title: Handgrip strength as a predictor of bone mineral density in outpatients with cirrhosis.
abstract: OBJECTIVE
  Osteoporosis is well recognized as a cirrhosis complication; however, most studies assessing this condition included only patients on liver transplantation lists with an elevated rate of bone diseases. While general population studies show that handgrip strength is clearly associated with bone mineral density, until now this tool has not been applied to patients with cirrhosis in relation to their bone condition. This study aimed to evaluate whether handgrip strength, bone, and liver tests may be useful as predictors of bone disease in outpatients with cirrhosis.
  
  
  METHODS
  One hundred twenty-nine subjects were included (77 men and 52 women). Dual-energy X-ray absorptiometry was applied to evaluate lumbar-spine and femoral-neck T scores. Osteoporosis/osteopenia rates were 26.3%/35.6% in the lumbar spine and 6.9%/41.8% in the femoral neck, respectively. Model selections were based on backward procedures to find the best predictors of low T scores.
  
  
  RESULTS
  For lumbar spine, only low handgrip strength and high parathyroid hormone levels were clearly related to low T scores. For femoral neck, only age was associated with low T scores.
  
  
  CONCLUSIONS
  Handgrip strength may serve as an effective predictor of low lumbar spine T score among outpatients with cirrhosis. As cirrhosis affects the lumbar spine more than the femoral neck, these results suggest that handgrip strength should be tested in all patients with cirrhosis as a first indicator of bone health.
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Lívia Alves Amaral
authors.initials: LA
authors.lastname: Santos
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Talles Bazeia
authors.initials: TB
authors.lastname: Lima
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Laís
authors.initials: L
authors.lastname: Augusti
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Letícia de Campos
authors.initials: Lde C
authors.lastname: Franzoni
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Fabio da Silva
authors.initials: Fda S
authors.lastname: Yamashiro
authors.affiliation: Endocrinology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Bolfi
authors.affiliation: Endocrinology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Vânia dos Santos
authors.initials: Vdos S
authors.lastname: Nunes
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Mariana de Souza
authors.initials: Mde S
authors.lastname: Dorna
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Cássio Vieira
authors.initials: CV
authors.lastname: de Oliveira
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Caramori
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Giovanni Faria
authors.initials: GF
authors.lastname: Silva
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Fernando Gomes
authors.initials: FG
authors.lastname: Romeiro
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density; D005260:Female; D005272:Femur Neck; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D010045:Outpatients; D011237:Predictive Value of Tests
keywords: handgrip strength; liver cirrhosis; osteopenia; osteoporosis