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A New Threshold for Appendicular Lean Mass Discriminates Muscle Weakness in Women With Hip Fracture

A Cross-Sectional Study

Di Monaco, Marco MD; Castiglioni, Carlotta MD; Bardesono, Francesca MD; Milano, Edoardo MD; Massazza, Giuseppe MD

American Journal of Physical Medicine & Rehabilitation: November 2019 - Volume 98 - Issue 11 - p 1005–1009
doi: 10.1097/PHM.0000000000001234
Original Research Articles
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Objective The aim of the study was to investigate the relationship between measures of muscle mass and grip strength in women with subacute hip fracture. Firstly, we aimed to assess the capability of the current thresholds for appendicular lean mass, appendicular lean mass/body mass index ratio and appendicular lean mass/height2 to separate weak and nonweak women. Secondly, we aimed to explore alternative thresholds for the three measures of muscle mass to discriminate weakness.

Design This is cross-sectional study of 160 women with hip fracture admitted to a rehabilitation hospital. We assessed appendicular lean mass by dual-energy x-ray absorptiometry and grip strength by a Jamar hand dynamometer. Weakness was defined as grip strength of less than 16 kg.

Results Weakness was not significantly associated with appendicular lean mass of less than 15.02 kg, appendicular lean mass/body mass index ratio of less than 0.512 or appendicular lean mass/height2 of less than 5.67 kg/m2. For appendicular lean mass (but not for the other 2 measures of muscle mass), an alternative threshold (11.87 kg instead of 15.02 kg) significantly discriminated weakness: χ2 (1, n = 160) = 10.77 (P = 0.001). The association between appendicular lean mass of less than 11.87 kg and grip strength of less than 16 kg persisted after adjustment for age and body mass index (odds ratio = 2.50, 95% confidence interval = 1.17–5.34, P = 0.018).

Conclusions Data suggest that the current thresholds for measures of muscle mass do not discriminate weakness in women with subacute hip fracture. For appendicular lean mass, an alternative cutoff point actually separated weak and nonweak women.

From the Osteoporosis Research Center, Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy (MDM, CC, EM); and Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University, Torino, Italy (FB, GM).

All correspondence should be addressed to: Marco Di Monaco, MD, Osteoporosis Research Center, Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131, Torino, Italy.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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Online date: May 31, 2019

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