Cheung Ching-Lung, Tan Kathryn C B, Bow Cora H, Soong Cissy S S, Loong Connie H N, Kung Annie Wai-Chee
Department of Medicine, The University of Hong Kong, L833B, Lab Block, 21 Sassoon Road, Hong Kong, China.
Age (Dordr). 2012 Oct;34(5):1239-48. doi: 10.1007/s11357-011-9297-2. Epub 2011 Aug 19.
Handgrip strength (HGS) is a potentially useful objective parameter to predict fracture since it is an indicator of general muscle strength and is associated with fragility and propensity to fall. Our objective was to examine the association of HGS with fracture, to evaluate the accuracy of HGS in predicting incident fracture, and to identify subjects at risk of fracture. We analyzed a cross-sectional cohort with 2,793 subjects (1,217 men and 1,576 women aged 50-101 years) and a subset of 1,702 subjects which were followed for a total of 4,855 person-years. The primary outcome measures were prevalent fractures and incident major fragility fractures. Each standard deviation (SD) reduction in HGS was associated with a 1.24-fold increased odds for major clinical fractures even after adjustment for other clinical factors. A similar result was obtained in the prospective cohort with each SD reduction in HGS being associated with a 1.57-fold increased hazard ratio of fracture even after adjustment for clinical factors. A combination of HGS and femoral neck bone mineral density (FN BMD) T-score values (combined T-score), together with other clinical factors, had a better predictive power of incident fractures than FN BMD or HGS T-score alone with clinical factors. In addition, combined T-score has better sensitivity and specificity in predicting incidence fractures than FN BMD alone. This study is the first study to compare the predictive ability of HGS and BMD. We showed that HGS is an independent risk factor for major clinical fractures. Compared with using FN BMD T-score of -2.5 alone, HGS alone has a comparable predictive power to BMD, and the combined T-score may be useful to identify extra subjects at risk of clinical fractures with improved specificity.
握力（HGS）是预测骨折的一个潜在有用的客观参数，因为它是一般肌肉力量的指标，与身体脆弱性和跌倒倾向相关。我们的目的是研究HGS与骨折的关联，评估HGS预测新发骨折的准确性，并识别骨折风险人群。我们分析了一个横断面队列，其中有2793名受试者（1217名男性和1576名年龄在50 - 101岁的女性）以及一个包含1702名受试者的子集，这些受试者总共被随访了4855人年。主要结局指标是现患骨折和新发严重脆性骨折。即使在对其他临床因素进行调整后，HGS每降低一个标准差（SD），主要临床骨折的发生几率增加1.24倍。在前瞻性队列中也得到了类似结果，即使在对临床因素进行调整后，HGS每降低一个SD，骨折的风险比增加1.57倍。HGS与股骨颈骨密度（FN BMD）T评分值（联合T评分）相结合，再加上其他临床因素，比单独使用FN BMD或HGS T评分与临床因素相结合，对新发骨折具有更好的预测能力。此外，联合T评分在预测新发骨折方面比单独使用FN BMD具有更好的敏感性和特异性。本研究是第一项比较HGS和骨密度预测能力的研究。我们表明HGS是主要临床骨折的独立危险因素。与单独使用-2.5的FN BMD T评分相比，单独使用HGS具有与骨密度相当的预测能力，联合T评分可能有助于识别更多有临床骨折风险的受试者，且特异性有所提高。
