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. 2024 Dec 30;25(1):1095.
doi: 10.1186/s12891-024-08237-9.

Association of calf circumference with osteoporosis and hip fracture in middle-aged and older adults: a secondary analysis

Mumin Cao #  1   2   3   4 , Yuanwei Zhang #  5 , Mengze Tong #  2 , Xiangxu Chen  1   2   3   4 , Ziang Xu  6 , Renwang Sheng  1   2   3   4 , Liu Shi  1   2   3   4 , Cheng Zhang  1   2   3   4 , Wenbin Fan  1   2   3   4 , Tian Xie  1   2   3   4 , Yingjuan Li  4   7 , Jinyu Wang  4   8 , Wei Gao  9   10 , Yunfeng Rui  11   12   13   14
Affiliations

Association of calf circumference with osteoporosis and hip fracture in middle-aged and older adults: a secondary analysis

Mumin Cao et al. BMC Musculoskelet Disord. .

Abstract

Background: Osteosarcopenia is a geriatric syndrome associated with an increased risk of frailty, falls, fractures, disability, and death. Calf circumference (CC) has been used as a simple and practical skeletal muscle marker to diagnose sarcopenia. This study aimed to explore the relationship of calf circumference and osteoporosis (OP) and hip fractures (HF) in middle-aged and older adults. This is important for screening OP and HF in the community and improving the quality of life of older adults.

Methods: This study was based on the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Logistic regression analysis and restricted cubic spline were used to investigate the correlation of CC with OP and HF. The receiver operating characteristic (ROC) curve was utilized to determine the optimal cut-off value for CC. Finally, logistic regression model analysis was applied to test the predictive efficacy of CC.

Results: Among 4575 individuals with a mean age of 63.0 ± 11.5 years, the OP group had higher proportions of females (P < 0.001) and non-Hispanic whites (P < 0.001). Logistic regression and RCS demonstrated that lower CC was associated with a greater risk of OP and HF in the female group (P < 0.001). ROC curves showed that CC of 33.65 cm and 33.85 cm were the best cut-off values for predicting OP and HF in middle-aged and older females. Logistic regression analyses found good predictive efficacy for cut-off values of CC in females.

Conclusion: In middle-aged and older women, low CC is associated with a higher risk of OP and HF. These findings have important implications for managing osteosarcopenia and associated fractures in older adults.

Clinical trial number: Not applicable.

Keywords: Calf circumference; Hip fracture; Older adults; Osteoporosis; Osteosarcopenia; Sarcopenia.

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Conflict of interest statement

Declarations. Ethics approval and consent of participate: Ethics approval and consent of participate All the participants from NHANES 1999–2006 gave documented signed consent. These studies were approved by the ethics reviews from the National Center for Health Statistics (NCHS) Ethics Review Board. The NCHS IRB/ERB protocol number for 1999–2004 was # 98 − 12, 2005–2006 was #2005-06. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Flow chart of the sample selection from NHANES (1999–2006)
Fig. 2
Fig. 2
The ROC curves showed AUCs for the CC-AIC models in predicting OP (A) and HF (B)
Fig. 3
Fig. 3
The RCS suggested that the risk of HF decreased with increasing CC (A), (OR = 0.92 (0.87–0.97), P = 0.001). This trend was more pronounced between CC and OP (B), (OR = 0.93 (0.90–0.96) P < 0.001)
Fig. 4
Fig. 4
(A) The optimal cut-off values of CC for OP obtained from ROC curves were 33.65 cm (female) and 38.15 cm (male). (B) The optimal cut-off values for OP and HF were 33.85 cm (female) and 35.05 cm (male)
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