{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T05:17:56Z","timestamp":1783228676089,"version":"3.54.6"},"reference-count":74,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,8,19]],"date-time":"2020-08-19T00:00:00Z","timestamp":1597795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,19]],"date-time":"2020-08-19T00:00:00Z","timestamp":1597795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005633","name":"Finnish Foundation for Cardiovascular Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005633","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["BRC-1215-20011"],"award-info":[{"award-number":["BRC-1215-20011"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["GeroScience"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Evolving debate suggests that handgrip strength, a measure of muscular strength, might be associated with the risk of fractures; however, the evidence is conflicting. We aimed to assess the association of handgrip strength with the risk of fracture in the general population. Handgrip strength, measured using a dynamometer, was assessed at baseline in a population-based sample of 853 men and women aged 61\u201373 years in the Kuopio Ischemic Heart Disease prospective cohort. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for incident fractures. Incident fractures (hip, humeral, or wrist) (<jats:italic>n<\/jats:italic> = 159) occurred during a median follow-up of 16.7 years. Comparing extreme tertiles of handgrip strength, the age- and sex-adjusted hazard ratio (95% CI) for fractures was 0.80 (0.55\u20131.18). The association remained similar on further adjustment for other potential confounders: HR (95% CI) of 0.82 (0.55\u20131.21). In a meta-analysis of 19 population-based prospective cohort studies (including the current study) comprising 220,757 participants and 9199 fractures (including 1302 hip fractures), the fully adjusted relative risk (RR) (95% confidence interval, CI) for incident fractures was 0.70 (0.61\u20130.80) comparing the top versus bottom thirds of handgrip strength. The association remained significant after trim-and-fill correction for publication bias. The corresponding RR (95% CI) for hip fractures (9 studies) was 0.61 (0.54\u20130.70). Handgrip was only modestly associated with fracture risk in the primary analysis, which may be driven by the low event rate. Pooled prospective cohort evidence suggests that elevated handgrip strength is associated with reduced future fracture risk.<\/jats:p>","DOI":"10.1007\/s11357-020-00251-8","type":"journal-article","created":{"date-parts":[[2020,8,19]],"date-time":"2020-08-19T01:02:35Z","timestamp":1597798955000},"page":"869-880","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Handgrip strength\u2014a risk indicator for future fractures in the general population: findings from a prospective study and meta-analysis of 19 prospective cohort studies"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2625-0273","authenticated-orcid":false,"given":"Setor K.","family":"Kunutsor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Seidu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Voutilainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley W.","family":"Blom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari A.","family":"Laukkanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,8,19]]},"reference":[{"key":"251_CR1","volume-title":"Bone health and osteoporosis: a report of the surgeon general. Reports of the Surgeon General","author":"(US) OotSG","year":"2004","unstructured":"(US) OotSG. Bone health and osteoporosis: a report of the surgeon general. Reports of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004."},{"key":"251_CR2","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/s8756-3282(02)00919-5","volume":"32","author":"G Albrand","year":"2003","unstructured":"Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD. Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone. 2003;32:78\u201385. https:\/\/doi.org\/10.1016\/s8756-3282(02)00919-5.","journal-title":"Bone"},{"key":"251_CR3","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.archger.2019.01.015","volume":"82","author":"S Balogun","year":"2019","unstructured":"Balogun S, et al. Prospective associations of osteosarcopenia and osteodynapenia with incident fracture and mortality over 10 years in community-dwelling older adults. Arch Gerontol Geriatr. 2019;82:67\u201373. https:\/\/doi.org\/10.1016\/j.archger.2019.01.015.","journal-title":"Arch Gerontol Geriatr"},{"key":"251_CR4","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.2307\/2533446","volume":"50","author":"CB Begg","year":"1994","unstructured":"Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088\u2013101.","journal-title":"Biometrics"},{"key":"251_CR5","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1056\/NEJMoa1109617","volume":"367","author":"HA Bischoff-Ferrari","year":"2012","unstructured":"Bischoff-Ferrari HA, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367:40\u20139. https:\/\/doi.org\/10.1056\/NEJMoa1109617.","journal-title":"N Engl J Med"},{"key":"251_CR6","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.2147\/CIA.S194543","volume":"14","author":"RW Bohannon","year":"2019","unstructured":"Bohannon RW. Grip strength: an indispensable biomarker for older. Adults Clin Interv Aging. 2019;14:1681\u201391. https:\/\/doi.org\/10.2147\/CIA.S194543.","journal-title":"Adults Clin Interv Aging"},{"key":"251_CR7","doi-asserted-by":"publisher","unstructured":"Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22:465\u201375. https:\/\/doi.org\/10.1359\/jbmr.061113.","DOI":"10.1359\/jbmr.061113"},{"key":"251_CR8","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1359\/jbmr.080227","volume":"23","author":"PM Cawthon","year":"2008","unstructured":"Cawthon PM, Fullman RL, Marshall L, Mackey DC, Fink HA, Cauley JA, et al. Physical performance and risk of hip fractures in older men. J Bone Miner Res. 2008;23:1037\u201344. https:\/\/doi.org\/10.1359\/jbmr.080227.","journal-title":"J Bone Miner Res"},{"key":"251_CR9","first-page":"111","volume":"49","author":"T Cederholm","year":"2013","unstructured":"Cederholm T, Cruz-Jentoft AJ, Maggi S. Sarcopenia and fragility fractures. Eur J Phys Rehabil Med. 2013;49:111\u20137.","journal-title":"Eur J Phys Rehabil Med"},{"key":"251_CR10","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1093\/eurheartj\/ehw249","volume":"38","author":"CA Celis-Morales","year":"2017","unstructured":"Celis-Morales CA, et al. The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: evidence from 498 135 UK-Biobank participants. Eur Heart J. 2017;38:116\u201322. https:\/\/doi.org\/10.1093\/eurheartj\/ehw249.","journal-title":"Eur Heart J"},{"key":"251_CR11","doi-asserted-by":"publisher","first-page":"k1651","DOI":"10.1136\/bmj.k1651","volume":"361","author":"CA Celis-Morales","year":"2018","unstructured":"Celis-Morales CA, et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ. 2018;361:k1651. https:\/\/doi.org\/10.1136\/bmj.k1651.","journal-title":"BMJ"},{"key":"251_CR12","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1007\/s00394-019-01998-3","volume":"58","author":"HG Chen","year":"2019","unstructured":"Chen HG, et al. Association of vitamin K with cardiovascular events and all-cause mortality: a systematic review and meta-analysis. Eur J Nutr. 2019;58:2191\u2013205. https:\/\/doi.org\/10.1007\/s00394-019-01998-3.","journal-title":"Eur J Nutr"},{"key":"251_CR13","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jamda.2013.11.025","volume":"15","author":"LK Chen","year":"2014","unstructured":"Chen LK, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95\u2013101. https:\/\/doi.org\/10.1016\/j.jamda.2013.11.025.","journal-title":"J Am Med Dir Assoc"},{"key":"251_CR14","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1093\/oxfordjournals.aje.a008971","volume":"144","author":"G Ch\u00eane","year":"1996","unstructured":"Ch\u00eane G, Thompson SG. Methods for summarizing the risk associations of quantitative variables in epidemiologic studies in a consistent form. Am J Epidemiol. 