title: Physical tests for patient selection for bone mineral density measurements in postmenopausal women.
abstract: BACKGROUND
  There is a need for cost-effective clinical methods to select women for bone densitometry. The aim of the present study was to determine whether relatively simple and clinically applicable physical tests could be useful in prediction of bone density in postmenopausal women.
  
  
  METHODS
  A total of 606 women (age range 66-71 years) taking part in the population based OSTPRE Fracture Prevention Study were investigated. Spinal and femoral bone mineral density (BMD) was measured by Dual X-ray Absorptiometry (DXA). Physical tests included the standing-on-one-foot (SOOF), grip strength (GS), leg extension strength, ability to squat down, standing 10 s eyes closed, chair rising, regular walk for 10 m and tandem walk for 6 m. All linear regression models were adjusted for age, body mass index, years on hormone therapy, years since menopause, current smoking and use of oral glucocorticoids.
  
  
  RESULTS
  The SOOF was associated with lumbar spine BMD (r2=0.16, p=0.004) and the femoral regions (r2 values from 0.17 to 0.23 and p-values all<0.001). The GS was associated with lumbar spine BMD (r2=0.16, p=0.011) and the femoral regions (r2 values from 0.16 to 0.21 and p-values from <0.001 to 0.004). The ability to squat down on the floor was associated with the femoral regions (r2 values from 0.15 to 0.21 and p-values from 0.028 to 0.040). In addition, functional capacity was decreased in women with femoral neck osteoporosis (WHO classification) compared to women with normal or osteopenic BMD: SOOF -39% (p=0.001), GS -18% (p<0.001), leg extension strength -19% (p=0.007) and ability to squat down on the floor -40% (p=0.004). For osteoporosis prediction (ROC analysis) a threshold of a 22 kg in GS would yield a true-positive rate (sensitivity) of about 58% and a true-negative rate (specificity) of 86% (AUC 0.76).
  
  
  CONCLUSIONS
  We suggest that grip strength could be used in medical decision making to identify those women who would benefit from BMD measurements albeit alone it may not provide accurate enough tool for osteoporosis screening.
authors.affiliation: Bone and Cartilage Research Unit, Clinical Research Center, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland. Matti.Karkkainen@uku.fi
authors.forename: Matti
authors.initials: M
authors.lastname: Kärkkäinen
authors.forename: Toni
authors.initials: T
authors.lastname: Rikkonen
authors.forename: Heikki
authors.initials: H
authors.lastname: Kröger
authors.forename: Joonas
authors.initials: J
authors.lastname: Sirola
authors.forename: Marjo
authors.initials: M
authors.lastname: Tuppurainen
authors.forename: Kari
authors.initials: K
authors.lastname: Salovaara
authors.forename: Jari
authors.initials: J
authors.lastname: Arokoski
authors.forename: Jukka
authors.initials: J
authors.lastname: Jurvelin
authors.forename: Risto
authors.initials: R
authors.lastname: Honkanen
authors.forename: Esko
authors.initials: E
authors.lastname: Alhava
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D018737:Hand Strength; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods*; D017698:Postmenopause; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic