Abstract
Evolving debate suggests that handgrip strength, a measure of muscular strength, might be associated with the risk of fractures; however, the evidence is conflicting. We aimed to assess the association of handgrip strength with the risk of fracture in the general population. Handgrip strength, measured using a dynamometer, was assessed at baseline in a population-based sample of 853 men and women aged 61–73 years in the Kuopio Ischemic Heart Disease prospective cohort. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for incident fractures. Incident fractures (hip, humeral, or wrist) (n = 159) occurred during a median follow-up of 16.7 years. Comparing extreme tertiles of handgrip strength, the age- and sex-adjusted hazard ratio (95% CI) for fractures was 0.80 (0.55–1.18). The association remained similar on further adjustment for other potential confounders: HR (95% CI) of 0.82 (0.55–1.21). In a meta-analysis of 19 population-based prospective cohort studies (including the current study) comprising 220,757 participants and 9199 fractures (including 1302 hip fractures), the fully adjusted relative risk (RR) (95% confidence interval, CI) for incident fractures was 0.70 (0.61–0.80) comparing the top versus bottom thirds of handgrip strength. The association remained significant after trim-and-fill correction for publication bias. The corresponding RR (95% CI) for hip fractures (9 studies) was 0.61 (0.54–0.70). Handgrip was only modestly associated with fracture risk in the primary analysis, which may be driven by the low event rate. Pooled prospective cohort evidence suggests that elevated handgrip strength is associated with reduced future fracture risk.
Highlights
Fractures constitute a global public health burden, especially among older individuals
Handgrip was only modestly associated with fracture risk in the primary analysis, which may be driven by the low event rate
Pooled prospective cohort evidence suggests that elevated handgrip strength is associated with reduced future fracture risk
Summary
Fractures ( osteoporotic fractures) constitute a global public health burden, especially among older individuals. A number of GeroScience (2021) 43:869–880 studies have demonstrated handgrip strength to be inversely associated with adverse vascular and nonvascular outcomes as well as mortality.[10, 18, 42, 52, 53] There is evidence suggesting an association between high handgrip strength and reduced risk for low bone mass density; [24] whether this translates to reduced risk of fractures is uncertain as the existing evidence is divergent. [8, 37, 38] The inconsistency in the evidence could be attributed to a number of factors which include differences in sample sizes and follow-up durations; inability of some studies to fully examine the impact of adjustment for potential confounding; differences in study population characteristics such as age, sex, race, or genetic background; differences in handgrip strength assessments; ascertainment and case definition of fracture outcomes; or a combination of all of these. We performed pooled analysis of available published prospective evidence on the association, thereby offering the opportunity to re-evaluate the nature and magnitude of the association in a larger representative sample of participants and fracture cases
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