1996;144:610\u201321.","journal-title":"Am J Epidemiol"},{"key":"251_CR15","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1007\/s11357-011-9297-2","volume":"34","author":"CL Cheung","year":"2012","unstructured":"Cheung CL, Tan KC, Bow CH, Soong CS, Loong CH, Kung AW. Low handgrip strength is a predictor of osteoporotic fractures: cross-sectional and prospective evidence from the Hong Kong Osteoporosis Study. Age (Dordr). 2012;34:1239\u201348. https:\/\/doi.org\/10.1007\/s11357-011-9297-2.","journal-title":"Age (Dordr)"},{"key":"251_CR16","doi-asserted-by":"publisher","first-page":"827","DOI":"10.7326\/0003-4819-155-12-201112200-00005","volume":"155","author":"M Chung","year":"2011","unstructured":"Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:827\u201338. https:\/\/doi.org\/10.7326\/0003-4819-155-12-201112200-00005.","journal-title":"Ann Intern Med"},{"key":"251_CR17","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1007\/s10654-018-0374-z","volume":"33","author":"V Colpani","year":"2018","unstructured":"Colpani V, et al. Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis. Eur J Epidemiol. 2018;33:831\u201345. https:\/\/doi.org\/10.1007\/s10654-018-0374-z.","journal-title":"Eur J Epidemiol"},{"key":"251_CR18","doi-asserted-by":"publisher","first-page":"c4467","DOI":"10.1136\/bmj.c4467","volume":"341","author":"R Cooper","year":"2010","unstructured":"Cooper R, Kuh D, Hardy R, Mortality Review G, Falcon, Teams HAS. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341:c4467. https:\/\/doi.org\/10.1136\/bmj.c4467.","journal-title":"BMJ"},{"key":"251_CR19","first-page":"1269","volume":"11","author":"J Cornfield","year":"1951","unstructured":"Cornfield J. A method of estimating comparative rates from clinical data; applications to cancer of the lung, breast, and cervix. J Natl Cancer Inst. 1951;11:1269\u201375.","journal-title":"J Natl Cancer Inst"},{"key":"251_CR20","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12877-019-1106-2","volume":"19","author":"F Cronholm","year":"2019","unstructured":"Cronholm F, Rosengren BE, Nilsson JA, Ohlsson C, Mellstrom D, Ribom E, et al. The fracture predictive ability of a musculoskeletal composite score in old men - data from the MrOs Sweden study. BMC Geriatr. 2019;19:90. https:\/\/doi.org\/10.1186\/s12877-019-1106-2.","journal-title":"BMC Geriatr"},{"key":"251_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.exger.2018.06.022","volume":"111","author":"K Denk","year":"2018","unstructured":"Denk K, Lennon S, Gordon S, Jaarsma RL. The association between decreased hand grip strength and hip fracture in older people: a systematic review. Exp Gerontol. 2018;111:1\u20139. https:\/\/doi.org\/10.1016\/j.exger.2018.06.022.","journal-title":"Exp Gerontol"},{"key":"251_CR22","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","volume":"7","author":"R DerSimonian","year":"1986","unstructured":"DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177\u201388 doi:0197-2456(86)90046-2 [pii].","journal-title":"Control Clin Trials"},{"key":"251_CR23","doi-asserted-by":"publisher","first-page":"e542","DOI":"10.1097\/MD.0000000000000542","volume":"94","author":"M Di Monaco","year":"2015","unstructured":"Di Monaco M, Castiglioni C, De Toma E, Gardin L, Giordano S, Tappero R. Handgrip strength is an independent predictor of functional outcome in hip-fracture women: a prospective study with 6-month follow-up. Medicine (Baltimore). 2015;94:e542. https:\/\/doi.org\/10.1097\/MD.0000000000000542.","journal-title":"Medicine (Baltimore)"},{"key":"251_CR24","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1093\/rheumatology\/keh569","volume":"44","author":"WG Dixon","year":"2005","unstructured":"Dixon WG, et al. Low grip strength is associated with bone mineral density and vertebral fracture in women. Rheumatology (Oxford). 