Zhang Nuoyun, Liang Chen, Du Wei, Zou Mingxia, Kang Qin, Xia Yuhao, Bao Yajing, Feng Liu, Ma Tiancheng, Li Feiyue, Fan Hongmin
Department of Epidemiology, School of Public Health, North China University of Science and Technology, 21 Bohai Road, Tangshan, Hebei, 063210, China.
Hebei Key Laboratory of Occupational Health and Safety for Coal Industry, Tangshan, Hebei, China.
Eur J Pediatr. 2025 May 29;184(6):370. doi: 10.1007/s00431-025-06204-7.
Hand grip strength (HGS) is significantly correlated with bone mineral density (BMD), but has been assessed at a single time point in the cross-sectional study. The relationship between long-term patterns of HGS and BMD has neglected and not been proven. Therefore, this study aimed to explore the long-term HGS trajectories in 6-7 years old children and the risk of low BMD. This study included 1122 individuals with healthy BMD from Hebei Children and Adolescents aged 6-7 years Cohort Study in 2018 (baseline). HGS was measured 3 times repeatedly in 2018, 2020, and 2022. A cohort-based trajectory model was used to identify 4-year HGS developmental trajectories in the total participants, while HGS developmental trajectories were identified separately in subgroup analyses for sex, body mass index (BMI), and height. Cox proportional hazards models were used to test the association between HGS trajectories and low BMD. Three trajectories of HGS in the 1122 participants from 2018 to 2022 were identified and labeled as low-rate growth (blue-group1) (530, 47.2%), moderately-rate growth (red-group2) (518, 46.2%), and high-rate growth (green-group3) (74, 6.6%) respectively. Only 102 cases of low BMD were identified, the risk of low BMD was 9.1%. Participants in the low-rate growth group had a higher incidence of low BMD compared with the high-rate growth group [12.8% vs 2.7%, hazard ratio (HR): 5.74; 95% confidence interval (CI): 1.31, 25.15; P = 0.02]. Besides, the risk of low BMD decreased with the HGS changing trajectory increased in those two models (P < 0.05). And the same dose-response relationship was demonstrated in subgroup analyses of sex (boys, girls); however, in subgroup analyses for body mass index (normal, overweight/obese) and height (≤ median, > median), this relationship was only observed in those with normal BMI and height > P.
The HGS changing trajectories were associated with the risk of new-onset low BMD, and low BMD risk decreased with the HGS changing trajectory increase. Future studies with larger sample sizes are needed to validate the relationship between HGS and BMD.
Clinicaltrials.gov Identifier: ChiCTR2400083223; date registered: April 18, 2024. Registered under the name: "A bidirectional cohort study on the growth and development of children and adolescents in Hebei Province."
• Cross-sectional study finds significant correlation between handgrip strength (HGS) and bone mineral density (BMD). • The relationship between long-term patterns of HGS and BMD has neglected and not been proven.
• Utilizing a group-based trajectory model to identify different patterns of HGS trajectories. • Low-rate growth HGS trajectory patterns are associated with a high risk of low BMD.
握力（HGS）与骨密度（BMD）显著相关，但在横断面研究中仅在单一时间点进行了评估。HGS的长期模式与BMD之间的关系一直被忽视且未得到证实。因此，本研究旨在探讨6 - 7岁儿童的长期HGS轨迹以及低骨密度风险。本研究纳入了2018年河北儿童与青少年6 - 7岁队列研究中1122名骨密度健康的个体（基线）。在2018年、2020年和2022年对HGS进行了3次重复测量。使用基于队列的轨迹模型确定所有参与者4年的HGS发育轨迹，同时在按性别、体重指数（BMI）和身高进行的亚组分析中分别确定HGS发育轨迹。使用Cox比例风险模型测试HGS轨迹与低骨密度之间的关联。在2018年至2022年的1122名参与者中确定了HGS的三种轨迹，分别标记为低增长率（蓝色组1）（530人，47.2%）、中等增长率（红色组2）（518人，46.2%）和高增长率（绿色组3）（74人，6.6%）。仅确定了102例低骨密度病例，低骨密度风险为9.1%。与高增长率组相比，低增长率组参与者的低骨密度发生率更高[12.8%对2.7%，风险比（HR）：5.74；95%置信区间（CI）：1.31，25.15；P = 0.02]。此外，在这两个模型中，随着HGS变化轨迹增加，低骨密度风险降低（P < 0.05）。在按性别（男孩、女孩）进行的亚组分析中也显示了相同的剂量反应关系；然而，在按体重指数（正常、超重/肥胖）和身高（≤中位数、>中位数）进行的亚组分析中，这种关系仅在BMI正常且身高 > P的人群中观察到。
HGS变化轨迹与新发低骨密度风险相关，且低骨密度风险随HGS变化轨迹增加而降低。需要更大样本量的未来研究来验证HGS与BMD之间的关系。
Clinicaltrials.gov标识符：ChiCTR2400083223；注册日期：2024年4月18日。注册名称：“河北省儿童青少年生长发育双向队列研究”。
• 横断面研究发现握力（HGS）与骨密度（BMD）之间存在显著相关性。• HGS的长期模式与BMD之间的关系一直被忽视且未得到证实。
• 使用基于群体的轨迹模型识别HGS轨迹的不同模式。• 低增长率的HGS轨迹模式与低骨密度的高风险相关。
