Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

We aimed to determine the relationship between handgrip strength, smoking and alcohol consumption in young men and fracture risk at middle age. Thus, we carried out a cohort study including young men undergoing conscription examination in Sweden September 1969-May 1970 at typical age 18 years. Data on muscle strength, height, weight and lifestyle factors were linked to the National Patient Register 1987-2010.Handgrip strength was considered the main exposure, and smoking and alcohol consumption as secondary exposures. Outcomes were all fractures (except face, skull, digits), major osteoporotic fractures (thoracic/lumbar spine, proximal humerus, distal forearm or hip) and major traumatic fractures (shaft of humerus, forearm, femur, or lower leg) based on ICD-9 and 10 codes. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) according to handgrip strength as a continuous variable (per 1 SD), after adjustment for weight, height, parental education, smoking, and alcohol consumption. A total of 40 112 men were included, contributing 892 572 person-years. Overall, 3974 men fractured in middle age with the incidence rate (95%CI) of 44.5 (43.2-45.9) per 1000 person-years. The corresponding rates were12.2 and 5.6per 1000 person-years for major osteoporotic and traumatic fractures, respectively. Handgrip strength-adjusted HR (95%CI) was 1.01 (0.98-1.05), 0.94 (0.88-1.00) and 0.98 (0.88-1.08) per SD for all, major osteoporotic, and major traumatic fractures, respectively. Adjusted HR (95%CI) for smokers (>21cigarettes/day):1.44 (1.21, 1.71) for all fractures, while the association between alcohol consumption and hazards of fracture was J-shaped. Therefore, young adult handgrip strength was not associated with fracture risk in middle-age men, though smoking and high alcohol consumption did confer an increased risk. This article is protected by copyright. All rights reserved.

Original publication




Journal article


J bone miner res

Publication Date



epidemiology, fracture, general population, prevention, skeletal muscle