Original Full Length ArticleGreater association of peak neuromuscular performance with cortical bone geometry, bone mass and bone strength than bone density: A study in 417 older women
Introduction
It is well established that bone mineral density (BMD) is related to, or can be modulated by, physical activity [1], [2], local muscular force generation capacity [3], [4], local muscle size [5], [6], [7], [8] and peak explosive power [5]. This has been investigated in a number of populations such as children [5], [6], [8], adolescents [6], young adults [1], athletes [7] and individuals up into their 9th decade of life [2], [3], [4].
However, differences in bone properties are not adequately explained by bone mineral density alone as bone geometry plays an important role [6]. This dependency has been investigated in some cross-sectional studies. For example in pre-pubertal children [5], measures of muscle size and power were related to the derived polar strength-strain index, but not to volumetric BMD (vBMD) as measured via peripheral quantitative computed tomography (pQCT) of the tibial shaft. In female tennis players [7], muscle area was associated with total bone and cortical area and polar second moment of area at the humeral shaft as measured by magnetic resonance imaging and dual X-ray absorptiometry (DXA). In another study of pre-pubertal girls [8], lean tissue mass was the most predictive of bone strength, geometry and areal bone mineral content (BMC) versus other muscle related factors as measured by DXA at the femoral neck. In children, adolescents and adults up to the age of 35 [9], muscle CSA, muscle force, body weight, physical activity were independently associated with polar section modulus, periosteal circumference and cortical area of the tibial shaft but none of the load co-variates were associated with tibial shaft vBMD as measured by pQCT. Whilst the relationship of bone density to physical capacity has been relatively well investigated, further work is needed to better understand the relationship to broader bone characteristics. Specifically, we wanted to better understand which aspects of bone density, mass and geometry are most related to, or most influenced by, neuromuscular function.
In the current investigation we considered the relationship between physical capacity (grip strength, jumping), forearm and calf muscle size to bone mineral density, bone mass, bone geometry and derived measures of bone strength in women aged 60 to 95 years of age. This investigation was conducted on the basis of data collected as part of the larger “Bus-tour” study [10].
Section snippets
Study-design, setting, participants and ethical clearance
The study was designed to recruit a representative cross-sectional database of the female population aged 60 to 95 years in Germany [10]. For this purpose, all testing devices were loaded onto a truck and a team from the Center of Muscle and Bone Research toured through twenty German cities. The cities were spread throughout Germany. Subjects were recruited via the local media and came to the testing facility for screening and subsequent testing. Subjects were excluded if they used any kind of
Results
Relationships of grip strength and jump power to, respectively, arm 66% site and tibia 66% site vBMD, vBMC, cortical thickness and section modulus are shown in Fig. 1.
Discussion
The main finding of the current study was that, for pQCT measures of the tibia, fibula, radius and ulna, the functional parameters of peak performance (maximal grip strength, peak jump power, and muscle area, but not sit-to-stand time) showed stronger relationships with vBMC, cortical area and cortical thickness than with vBMD. At the proximal forearm, ulna and radius section modulus showed a stronger relationship than vBMD to grip strength and muscle area. Step-wise regression confirmed this
Conclusions
In conclusion, we observed that, for pQCT measures of the tibia, fibula, radius and ulna, the strongest relationship with neuromuscular parameters was seen with cortical bone geometry and bone mass than for bone density. Also, at the proximal forearm (radius and ulna) the relationship of muscle size and grip strength to bone strength (sectional modulus) was greater than to bone density. These findings provide evidence that the influence of mechanical loading on bone is more important for bone
Conflict of interest
JW and RR are employees of Stratec Medizintechnik. All other authors declare no conflicts of interest.
Funding sources
The “Bus-tour” study was supported by the Kuratorium Knochengesundheit (Sinsheim, Germany) and institutional funds.
Author contributions
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Daniel L. Belavy: statistical analysis, preparation of manuscript.
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Gabriele Armbrecht: conception and design of experiments, data collection, analysis of DXA data, revision of manuscript.
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Tilo Blenk: conduct of the study, data management, initial statistical analyses.
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Oliver Bock: conception and design of experiments, data collection, revision of manuscript.
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Hendrikje Börst: conception and design of experiments, implementation of the study concept, implementation of experiments.
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Emine Kocakaya: data
Acknowledgments
The authors wish to thank the subjects who participated in the study.
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