Increase in life expectancy is among the most significant achievements of modern medicine. Currently, the majority of patients are elderly, being characterised by multimorbidity and frailty. Sarcopenia, a progressive and generalized loss of skeletal muscle mass and strength, is associated with a reduced quality of life and high risk of adverse outcomes including disability and death in these patients. Age-related neuromuscular degeneration, decline of circulating anabolic hormones, chronic inflammation and oxidative stress considerably affect the development of sarcopenia. In addition, low intake of proteins and carbohydrates along with a decrease in physical activity also affect muscular homeostasis. Being combined with obesity, osteopenia/osteoporosis, and vitamin D deficiency, sarcopenia worsens the prognosis of the patient in terms of life expectancy. In this review, we discuss the current advances in epidemiology, pathophysiology, and diagnosis of sarcopenia.

BackgroundThe impact of knee osteoarthritis on the risk of low-energy fractures remains an open question in recent times. Some cohort studies show that OА of the knee joint is associated with increased risk of fractures [1-3]. Other studies do not support this link [4-5].Objectivesto compare the incidence of osteopenic syndrome and low-energy fractures in postmenopausal women with osteoarthritis (OA) of the knee joint.MethodsThe study includes 98 women, of whom: 51 (median age 63.0 [59.3;69.8] years) are diagnosed with OA of the knee joint according to the ACR criteria (1991) and 47 without OA of the knee joint (median age 65.0[61.8;71.0] years). The bone mineral density (BMD) (g/cm2) and the T-criterion (standard deviation, CO) of the femur neck and lumbar spine (LI-LIV) were evaluated by the two-energy X-ray absorption (DXA) method (Lunar Prodigy Primo, USA). The DXA data of the femoral neck and the lumbar spine were interpreted using the following reference intervals: normal BMD - T-criterion -1 CO, osteopenia - T-criterion from -1 or less CO. Low-energy fractures were considered to have occurred with minimal trauma (falling from a height of own height to the same surface or an even smaller injury) and were found in the anamnesis.ResultsIn the group of patients with OA of the knee joint, normal BMD was found to be statistically significantly more frequent than the control group (15.7% vs. 4.3%) p=0.033. It is shown that in women with OA of the knee joint, low-energy fractures were statistically less recorded than in the control group: in 29.4% and 51.0% of women respectively (p=0.002). The chances of having low-energy fractures in the group of patients with OA of the knee joint were statistically lower by a factor of 2.64 compared to the control group (OR = 0.378; 95%CI: 0.203 - 0.703).ConclusionThe low frequency of low-energy fractures and the lower the chances of them in women with OA of the knee joint compared to the control group are probably associated with lower prevalence of the osteopenic syndrome among these patients.References[1]Smith TO, Higson E, Pearson M, Mansfield M. Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative. Int J Rheum Dis. 2018;21(6):1193-1201. doi:10.1111/1756-185X.12871[2]Soh SE, Barker AL, Morello RT, Ackerman IN. Applying the International Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the Osteoarthritis Initiative. BMC Musculoskelet Disord. 2020;21(1):138. Published 2020 Feb 29. doi:10.1186/s12891-020-3160-5[3]Jacob L, Kostev K. Osteoarthritis and the incidence of fracture in the United Kingdom: a retrospective cohort study of 258,696 patients. Osteoarthritis Cartilage. 2021;29(2):215-221. doi:10.1016/j.joca.2020.12.006[4]Vala CH, Kärrholm J, Kanis JA, et al. Risk for hip fracture before and after total knee replacement in Sweden. Osteoporos Int. 2020;31(5):887-895. doi:10.1007/s00198-019-05241-x[5]Barbour KE, Sagawa N, Boudreau RM, et al. Knee Osteoarthritis and the Risk of Medically Treated Injurious Falls Among Older Adults: A Community-Based US Cohort Study. Arthritis Care Res (Hoboken). 2019;71(7):865-874. doi:10.1002/acr.23725AcknowledgementsWe thank Vyacheslav Fanaskov and Svetlana Skutina are radiologists of State Autonomous healthcare institution “Kuzbass clinical hospital for war veterans” for the possibility of holding the two-energy X-ray absorption.Disclosure of InterestsNone declared

Aim. To identify the causes of mortality in elderly and senile patients with non-traumatic hip fracture during the first year after fracture.Materials and Methods. The reasons for death were analyzed in the cohort consisted of 432 patients with a non-traumatic hip fracture: 328 women aged from 70 to 82 years (mean age 75.4) and 104 men aged from 60 to 80 years (mean age 71.5).Results. It was revealed that in first 6 months after the injury, death occurred in 22.00 % of cases (95 from 432 patients died). After 12 months period, mortality increased to 137 cases (total mortality accounted for 31.80 %). Most of the deaths were due to cardiovascular system diseases. Cardiovascular causes were in 93 cases (21.00 %), without any gender difference: 22 in men (21.10 %) and 71 in women 21.60 %). The ratio of cardiovascular diseases in the total number of fatal outcomes was 93 (67.80 %), comparable for men and women subgroups (66.00 and 68.30 % respectively; p = 0.65). Diseases of respiratory system as a reason for death accounted for 16.80 % in the structure of total mortality: 15.10 % in men subgroup and 17.30 % in women (p = 0.31). Mortality from tumors was defined in 10.90 % from all cases of death: in men 9.09 % cases and in women 11.50 % cases (p = 0.45). The ratio of digestive system disorders as the cause of death accounted for 3.60 %: 6.06 % in men and 2.90 % in women respectively (p = 0.1).Conclusions. Cardiovascular and respiratory diseases were the most common causes of first-year mortality in elderly and senile patients with non-traumatic hip fracture. The gender differences in mortality rates were not found.

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