Pedro F Saint-Maurice1,2, Kelly Laurson3, Gregory J Welk4, Joe Eisenmann5, Luis Gracia-Marco6,7, Enrique G Artero8, Francisco Ortega9, Jonatan R Ruiz10,11, Luis A Moreno7,12,13, German Vicente-Rodriguez7,14,15, Kathleen F Janz16. 1. Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, HHS, 9609 Medical Center Drive, Room 6E-572, Rockville, MD, 20850, USA. pedro.saintmaurice@nih.gov. 2. Department of Kinesiology, Iowa State University, 283 Forker Building, Ames, IA, 50011, USA. pedro.saintmaurice@nih.gov. 3. School of Kinesiology and Recreation, Illinois State University, McCormick Hall, Normal, IL, 61790, USA. 4. Department of Kinesiology, Iowa State University, 257 Forker Building, Ames, IA, 50011, USA. 5. College of Osteopathic Medicine, Michigan State University, East Fee Hall, 965 Fee Rd, East Lansing, MI, 48825, USA. 6. Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. 7. University of Zaragoza, Zaragoza, Spain. 8. SPORT Research Group (CTS-1024), University of Almería, 04120, Almería, Spain. 9. School of Sport Sciences, University of Granada, 18071, Granada, Spain. 10. University of Granada, Granada, Spain. 11. Department of Physical Education and Sport, Faculty of Sport Sciences, 18071, Granada, Spain. 12. Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain. 13. Instituto Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Zaragoza, Spain. 14. Department of Physiatry and Nursing, Faculty of Health and Sport Sciences, Pza. Universidad 3, 22002, Huesca (España), Zaragoza, Spain. 15. Instituto Agroalimentario de Aragón (IA2), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Zaragoza, Spain. 16. Department of Health and Human Physiology, University of Iowa, 130 E FH, Iowa City, IA, 52242, USA.
Abstract
The National Academy of Medicine recommends the handgrip for school-based surveillance of muscle strength for bone health. We established grip strength cutpoints that are linked to bone health in both US and European youth. These cutpoints could serve as a potential set of standards for surveillance and clinical applications. PURPOSE: The U.S. National Academy of Medicine and experts in Europe recommend the use of grip strength as a valuable and accessible musculoskeletal fitness measure due to its association with bone health. This is the first study to facilitate this recommendation by developing bone health-related grip strength cutpoints for youth based on empirical associations with the well accepted marker of bone development, i.e., height-adjusted total body less head bone mineral content (TBLH_BMC). METHODS: A purposive sample of healthy youth from Midwest USA (n = 433 youth; 14.1 ± 2.3 years; 1998-2004) and a random sample of healthy adolescents from Zaragoza, Spain (n = 355 youth; 14.9 ± 1.2 years; 2006-2007) were used to develop and test cut-points. Participants' grip strength was measured using a hand-held dynamometer while height-adjusted TBLH_BMC was determined using dual-energy x-ray absorptiometry. Grip strength scores were linked to TBLH_BMC using receiver operator characteristic curves, and grip strength cutpoints were tested based on the area under the curve (AUC), sensitivity (Se), specificity (Sp), and predictive odds ratios. All analyses were conducted in 2016. RESULTS: The AUC approximated or exceeded 0.80 for grip strength cutpoints, and the associated Se and Sp indices ranged from 53.6 to 92.5%. Sensitivity and Sp remained similar in the validation sample and those not meeting the grip strength cutpoints were five to eight times more likely to have insufficient TBLH_BMC, depending on their sex and cutpoint being considered. CONCLUSIONS: Grip strength is strongly related to TBLH_BMC, and the proposed cutpoints demonstrated acceptable classification accuracy for screening healthy youth and tracking healthy bone development in community settings. The utility of the cutpoints should be further examined in more diverse populations of youth.
The National Academy of Medicine recommends the handgrip for school-based surveillance of muscle strength for bone health. We established grip strength cutpoints that are linked to bone health in both US and European youth. These cutpoints could serve as a potential set of standards for surveillance and clinical applications. PURPOSE: The U.S. National Academy of Medicine and experts in Europe recommend the use of grip strength as a valuable and accessible musculoskeletal fitness measure due to its association with bone health. This is the first study to facilitate this recommendation by developing bone health-related grip strength cutpoints for youth based on empirical associations with the well accepted marker of bone development, i.e., height-adjusted total body less head bone mineral content (TBLH_BMC). METHODS: A purposive sample of healthy youth from Midwest USA (n = 433 youth; 14.1 ± 2.3 years; 1998-2004) and a random sample of healthy adolescents from Zaragoza, Spain (n = 355 youth; 14.9 ± 1.2 years; 2006-2007) were used to develop and test cut-points. Participants' grip strength was measured using a hand-held dynamometer while height-adjusted TBLH_BMC was determined using dual-energy x-ray absorptiometry. Grip strength scores were linked to TBLH_BMC using receiver operator characteristic curves, and grip strength cutpoints were tested based on the area under the curve (AUC), sensitivity (Se), specificity (Sp), and predictive odds ratios. All analyses were conducted in 2016. RESULTS: The AUC approximated or exceeded 0.80 for grip strength cutpoints, and the associated Se and Sp indices ranged from 53.6 to 92.5%. Sensitivity and Sp remained similar in the validation sample and those not meeting the grip strength cutpoints were five to eight times more likely to have insufficientTBLH_BMC, depending on their sex and cutpoint being considered. CONCLUSIONS: Grip strength is strongly related to TBLH_BMC, and the proposed cutpoints demonstrated acceptable classification accuracy for screening healthy youth and tracking healthy bone development in community settings. The utility of the cutpoints should be further examined in more diverse populations of youth.
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