2005;44:642\u20136. https:\/\/doi.org\/10.1093\/rheumatology\/keh569.","journal-title":"Rheumatology (Oxford)"},{"key":"251_CR25","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","volume":"56","author":"S Duval","year":"2000","unstructured":"Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455\u201363.","journal-title":"Biometrics"},{"key":"251_CR26","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","volume":"315","author":"M Egger","year":"1997","unstructured":"Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629\u201334.","journal-title":"BMJ"},{"key":"251_CR27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1359\/jbmr.070814","volume":"23","author":"J Finigan","year":"2008","unstructured":"Finigan J, Greenfield DM, Blumsohn A, Hannon RA, Peel NF, Jiang G, et al. Risk factors for vertebral and nonvertebral fracture over 10 years: a population-based study in women. J Bone Miner Res. 2008;23:75\u201385. https:\/\/doi.org\/10.1359\/jbmr.070814.","journal-title":"J Bone Miner Res"},{"key":"251_CR28","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1007\/s00223-013-9836-1","volume":"94","author":"R Furrer","year":"2014","unstructured":"Furrer R, van Schoor NM, de Haan A, Lips P, de Jongh RT. Gender-specific associations between physical functioning, bone quality, and fracture risk in older people. Calcif Tissue Int. 2014;94:522\u201330. https:\/\/doi.org\/10.1007\/s00223-013-9836-1.","journal-title":"Calcif Tissue Int"},{"key":"251_CR29","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1093\/oxfordjournals.aje.a116237","volume":"135","author":"S Greenland","year":"1992","unstructured":"Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301\u20139.","journal-title":"Am J Epidemiol"},{"key":"251_CR30","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1302\/0301-620X.97B3.35738","volume":"97-B","author":"XL Griffin","year":"2015","unstructured":"Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML. Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation--a prospective cohort study. Bone Joint J. 2015;97-B:372\u201382. https:\/\/doi.org\/10.1302\/0301-620X.97B3.35738.","journal-title":"Bone Joint J"},{"key":"251_CR31","doi-asserted-by":"publisher","first-page":"2150","DOI":"10.1002\/jbmr.3556","volume":"33","author":"NC Harvey","year":"2018","unstructured":"Harvey NC, et al. Measures of physical performance and muscle strength as predictors of fracture risk independent of FRAX, falls, and aBMD: a meta-analysis of the osteoporotic fractures in men (MrOS) Study. J Bone Miner Res. 2018;33:2150\u20137. https:\/\/doi.org\/10.1002\/jbmr.3556.","journal-title":"J Bone Miner Res"},{"key":"251_CR32","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","volume":"327","author":"JP Higgins","year":"2003","unstructured":"Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557\u201360. https:\/\/doi.org\/10.1136\/bmj.327.7414.557.","journal-title":"BMJ"},{"key":"251_CR33","doi-asserted-by":"publisher","first-page":"h2088","DOI":"10.1136\/bmj.h2088","volume":"350","author":"TL Jarvinen","year":"2015","unstructured":"Jarvinen TL, Michaelsson K, Jokihaara J, Collins GS, Perry TL, Mintzes B, et al. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ. 2015;350:h2088. https:\/\/doi.org\/10.1136\/bmj.h2088.","journal-title":"BMJ"},{"key":"251_CR34","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1136\/gutjnl-2020-320926","volume":"69","author":"X Jin","year":"2020","unstructured":"Jin X, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69:1002\u20139. https:\/\/doi.org\/10.1136\/gutjnl-2020-320926.","journal-title":"Gut"},{"key":"251_CR35","doi-asserted-by":"publisher","first-page":"1726","DOI":"10.1007\/s00198-006-0172-4","volume":"17","author":"O Johnell","year":"2006","unstructured":"Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726\u201333. https:\/\/doi.org\/10.1007\/s00198-006-0172-4.","journal-title":"Osteoporos Int"},{"key":"251_CR36","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.maturitas.2019.09.008","volume":"130","author":"K Kamiya","year":"2019","unstructured":"Kamiya K, et al. Association between hand-grip strength and site-specific risks of major osteoporotic fracture: results from the Japanese Population-based Osteoporosis Cohort Study. Maturitas. 