Low handgrip strength prospectively predicts osteoporosis incidence in community-dwelling older adults: A population-based longitudinal analysis

BACKGROUND: Global population aging has made osteoporosis (OP) and its related fractures a major public health concern. Handgrip strength is an important indicator for assessing muscle function, and its cross-sectional association with OP has been reported. However, whether low handgrip strength (LHS) can prospectively predict OP incidence still requires validation in large cohorts. METHODS: This study utilized prospective data from the English Longitudinal Study of Ageing (ELSA). At baseline, 5921 participants aged 50 years and older without OP were included. LHS was defined according to the EWGSOP2 criteria. The primary outcome was self-reported incident physician-diagnosed OP during follow-up. Cox proportional hazards regression models were used to assess the relationship between baseline LHS and the risk of incident OP, adjusting for multiple confounders, including age, sex, body mass index, education, lifestyle, and comorbidities. RESULTS: During a median follow-up of 12.5 years, individuals with LHS at baseline had a significantly higher risk of incident OP compared to those with normal grip strength, with a multivariable-adjusted HR of 1.413 (P = 0.009). Subgroup analysis revealed that this association was particularly pronounced among women. Furthermore, sensitivity analyses confirmed a significant dose-response relationship between continuous grip strength decline and increased OP risk. Cross-sectional analysis also confirmed that LHS was independently associated with the prevalence of OP. CONCLUSION: This study provides longitudinal evidence from a large prospective cohort indicating that LHS is an independent predictor of self-reported incident OP in the older population. As a simple and practical tool, handgrip strength testing can aid in the early identification of individuals at high risk for OP in community and clinical settings, providing a basis for implementing targeted preventive strategies, while highlighting the need for future research to confirm the observed sex-specific associations.