics)] and FRAX® [AUC 58% (p value < 0.0001 ‘c’ statistic)].

Conclusion

A novel screening tool that combines age, weight, and menopausal status with chronic joint pain and right handgrip strength more reliably predicts spinal OP in mid-life Singaporean women.

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Acknowledgments

We would like to thank our study participants and study coordinators, Eng Sok Kheng, Chua Seok Eng, Poon Peng Cheng, Ng Poh Lian, Zhang Xuan, Teo Yean Ling, Saw Myat Sabai, and Ho Kum Chue who assisted in the data compilation. We are thankful to Low Siew Leng and Tan Sze Yee, the staff of Orthopaedic Diagnostic Centre, who conducted all the DEXA scans for our participants. We acknowledge the contribution by Dr. Stephen Smagula (SS) in conducting the pre-study workshops and advising on the study design methodologies and analysis.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National University of Singapore, Singapore, Republic of Singapore

    S. Logan, W. P. P. Thu, L. Y. Wang & E. L. Yong

  2. Singapore Institute for Clinical Sciences (SICS), A-STAR, Singapore, Republic of Singapore

    W. K. Lay

  3. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    J. A. Cauley

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  1. S. Logan
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  6. E. L. Yong
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Corresponding author

Correspondence to E. L. Yong.

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Funding

Susan Logan received research funding support (OG Pitch for Fund Research Grant FY 2014) from Department of Obstetrics and Gynaecology, National University of Singapore.

Conflict of interest

Susan Logan, Win Pa Pa Thu, Wai Khin Lay, Luna Yue Wang, Jane A. Cauley, and Eu-Leong Yong declare that they have no conflict of interest.

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Supplies

a. Wall-mounted stadiometer, SECA Corp, 220, Equip Medical Pte.Ltd., No. 81 Toh Guan Road East, #03-01, Secom Centre, Singapore 608606, Singapore.

b. Jamar hydraulic hand dynamometer; Sammons Preston Rolyan, 4 Sammons Court, Bolingbrook, IL 60440.

c. Automatic Blood Pressure Monitor, Model HEM-7211OMRON Healthcare Singapore Pte Ltd. 438A Alexandra Technopark, Singapore 119967.

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Logan, S., Thu, W.P.P., Lay, W.K. et al. Chronic joint pain and handgrip strength correlates with osteoporosis in mid-life women: a Singaporean cohort. Osteoporos Int 28, 2633–2643 (2017). https://doi.org/10.1007/s00198-017-4095-z

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  • DOI: https://doi.org/10.1007/s00198-017-4095-z

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