2019;130:13\u201320. https:\/\/doi.org\/10.1016\/j.maturitas.2019.09.008.","journal-title":"Maturitas"},{"key":"251_CR37","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1007\/s00198-008-0561-y","volume":"19","author":"M Karkkainen","year":"2008","unstructured":"Karkkainen M, et al. Association between functional capacity tests and fractures: an eight-year prospective population-based cohort study. Osteoporos Int. 2008;19:1203\u201310. https:\/\/doi.org\/10.1007\/s00198-008-0561-y.","journal-title":"Osteoporos Int"},{"key":"251_CR38","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1007\/s00198-014-2674-9","volume":"25","author":"M Kauppi","year":"2014","unstructured":"Kauppi M, Stenholm S, Impivaara O, Maki J, Heliovaara M, Jula A. Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample. Osteoporos Int. 2014;25:1685\u201395. https:\/\/doi.org\/10.1007\/s00198-014-2674-9.","journal-title":"Osteoporos Int"},{"key":"251_CR39","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.1097\/HJH.0000000000000763","volume":"33","author":"SK Kunutsor","year":"2015","unstructured":"Kunutsor SK, Apekey TA, Cheung BM. Gamma-glutamyltransferase and risk of hypertension: a systematic review and dose-response meta-analysis of prospective evidence. J Hypertens. 2015;33:2373\u201381. https:\/\/doi.org\/10.1097\/HJH.0000000000000763.","journal-title":"J Hypertens"},{"key":"251_CR40","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.atherosclerosis.2014.06.006","volume":"236","author":"SK Kunutsor","year":"2014","unstructured":"Kunutsor SK, Apekey TA, Khan H. Liver enzymes and risk of cardiovascular disease in the general population: a meta-analysis of prospective cohort studies. Atherosclerosis. 2014;236:7\u201317. https:\/\/doi.org\/10.1016\/j.atherosclerosis.2014.06.006.","journal-title":"Atherosclerosis"},{"key":"251_CR41","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/s10654-017-0285-4","volume":"32","author":"SK Kunutsor","year":"2017","unstructured":"Kunutsor SK, Blom AW, Whitehouse MR, Kehoe PG, Laukkanen JA. Renin-angiotensin system inhibitors and risk of fractures: a prospective cohort study and meta-analysis of published observational cohort studies. Eur J Epidemiol. 2017a;32:947\u201359. https:\/\/doi.org\/10.1007\/s10654-017-0285-4.","journal-title":"Eur J Epidemiol"},{"key":"251_CR42","doi-asserted-by":"publisher","unstructured":"Kunutsor SK, Isiozor NM, Khan H, Laukkanen JA. Handgrip strength - a risk indicator for type 2 diabetes: systematic review and meta-analysis of observational cohort studies. Diabetes Metab Res Rev. 2020a:e3365. https:\/\/doi.org\/10.1002\/dmrr.3365.","DOI":"10.1002\/dmrr.3365"},{"key":"251_CR43","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1016\/j.ijcard.2016.06.069","volume":"220","author":"SK Kunutsor","year":"2016","unstructured":"Kunutsor SK, Khan H, Nyyssonen K, Laukkanen JA. Lipoprotein(a) and risk of sudden cardiac death in middle-aged Finnish men: a new prospective cohort study. Int J Cardiol. 2016;220:718\u201325. https:\/\/doi.org\/10.1016\/j.ijcard.2016.06.069.","journal-title":"Int J Cardiol"},{"key":"251_CR44","doi-asserted-by":"publisher","first-page":"e1937","DOI":"10.1212\/WNL.0000000000005606","volume":"90","author":"SK Kunutsor","year":"2018","unstructured":"Kunutsor SK, Khan H, Zaccardi F, Laukkanen T, Willeit P, Laukkanen JA. Sauna bathing reduces the risk of stroke in Finnish men and women: a prospective cohort study. Neurology. 2018;90:e1937\u201344. https:\/\/doi.org\/10.1212\/WNL.0000000000005606.","journal-title":"Neurology"},{"key":"251_CR45","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1097\/HJH.0000000000000923","volume":"34","author":"SK Kunutsor","year":"2016","unstructured":"Kunutsor SK, Laukkanen JA. Serum zinc concentrations and incident hypertension: new findings from a population-based cohort study. J Hypertens. 2016;34:1055\u201361. https:\/\/doi.org\/10.1097\/HJH.0000000000000923.","journal-title":"J Hypertens"},{"key":"251_CR46","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1007\/s10654-019-00579-2","volume":"35","author":"SK Kunutsor","year":"2020","unstructured":"Kunutsor SK, Makikallio TH, Seidu S, de Araujo CGS, Dey RS, Blom AW, et al. Physical activity and risk of venous thromboembolism: systematic review and meta-analysis of prospective cohort studies. Eur J Epidemiol. 