Archives of Osteoporosis

, 13:100 | Cite as

Defining sarcopenia in terms of skeletal health

  • Jung Hee Kim
  • A Ram Hong
  • Hyung Jin Choi
  • Eu Jeong Ku
  • Ji Hyun Lee
  • Nam H. Cho
  • Chan Soo Shin
Original Article



Among several sarcopenic indices, height-adjusted appendicular lean mass (ALM) in men and BMI-adjusted ALM in women are associated with fragility fracture. Handgrip strength is the risk factor for fragility fracture.


Various sarcopenia definitions and cutoff points result in mixed skeletal health results. Here, we aimed to determine a suitable definition and elucidate the cutoff values of sarcopenic indices for identifying fracture risk in a community-dwelling Korean cohort.


In an Ansung cohort study (2009–2010), we included 1201 men aged > 50 years and 1627 postmenopausal women with a median age of 64 years. Body composition and bone mineral density were derived on dual-energy X-ray absorptiometry. Grip strength was measured using a hand dynamometer. Fragility fractures included the history of osteoporotic fractures using self-reported questionnaires.


Among appendicular lean mass (ALM)/body mass index (BMI), ALM/height2, and ALM/weight, ALM/height2 for men and ALM/BMI for women significantly predicted fragility fractures. On receiver operating characteristic curve analysis, the cutoff values of ALM/height2 in men and ALM/BMI in women were 7.69 kg/m2, and 0.57, respectively. The optimal grip strength values were 31 kg in men and 19 kg in women. The odds ratios of low ALM/height2 (95% confidence interval) and weak grip strength for fragility fracture were 1.95 (1.03–3.68) and 2.05 (1.01–4.18), respectively, in men after covariate adjustment. The combination of low ALM/height2 and weak grip strength increased fragility fractures 2.16-fold in men. Only the combination of low ALM/BMI and grip strength increased the fracture risk by 1.76-fold in women.


In men, low ALM/height2 or grip strength played a role in fragility fractures. In women, only the combination of low ALM/BMI and grip strength had discriminatory power for fragility fractures.


Muscle mass Muscle strength Bone Fracture 


Funding information

This work was supported by the Korean Genome and Epidemiology Study (2001-347-6111-221, 2002-347-6111-221, 2003-347-6111-221, 2004-E71001-00, 2005-E71001-00, 2006-E71005-00, 2007-E71001-00, 2008-E71001-00, 2009-E71002-00, 2010-E71001-00, 2011-E71004-00, and 2012-E71005-00) and the Korea Centers for Disease Control and Prevention (2009-E71007-00 and 2010-E71004-00).

Compliance with ethical standards

This study was approved by an institutional review board of the Ajou University.

Conflict of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Jung Hee Kim
    • 1
  • A Ram Hong
    • 1
  • Hyung Jin Choi
    • 2
  • Eu Jeong Ku
    • 3
  • Ji Hyun Lee
    • 4
  • Nam H. Cho
    • 5
  • Chan Soo Shin
    • 1
  1. 1.Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of AnatomySeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Internal MedicineChungbuk National University HospitalCheongju SiRepublic of Korea
  4. 4.Department of Internal MedicineVHS Medical centerSeoulRepublic of Korea
  5. 5.Department of Preventive MedicineAjou University School of MedicineSuwonRepublic of Korea

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