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Diagnostic power of relative sit-to-stand muscle power, grip strength, and gait speed for identifying a history of recurrent falls and fractures in older adults

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Key summary points

AbstractSection Aim

To compare the diagnostic value of relative sit-to-stand muscle power with grip strength or gait speed for identifying a history of adverse outcomes in older adults.

AbstractSection Findings

When compared to grip strength or gait speed, relative sit-to-stand muscle power offered slightly (but not statistically) higher diagnostic power for identifying a history of recurrent falls and fractures in older adults. However, all tests showed low diagnostic power (AUC < 0.7).

AbstractSection Message

Further prospective cohort studies should examine the diagnostic power of relative sit-to-stand muscle power for incident falls and fractures. This information is important to evaluate if this test offers true clinical value (and benefit over grip strength or gait speed) for identifying these adverse outcomes.

Abstract

Purpose

To compare the diagnostic value of relative sit-to-stand muscle power with grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults.

Methods

Data from an outpatient clinic included anthropometry (height/weight), bone density, 5 times sit-to-stand time (stopwatch and standardized chair), grip strength (hydraulic dynamometer), and gait speed (4 m). Relative sit-to-stand muscle power (W.kg−1, normalised to body mass) was calculated using a validated equation. Outcomes of falls (past 1 year) and fractures (past 5 years) were self-reported and verified by medical records wherever possible. Binary logistic regression considering for potential confounders (age, sex, BMI, Charlson comorbidity index, femoral neck bone density) and receiver operating characteristics (ROC) curves were used in statistical analysis.

Results

508 community-dwelling older adults (median age: 78 years, interquartile range: 72, 83, 75.2% women) were included. Compared to greater relative sit-to-stand muscle power (1.62–3.78W.kg−1 for women; 2.03–3.90W.kg−1 for men), those with extremely low relative sit-to-stand muscle power were 2.35 (95% CI 1.54, 3.60, p < 0.001) and 2.41 (95% CI 1.25, 4.65, p = 0.009) times more likely to experience recurrent falls and fractures, respectively, in fully adjusted model. Compared to grip strength or gait speed, relative sit-to-stand muscle power showed the highest area under the ROC curve for identifying recurrent falls (AUC: 0.64) and fractures (AUC: 0.62). All tests showed low diagnostic power (AUC: < 0.7).

Conclusion

Relative sit-to-stand muscle power performed slightly (but not statistically) better than grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. However, all tests showed low diagnostic power.

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Acknowledgements

The authors would like to thank the participants and the Australian Institute for Musculoskeletal Science (AIMSS) for their support throughout the study and our Fracture Liaison Nurse Mrs. Solange Bernardo for her assistance at the Falls and Fractures Clinic.

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Author notes

  1. Ben Kirk and Chloe French are contributed equally to this work.

Authors and Affiliations

  1. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia

    Ben Kirk, Chloe French, Maria Gebauer, Sara Vogrin, Jesse Zanker, Myrla Sales & Gustavo Duque

  2. Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia

    Ben Kirk, Chloe French, Maria Gebauer, Sara Vogrin, Jesse Zanker, Myrla Sales & Gustavo Duque

  3. School of Health Sciences, University of Manchester, Manchester, UK

    Chloe French

  4. University Hospital of Guadalajara, Guadalajara, Spain

    Maria Gebauer

  5. Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada

    Gustavo Duque

  6. Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada

    Gustavo Duque

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  1. Ben Kirk
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Contributions

BK, CF, JZ, and GD designed the study; BK, MS, CF, MG, and GD were involved in data collection; CF and BK analysed the data, which was overseen by SV (Biostatistician); BK and CF primarily wrote the paper; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Gustavo Duque.

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Conflicts of interest

The authors have no direct conflicts of interest regarding the content of this manuscript.

Ethical approval

Ethical approval was provided by the Western Health Low Risk Ethics Panel at Sunshine Hospital (ID: QA2018.106_44499).

Informed consent

As data were collected as part of standard care, a waiver of informed consent was sought.

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Kirk, B., French, C., Gebauer, M. et al. Diagnostic power of relative sit-to-stand muscle power, grip strength, and gait speed for identifying a history of recurrent falls and fractures in older adults. Eur Geriatr Med 14, 421–428 (2023). https://doi.org/10.1007/s41999-023-00778-x

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  • DOI: https://doi.org/10.1007/s41999-023-00778-x

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