2020b;35:431\u201342. https:\/\/doi.org\/10.1007\/s10654-019-00579-2.","journal-title":"Eur J Epidemiol"},{"key":"251_CR47","doi-asserted-by":"publisher","unstructured":"Kunutsor SK, Makikallio TH, Voutilainen A, Laukkanen JA. Handgrip strength is not associated with risk of venous thromboembolism: a prospective cohort study. Scand Cardiovasc J. 2020c:1\u20135. https:\/\/doi.org\/10.1080\/14017431.2020.1751267.","DOI":"10.1080\/14017431.2020.1751267"},{"key":"251_CR48","doi-asserted-by":"crossref","unstructured":"Kunutsor SK, Voutilainen A, Laukkanen JA. Handgrip strength improves prediction of type 2 diabetes: a prospective cohort study. Ann Med. 2020 (In Press).","DOI":"10.1080\/07853890.2020.1815078"},{"key":"251_CR49","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1007\/s10654-017-0242-2","volume":"32","author":"SK Kunutsor","year":"2017","unstructured":"Kunutsor SK, Whitehouse MR, Blom AW, Laukkanen JA. Low serum magnesium levels are associated with increased risk of fractures: a long-term prospective cohort study. Eur J Epidemiol. 2017b;32:593\u2013603. https:\/\/doi.org\/10.1007\/s10654-017-0242-2.","journal-title":"Eur J Epidemiol"},{"key":"251_CR50","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1038\/sj.ejcn.1602414","volume":"60","author":"IT Laaksi","year":"2006","unstructured":"Laaksi IT, Ruohola JP, Ylikomi TJ, Auvinen A, Haataja RI, Pihlajamaki HK, et al. Vitamin D fortification as public health policy: significant improvement in vitamin D status in young Finnish men. Eur J Clin Nutr. 2006;60:1035\u20138. https:\/\/doi.org\/10.1038\/sj.ejcn.1602414.","journal-title":"Eur J Clin Nutr"},{"key":"251_CR51","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1016\/j.amjcard.2009.01.371","volume":"103","author":"JA Laukkanen","year":"2009","unstructured":"Laukkanen JA, Laaksonen D, Lakka TA, Savonen K, Rauramaa R, Makikallio T, et al. Determinants of cardiorespiratory fitness in men aged 42 to 60 years with and without cardiovascular disease. Am J Cardiol. 2009;103:1598\u2013604. https:\/\/doi.org\/10.1016\/j.amjcard.2009.01.371.","journal-title":"Am J Cardiol"},{"key":"251_CR52","doi-asserted-by":"publisher","unstructured":"Laukkanen JA, Voutilainen A, Kurl S, Araujo CGS, Jae SY, Kunutsor SK. Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events. Ann Med. 2020a:1\u201311. https:\/\/doi.org\/10.1080\/07853890.2020.1748220.","DOI":"10.1080\/07853890.2020.1748220"},{"key":"251_CR53","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1016\/j.mayocp.2020.02.029","volume":"95","author":"JA Laukkanen","year":"2020","unstructured":"Laukkanen JA, Voutilainen A, Kurl S, Isiozor NM, Jae SY, Kunutsor SK. Handgrip strength is inversely associated with sudden cardiac death. Mayo Clin Proc. 2020b;95:825\u20138. https:\/\/doi.org\/10.1016\/j.mayocp.2020.02.029.","journal-title":"Mayo Clin Proc"},{"key":"251_CR54","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","volume":"386","author":"DP Leong","year":"2015","unstructured":"Leong DP, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386:266\u201373. https:\/\/doi.org\/10.1016\/S0140-6736(14)62000-6.","journal-title":"Lancet"},{"key":"251_CR55","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/S0140-6736(94)91468-0","volume":"343","author":"JW Lynch","year":"1994","unstructured":"Lynch JW, Kaplan GA, Cohen RD, Kauhanen J, Wilson TW, Smith NL, et al. Childhood and adult socioeconomic status as predictors of mortality in Finland. Lancet. 