Muscle Strength, Physical Performance Measures Improve Fracture Risk Prediction in Men

In a plenary poster presentation at ASBMR 2021, researchers determined whether muscle strength and performance measures improved fracture risk prediction in men.

Muscle strength and physical performance measurements were found to be equal to or superior to other risk factors, including prior falls, for fracture risk prediction in men, and may help identify those at high risk for fracture, according to study results presented at the American Society for Bone and Mineral Research (ASBMR) 2021 Annual Meeting, held from October 1 to 4, in San Diego, California, and real-time virtually.

The researchers sought to explore whether the incorporation of muscle strength and physical performance measures improved the performance of Garvan and FRAX fracture risk tools in men.

The Osteoporotic Fractures in Men (MrOS) United States study was conducted among a group of men between 2000 and 2019. Researchers identified 5665 community-dwelling men aged 65 years and older from the MrOS US study, with available data on 5 Times Sit-to-Stand Test (5XSST), grip strength, and grip speed. Development of any fracture, major osteoporotic fracture (MOF), initial hip fracture, and any hip fracture were evaluated. Relative importance analysis and categorical net reclassification improvement (NRI) were used to assess the additional predictive value of physical performance and muscle strength measures.

A total of 1014 fractures, 536 MOFs, 215 initial hip fractures, and 274 any hip fractures were included in the study. The mean study follow-up was 13 years (range, 7-17 years).

Regardless of the model used, weaker strength and physical performance were independently associated with an increased risk for fracture, with hazard ratios ranging from 1.11 to 1.37.

Grip strength and 5XSST improved the prediction of any fracture (NRI, 3.9% and 3.2%, respectively) and MOF (NRI, 5.2% and 6.1%, respectively). However, gait speed improved the prediction of initial hip fractures and any hip fractures (NRI, 5.7% and 7.0%, respectively). Further, the addition of both grip strength and 5XSST improved the prediction of any fracture and MOF (NRI, 5.7% and 8.9%, respectively); the addition of grip strength and gait speed improved the prediction of initial hip and any hip fracture (NRI, 9.4% and 7.0%, respectively).

The researchers concluded that apart from age and femoral neck bone mineral density — the 2 most important risk factors — measures of muscle strength and physical performance were equal to or better than the other established risk factors included in all risk fracture models.

They noted, “[Physical performance and muscle strength measures] should be considered for inclusion in fracture risk assessment tools.”


Alajlouni D, Tran T, Bliuc D, Blank R, Cawthon P, Center J. Muscle strength and physical performance improve fracture risk prediction in men beyond Garvan and FRAX: the Osteoporotic Fractures in Men (MrOS) study. Presented at: ASBMR 2021; October 1-4, 2021. San Diego, CA. Abstract VPL-346.

This article originally appeared on Rheumatology Advisor