目的 使用公共数据分析双上肢握力与全身总骨密度的相关性。 方法 在美国国家健康和营养检查调查（national health and nutrition examination surveys，NHANES）数据库2011~2012，2013~2014年2个周期中，提取含有握力、骨密度及多个潜在混杂因素的5 148例参与者，加权后计算基线水平。使用R语言survey包进行多元线性回归分析握力与骨密度的关系，随后对性别、年龄及体质指数（body mass index，BMI）进一步做分层分析。使用rcssci包进行曲线拟合分析二者的曲线关系。 结果 共5 148例参与者（男性2 493例，女性2 655例）被纳入研究。总体握力为（77.48±0.40） kg，男性（93.98±0.45） kg，女性（59.71±0.24） kg；左上肢握力总体（37.75±0.21） kg，女性（28.89±0.12） kg，男性（45.98±0.24） kg；总体右上肢握力（39.73±0.20） kg，女性（30.83±0.13） kg，男性（48.00±0.23） kg；总体左侧握力BMI 46.87±0.33，男性53.65±0.46，女性39.56±0.26；总体右侧握力BMI 49.37±0.33，男性56.01±0.47，女性42.21±0.26；总体平均握力指数48.12±0.33，男性54.83±0.46，女性40.89±0.26，总体骨密度水平为（1.11±0.00） g/cm²，男性（1.15±0.00） g/cm²，女性（1.08±0.00） g/cm²。排除了混杂因素后，握力与总骨密度显示出明显正相关（P<0.000 1）。此外，年龄与骨密度呈现负相关，而非西班牙裔黑人种族（墨西哥裔为参照），大学毕业及以上（高中未毕业为参照）、身高、BMI则与骨密度呈正相关。分层分析结果显示年龄、性别及BMI都与骨密度存在交互作用。曲线拟合结果显示，握力与骨密度仅存在线性关系（P<0.001），但握力指数（左侧为主）与骨密度存在着L型的曲线关系。随着握力及握力指数的增强，骨密度分别以线性及L型曲线（随握力指数增长，骨密度增长变缓）的方式相应增加，其变化范围达到0.1 g/cm²。 结论 双上肢握力水平及握力指数（左侧为主）与骨密度呈正相关，骨密度与握力呈线性关系，与握力指数呈L型曲线关联。本研究结果进一步支持了握力水平与骨密度之间的相关性，并为了解握力对骨密度的影响提供了重要的实证数据，对于进一步研究骨密度的调节机制以及预防和治疗骨质疏松症具有重要意义。

Objective To investigate the correlation between upper limb grip strength and total body bone mineral density （BMD） using public data. Methods During the 2011-2012 and 2013-2014 cycles of National Health and Nutrition Examination Surveys，a total of 5148 participants with grip strength，BMD，and multiple potential confounding factors were identified，and baseline levels were calculated after weighting. R language survey package was used for the multiple linear regression analysis to investigate the correlation between grip strength and BMD，and then stratified analysis was performed based on sex and age. The rcssci package was used for curve fitting to analyze the curve relationship between the two indicators. Results A total of 5 148 participants（2 493 male participants and 2 655 female participants） were included in this study. The overall grip strength was （77.48±0.40） kg，with a value of （93.98±0.45） kg for male participants and （59.71±0.24） kg for female participants； overall left upper limb grip strength was （37.75±0.21） kg，with a value of （28.89±0.12） kg for female participants and （45.98±0.24） kg for male participants； overall right upper limb grip strength was （39.73±0.20） kg，with a value of （30.83±0.13） kg for female participants and （48.00±0.23） kg in male participants. Overall left grip strength values of body mass index was 46.87±0.33，with a value of 53.65±0.46 for male participants and 39.56±0.26 for female participants（P<0.000 1）； overall right grip strength values of body mass index was 49.37±0.33，with a value of 56.01±0.47 for male participants and 42.21±0.26 for female participants； overall mean grip strength index was 48.12±0.33，with a value of 54.83±0.46 for male participants and 40.89±0.26 for female participants； overall BMD was （1.11±0.00） g/cm²，with a value of （1.15±0.00） g/cm² in male participants and （1.08±0.00） g/cm² in female participants. After exclusion of confounding factors，grip strength showed a significant positive correlation with total BMD（P<0.000 1），and in addition，age was negatively correlated with BMD. Black race（with Mexican descent as reference），college graduation or above（with the participants not graduated from high school as reference），body height，and body mass index（BMI） were positively correlated with BMD. Stratified analysis showed that age，sex，and BMI had interaction with BMD. The curve fitting results showed that there was only a linear relationship between grip strength and BMD（P<0.001），but there was an L-shaped curve relationship between grip strength index（mainly of the left side） and BMD. With the increases in grip strength and grip strength index，BMD increased in a linear and L-shaped curve（BMD increased slowly with the increase in grip strength index），with a variation range of 0.1 g/cm². Conclusion Grip strength of both upper limbs and grip strength index（mainly of the left side） are positively correlated with BMD，and BMD shows a linear relationship with grip strength and an L-shaped curve relationship with grip strength index. The results of this study further support the correlation between grip strength and BMD and provide important empirical data for understanding the impact of grip strength on BMD，which has important significance for further research on the regulatory mechanism of BMD and the prevention and treatment of osteoporosis.