Osteoporosis International

, Volume 29, Issue 11, pp 2447–2456 | Cite as

Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study

  • A. V. HaugerEmail author
  • A. Bergland
  • K. Holvik
  • A. Ståhle
  • N. Emaus
  • B. H. Strand
Original Article



Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway.


To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier.


The study population constituted 6565 participants aged 50–79 years at baseline in the Tromsø Study wave 4 conducted in 1994–1995. Forearm BMD measured by SXA was categorized as “normal,” “osteopenia,” or “osteoporosis” following WHO’s definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures.


During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction.


Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors.


Bone mineral density Grip strength Hip fracture Mortality Osteoporosis Osteopenia 



No external funding has been received to finance this project. The manuscript will be part of Annette V. Hauger’s Ph.d thesis and is internally funded by Oslo Metropolitan University.

Compliance with ethical standards

Conflict of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Department of Physiotherapy, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
  2. 2.Norwegian Institute of Public HealthOsloNorway
  3. 3.Department of Neurobiology, Care Sciences and Society, Division of PhysiotherapyKarolinska InstitutetHuddingeSweden
  4. 4.Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals FunctionKarolinska University HospitalStockholmSweden
  5. 5.Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
  6. 6.Norwegian National Advisory Unit on Aging and HealthVestfold Hospital TrustTønsbergNorway
  7. 7.Faculty of MedicineUniversity of OsloOsloNorway

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