Evaluation of using grip strength and hand muscle cross-sectional area to predict secondary fractures post distal radius fracture

Abstract

Grip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in distal radius fracture patients. This simple tool enhances clinical practice by identifying high-risk patients for targeted interventions, potentially preventing or reversing functional decline and recurrent fractures.

Purpose: To evaluate grip strength and hand muscle cross-sectional area as predictors of secondary fracture risk in patients with a history of distal radius fracture (DRF), serving as surrogates of the diagnosis of sarcopenia.

Methods: A retrospective cohort study of 745 DRF patients was analyzed with their grip strength data using Cox proportional hazards regression, receiver operating characteristic analysis, and Kaplan-Meier analysis to predict secondary fracture risk over an average of 12 years. Hand muscle cross-sectional area was similarly analyzed.

Results: Patients with a history of DRF were predicted to have a 4.1% higher likelihood of experiencing a secondary fracture per kilogram reduction in their grip strength (p < 0.008), independent of age and sex. Patients were categorized as high-risk (≤ 16 kg), moderate-risk (17-24 kg), or low-risk (≥ 25 kg) (p < 0.001). High-risk patients showed a 2.2-fold (95% CI = 1.55-3.17) higher recurrent fracture risk compared to low-risk patients. Cumulative secondary fracture probabilities of the high-risk group patients at 5, 10, and 15 years were estimated to be 16%, 30%, and 54%, respectively.

Conclusions: Grip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in patients with DRF. This simple tool could improve clinical practice by identifying high-risk patients for targeted interventions to prevent recurrent fractures or even reverse functional decline.

Keywords: Colles fracture; Distal radius fracture; Grip strength; Osteoporosis; Osteosarcopenia; Recurrent fracture; Sarcopenia; Secondary fracture; Wrist fracture.

Fig. 1

Design of the research study

Fig. 2

Demographic representation of all patients with and without re-fractures

Fig. 3

Receiver operating characteristic (ROC) analysis on grip strength data

Fig. 4

Survival/ time-to-event curves of grip strength strata

Fig. 5

Scatterplot of grip strength and thenar/ hypothenar muscle cross-sectional area

Fig. 6

Receiver operating characteristic (ROC) analysis on the age data and corresponding survival / time-to-event curves

Fig. 7

Survival / time-to-event curves of the sex strata female vs male

Fig. 8

Receiver operating characteristic (ROC) analysis on thenar and hypothenar muscles