Grip Strength: An Alternative for Measuring Osteoporosis in Elderly

Introduction The increasing prevalence of osteoporosis has substantial impact on health and economic status of elderly population. The assessment of bone mineral density by dual-energy x-ray absorptiometry (DEXA) scan is inconvenient and not always plausible; especially in the resource-limited settings of developing countries due to various factors like availability, accessibility and affordability. The objective of the study was to assess whether hand grip strength (HGS) measured by a simple hand-held dynamometer could be an alternative tool for screening of osteoporosis in the elderly population. Method The study was a cross-sectional, hospital based study conducted on 98 elderly participants (aged with 65 years and above) not having any osteoporotic fracture or symptoms related to musculoskeletal system. The participants were recruited in the geriatric out-patient department of All India Institute of Medical Sciences, New Delhi, India, after written consent. Bone mineral density was evaluated at three sites - at the distal forearm of non-dominant hand, lumbar spine and hip using Dual-energy x-ray Absorptiometry (DEXA). HGS was measured in both the dominant and non-dominant hands using a hand held Gripper Gym Dynamometer. Multivariate Regression analysis was done to find associations and receiver operating characteristic (ROC) analysis was done to find accuracy of grip strength. Results Study included 55 (56%) males and 43 (44%) post-menopausal females. The mean age of study participants was 70.22 years. The mean HGS was 18.11 Kg. The mean T-score for spine, hip and forearm were -2.2, -2.18 and -3.4 respectively. Older age is associated with poor HGS (p=0.02). Multivariate regression showed significant association of HGS with loss of bone mineral density in the lumbar spine (p=0.000), hip (p= 0.022) as well as the forearm (p=0.000). ROC analysis showed the area under curve (AUC) for lumbar spine was found to be 0.725 (0.623-0.827), AUC for hip bone 0.724 (0.680-0.869), AUC for forearm bone 0.837 (0.729-.0953) .ROC analysis showed that 83.7% of osteoporosis of forearm bone diagnosed by DEXA has been explained by HGS with area under curve(AUC) 0.837 .729-.0953) 92 P Chatterjee, R Kandel, H Bhatti, V Challyion, R Chowdhury, G Desai, V Kumar & A B Dey Impact Factor (JCC): 5.1064 Index Copernicus Value (ICV): 3.0 Conclusions In this cohort of elderly, HGS was found to be an useful and independent indicator of general bone density. Also, HGS analysis is a far more practical and cheaper alternative to bone densitometry evaluation by the expensive DEXA machine.