Diagnostic accuracy of quadriceps strength-based criteria compared to handgrip-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults

Review written by Dr Mariana Wingood info

Key Points

  1. Multiple studies have identified poor handgrip strength as a key indicator of sarcopenia. However, many older adults have a hand abnormality or impairment that prevents reliable assessment.
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Handgrip strength (HS) is a common measure used to assess sarcopenia, frailty, risk of mobility limitation, and fall risk; resulting in the suggestion of using HS as a biomarker of aging (1). Due to the value of collecting HS information, healthcare providers regularly examine HS. However, many do not regularly think about the factors impacting their patients’ performance on the HS assessment. Some of these factors, including hand dominance, height, gender, and upper extremity position during testing, have resulted in alternative test protocols or patient-specific norms. While other factors, such as upper extremity pain and hand impairments, are not usually evaluated or considered during handgrip assessments (2).

The lack of upper extremity impairment evaluation and consideration when performing HS assessments is concerning, particularly because approximately 50% of older adults have a hand-related musculoskeletal impairment (3). Due to the concerns related to upper extremity impairments, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) 2019 and the Asian Working Group for Sarcopenia (AWGS) 2018 came to the consensus that knee extension (quadriceps strength; QS) is recommended as an alternative muscle strength measurement to HS measurement (4,5). However, QS and HS have been found to have a low-to-moderate agreement (6).

This study aimed to investigate the diagnostic accuracy of QS-based criteria and compare it to HS-based criteria for diagnosing sarcopenia in older adults.

Handgrip strength is a common measure used to assess sarcopenia, frailty, risk of mobility limitation, and fall risk.
The authors recommend that QS-based diagnostic criteria are only used for older adults with upper extremity impairments and when HS-based assessments can not be obtained.


Participants: 381 adults 60 years or older that did not have a severe cognitive impairment that would prevent them from understanding or following measurement instructions, were able to stand upright, and did not have a cardiac pacemaker, metallic implant, or

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