Handgrip strength is positively associated with bone mineral density in middle and aged adults: results from NHANES 2013–2014

Few studies have examined the association between handgrip strength and BMD in specific subgroups. Therefore, we examined the associations of handgrip strength with BMD aged ≥ 40 years and found that handgrip strength is associated with BMD which is independent of BMI, physical activity, and other potential confounders.

Previous studies have revealed that handgrip strength is a measure of muscular fitness and is associated with fracture and bone mineral density (BMD) in adolescents and adults, with conflicting results. In addition, few studies have examined the association between handgrip strength in predefined subgroups such as sex, age, and physical activity in a whole population.

We examined the associations of handgrip strength with BMD in 2720 adults (1359 men and 1361 women) aged ≥ 40 years (mean age, 58.6 ± 11.8 years) from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. NHANES collects data via household interviews and direct standardized physical examinations conducted in specially equipped mobile examination centers. The date of final data collection was 2014 and the present data analysis was conducted in January to February 2020.

Handgrip strength was significantly associated with total femur (r = 0.482, P < 0.001) and femoral neck BMD (r = 0.427, P < 0.001) among all participants, respectively. After adjustment for age, sex, race, body mass index (BMI), physical activity, smoking, history of diabetes, history of hypertension, and history of high cholesterol, each unit (1 SD) of BMI-adjusted handgrip strength was positively associated with 0.026 g/cm² increase in total femur BMD (P < 0.001) and 0.027 g/cm² increase in femoral neck BMD (P < 0.001). There was a significant increasing trend in total femur and femoral BMD as handgrip strength increased from the lowest quartile to the highest quartile (P for trend < 0.001). For subgroup analysis, there were no significant interaction effects of handgrip strength with BMD between predefined subgroups (all P > 0.05).

High level of handgrip strength is associated with increased BMD. The association is independent of BMI, physical activity, and other potential confounders.