Toshifumi Fujiwara, Motoki Koga, Ryosuke Yamaguchi, Nobuhiko Yokoyama, Yasuharu Nakashima
IntroductionSarcopenia is a progressive decline in skeletal muscle mass, strength, and physical function associated with aging [1][2][3][4][5] .It is linked to poor prognosis in various conditions, including cancer, cardiovascular disease, and osteoporotic fractures 4,[6][7][8][9][10] .Given its impact on overall health, early prevention, diagnosis, and treatment are essential.Sarcopenia is also closely associated with reduced bone mineral density (BMD) in musculoskeletal disorders 2,3 , emphasizing the interdependence between muscle and bone health.Current sarcopenia guidelines recommend diagnosing the condition based on criteria such as walking speed, hand grip strength, stand-up tests, leg circumference, and skeletal muscle mass 4,11,12 , highlighting the crucial role of lower limb muscle strength in sarcopenia assessment.Toe grasp strength (TGS), a simple and noninvasive measure of lower limb muscle function, reflects the strength of multiple toe flexor muscles in the lower leg.TGS is influenced by factors such as height, weight, sex, and age, and it is recognized as a predictor of fall risk 13,14 .Additionally, studies indicate that TGS can be improved through targeted muscle-strengthening interventions, further underscoring its importance in musculoskeletal health [13][14][15][16] .Despite these insights, the relationship between TGS, whole-body skeletal muscle mass, and bone status remains