1994;343:524\u20137.","journal-title":"Lancet"},{"key":"251_CR56","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/0140-6736(90)90878-9","volume":"335","author":"S MacMahon","year":"1990","unstructured":"MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765\u201374.","journal-title":"Lancet"},{"key":"251_CR57","doi-asserted-by":"publisher","first-page":"e199","DOI":"10.1371\/journal.pmed.0040199","volume":"4","author":"K Michaelsson","year":"2007","unstructured":"Michaelsson K, et al. Leisure physical activity and the risk of fracture in men. PLoS Med. 2007;4:e199. https:\/\/doi.org\/10.1371\/journal.pmed.0040199.","journal-title":"PLoS Med"},{"key":"251_CR58","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","volume":"6","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. https:\/\/doi.org\/10.1371\/journal.pmed.1000097.","journal-title":"PLoS Med"},{"key":"251_CR59","doi-asserted-by":"publisher","unstructured":"Phipps MM, et al. Acute liver injury in COVID-19: prevalence and association with clinical outcomes in a large US cohort. Hepatology. 2020. https:\/\/doi.org\/10.1002\/hep.31404.","DOI":"10.1002\/hep.31404"},{"key":"251_CR60","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1007\/bf03324780","volume":"20","author":"M Piirtola","year":"2008","unstructured":"Piirtola M, Vahlberg T, Isoaho R, Aarnio P, Kivela SL. Predictors of fractures among the aged: a population-based study with 12-year follow-up in a Finnish municipality. Aging Clin Exp Res. 2008;20:242\u201352. https:\/\/doi.org\/10.1007\/bf03324780.","journal-title":"Aging Clin Exp Res"},{"key":"251_CR61","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.2147\/TCRM.S138000","volume":"14","author":"F Pouresmaeili","year":"2018","unstructured":"Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:2029\u201349. https:\/\/doi.org\/10.2147\/TCRM.S138000.","journal-title":"Ther Clin Risk Manag"},{"key":"251_CR62","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1002\/jbmr.3917","volume":"35","author":"D Prieto-Alhambra","year":"2020","unstructured":"Prieto-Alhambra D, Turkiewicz A, Reyes C, Timpka S, Rosengren B, Englund M. Smoking and alcohol intake but not muscle strength in young men increase fracture risk at middle age: a cohort study linked to the Swedish National Patient Registry. J Bone Miner Res. 2020;35:498\u2013504. https:\/\/doi.org\/10.1002\/jbmr.3917.","journal-title":"J Bone Miner Res"},{"key":"251_CR63","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1007\/s00198-018-4588-4","volume":"29","author":"T Rikkonen","year":"2018","unstructured":"Rikkonen T, Poole K, Sirola J, Sund R, Honkanen R, Kroger H. Long-term effects of functional impairment on fracture risk and mortality in postmenopausal women. Osteoporos Int. 2018;29:2111\u201320. https:\/\/doi.org\/10.1007\/s00198-018-4588-4.","journal-title":"Osteoporos Int"},{"key":"251_CR64","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s00198-004-1661-y","volume":"16","author":"JA Robbins","year":"2005","unstructured":"Robbins JA, Schott AM, Garnero P, Delmas PD, Hans D, Meunier PJ. Risk factors for hip fracture in women with high BMD: EPIDOS study. Osteoporos Int. 2005;16:149\u201354. https:\/\/doi.org\/10.1007\/s00198-004-1661-y.","journal-title":"Osteoporos Int"},{"key":"251_CR65","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1016\/j.bone.2011.11.024","volume":"50","author":"AA Rouzi","year":"2012","unstructured":"Rouzi AA, Al-Sibiani SA, Al-Senani NS, Radaddi RM, Ardawi MS. Independent predictors of all osteoporosis-related fractures among healthy Saudi postmenopausal women: the CEOR Study. Bone. 2012;50:713\u201322. https:\/\/doi.org\/10.1016\/j.bone.2011.11.024.","journal-title":"Bone"},{"key":"251_CR66","first-page":"46","volume":"20","author":"JT Salonen","year":"1988","unstructured":"Salonen JT. Is there a continuing need for longitudinal epidemiologic research? The Kuopio Ischaemic Heart Disease Risk Factor Study. Ann Clin Res. 1988;20:46\u201350.","journal-title":"Ann Clin Res"},{"key":"251_CR67","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1016\/j.amjmed.2013.04.017","volume":"126","author":"E Savino","year":"2013","unstructured":"Savino E, et al. Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med. 2013;126:1068\u20131075 e1061. https:\/\/doi.org\/10.1016\/j.amjmed.2013.04.017.","journal-title":"Am J Med"},{"key":"251_CR68","doi-asserted-by":"publisher","first-page":"e0213223","DOI":"10.1371\/journal.pone.0213223","volume":"14","author":"I Selakovic","year":"2019","unstructured":"Selakovic I, Dubljanin-Raspopovic E, Markovic-Denic L, Marusic V, Cirkovic A, Kadija M, et al. Can early assessment of hand grip strength in older hip fracture patients predict functional outcome? PLoS One. 2019;14:e0213223. https:\/\/doi.org\/10.1371\/journal.pone.0213223.","journal-title":"PLoS One"},{"issue":"466","key":"251_CR69","doi-asserted-by":"publisher","first-page":"e461","DOI":"10.1016\/j.jamda.2016.02.026","volume":"17","author":"WM Sipers","year":"2016","unstructured":"Sipers WM, Verdijk LB, Sipers SJ, Schols JM, van Loon LJ. The Martin vigorimeter represents a reliable and more practical tool than the Jamar dynamometer to assess handgrip strength in the geriatric patient. J Am Med Dir Assoc. 2016;17(466):e461\u20137. https:\/\/doi.org\/10.1016\/j.jamda.2016.02.026.","journal-title":"J Am Med Dir Assoc"},{"key":"251_CR70","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s00198-019-05191-4","volume":"31","author":"AJ Sogaard","year":"2020","unstructured":"Sogaard AJ, et al. Grip strength in men and women aged 50-79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: the Tromso Study 1994-1995. Osteoporos Int. 2020;31:131\u201340. https:\/\/doi.org\/10.1007\/s00198-019-05191-4.","journal-title":"Osteoporos Int"},{"key":"251_CR71","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1002\/jbmr.3161","volume":"32","author":"K Stattin","year":"2017","unstructured":"Stattin K, Michaelsson K, Larsson SC, Wolk A, Byberg L. Leisure-time physical activity and risk of fracture: a cohort study of 66,940 men and women. J Bone Miner Res. 2017;32:1599\u2013606. https:\/\/doi.org\/10.1002\/jbmr.3161.","journal-title":"J Bone Miner Res"},{"key":"251_CR72","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","volume":"283","author":"DF Stroup","year":"2000","unstructured":"Stroup DF, et al. Meta-analysis of observational studies in epidemiology. JAMA. 2000;283:2008\u201312. https:\/\/doi.org\/10.1001\/jama.283.15.2008.","journal-title":"JAMA"},{"key":"251_CR73","doi-asserted-by":"publisher","first-page":"429","DOI":"10.2106\/JBJS.N.00648","volume":"97","author":"U Tarantino","year":"2015","unstructured":"Tarantino U, Piccirilli E, Fantini M, Baldi J, Gasbarra E, Bei R. Sarcopenia and fragility fractures: molecular and clinical evidence of the bone-muscle interaction. J Bone Joint Surg Am. 2015;97:429\u201337. https:\/\/doi.org\/10.2106\/JBJS.N.00648.","journal-title":"J Bone Joint Surg Am"},{"key":"251_CR74","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1136\/bmj.299.6704.889","volume":"299","author":"CA Wickham","year":"1989","unstructured":"Wickham CA, Walsh K, Cooper C, Barker DJ, Margetts BM, Morris J, et al. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. BMJ. 1989;299:889\u201392. https:\/\/doi.org\/10.1136\/bmj.299.6704.889.","journal-title":"BMJ"}],"container-title":["GeroScience"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11357-020-00251-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11357-020-00251-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11357-020-00251-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T23:51:35Z","timestamp":1629330695000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11357-020-00251-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,19]]},"references-count":74,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["251"],"URL":"https:\/\/doi.org\/10.1007\/s11357-020-00251-8","relation":{},"ISSN":["2509-2715","2509-2723"],"issn-type":[{"value":"2509-2715","type":"print"},{"value":"2509-2723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,19]]},"assertion":[{"value":"20 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was conducted in accordance with the ethical standards set forth in the Helsinki Declaration (1983). Participants in the study were included after obtaining their written and informed consent for the study. The institutional review board of the University of Kuopio and Kuopio University Hospital, Kuopio, Finland, (License number 143\/97) approved the study protocol.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}