Fall and Fracture Risk in Sarcopenia and Dynapenia With and Without Obesity: the Role of Lifestyle Interventions

Scott, David; Daly, Robin M.; Sanders, Kerrie M.; Ebeling, Peter R.

doi:10.1007/s11914-015-0274-z

Cited by 99 publications

(77 citation statements)

References 116 publications

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“…Loss of muscle mass due to sarcopenia also affects dynapenia. Several studies indicated that older adults with dynapenia have increased risk of functional disability [87], falling [70] and metabolic diseases [88], even after adjusting for sarcopenia [89]. In our earlier study, we found that individuals with lower muscle strength (the lowest 20th percentile) compared with the moderate or high muscle strength (upper 80th percentile) had over two-fold higher risk of developing metabolic syndrome in both young (<50 years) and old (≥50 years) men after adjusting for age, smoking and alcohol intake [90].…”

Section: Discussion (Current Limitations and Future Direction)mentioning

confidence: 99%

“…SO is associated with or leads to several adverse outcomes with increased risks of mobility disability [4–6], falling and fracture [70], low quality of life and independence [49], metabolic diseases [7,8] and cardiovascular diseases [9–11], which increases risk of premature mortality [12–14]. Potential mechanisms for the development of SO and its health problems include increased insulin resistance [20,56], increased chronic inflammation [58,71], decreased hormones (testosterone, growth hormone, DHEA, IFG-1) [72], decreased neuromuscular function [73–75] and decreases in energy expenditure and fat oxidation [76].…”

Section: Mechanisms Linking Physical Activity To Sarcopenic Obesitymentioning

confidence: 99%

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Physical Activity and Sarcopenic Obesity: Definition, Assessment, Prevalence and Mechanism

et al. 2016

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Sarcopenic obesity is the coexistance of sarcopenia and obesity. Modern sarcopenia definition includes low muscle mass, weak muscle strength (handgrip strength) and poor physical function (slow walking), although the clinical definition of each varies worldwide. The cut-points for low muscle mass for men and women using appendicular lean mass divided by height (kg/m2) are ≤7.0 and ≤5.4 in Asians, and ≤7.23 and ≤5.67 in Caucasians, respectively. The cut-points for weak handgrip strength (kg) for men and women are <26 and <18 in Asians, and <30 and <20 in Caucasians, respectively. The cut-point for slow walking is ≤0.8 m/s in men and women. Current data suggest the potential benefits of physical activity and fitness on sarcopenic obesity in older adults.

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Section: Discussion (Current Limitations and Future Direction)mentioning

confidence: 99%

Section: Mechanisms Linking Physical Activity To Sarcopenic Obesitymentioning

confidence: 99%

Physical Activity and Sarcopenic Obesity: Definition, Assessment, Prevalence and Mechanism

et al. 2016

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“…Moreover, this definition is likely limited in its ability to predict risk, as consensus population measures of obesity in men, such as BMI (≥ 30 kg/m 2 [99] ) and total body percent fat mass (> 30% [100] ), were not utilised. Of these two measures, a total body percent fat mass > 30% has been commonly suggested as a more appropriate indicator of obesity when compared to BMI [101] ; thus, this cut-off should be utilised when available.…”

Section: Sarcopenic Obesitymentioning

confidence: 99%

“…Obesity was defined as BMI ≥ 30 kg/m 2 [99] or total body percent fat mass ≥ 30% [100] , with the latter commonly deemed a more appropriate indicator of obesity when compared to BMI [101] . There are no consensus definitions for sarcopenic obesity, thus sarcopenic obesity was defined as concurrent sarcopenia (EWGSOP) and obesity (total body percent fat mass ≥ 30%) and pre-sarcopenic obesity was defined as concurrent pre-sarcopenia (ALMI ≤ 7.26 kg/m 2 or ALMI ≤ 7.49 kg/m 2 ) and obesity (total body percent fat mass ≥ 30%).…”

Section: Pre-sarcopenia Sarcopenia Obesity and Sarcopenic Obesitymentioning

confidence: 99%

Muscle, fat and performance during androgen deprivation for prostate cancer

Owen¹

2018

Preprint

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Introduction: Prostate cancer (PCa) is one of the most frequently diagnosed male cancers worldwide. One treatment, androgen deprivation therapy (ADT), is often accompanied with a myriad of adverse effects, including those that negatively impact muscle, fat and performance outcomes. Therefore, ADT-treated men may be living longer, but are at risk of both age- and treatment-related complications. The overall aim of this thesis was to quantify outcomes of muscle, fat and performance in men treated with ADT when compared to PCa (men diagnosed with PCa, not treated with ADT) and healthy controls (men not diagnosed with PCa), and assess the feasibility of implementing a multi-component exercise program combined with protein, calcium and vitamin D supplementation (Ex+ProCaD) compared to usual care in ADT-treated men. Methods: This thesis presents two studies that form part of a larger 52-week randomised controlled trial (RCT), which examined the efficacy of Ex+ProCaD compared to usual care in men treated with ADT for PCa. The first study presented was a nested cross-sectional study performed parallel to the baseline assessment of the RCT and examined differences in muscle, fat and performance outcomes between men treated with ADT when compared to PCa and healthy controls. The second study presented examined the feasibility of implementing the first 26 weeks of the RCT. Results: The cross-sectional study showed that height, weight, body mass index and diet were similar between the three groups, but ADT-treated men were four years older and tended to be less physically active (23-30%; P=0.054). After adjusting for age and physical activity, total body fat mass was 3.3-5.0 kg (P < 0.05) greater in men treated with ADT compared to PCa controls, but there was no difference in total body and regional lean mass. When adiposity was considered, ADT-treated men had 10-12% (P < 0.05) lower appendicular lean mass adjusted for body mass index and 5.6-6.4% (P < 0.05) lower forearm percent muscle cross-sectional area compared to controls. Absolute muscle strength was similar between groups, but when expressed relative to body weight, men treated with ADT had 13-21% (P < 0.05) lower muscle strength compared to controls. Whilst only two ADT-treated men had sarcopenia, these men had a higher proportion (P < 0.001) of pre-sarcopenia when appendicular lean mass was adjusted for body mass index (42%) compared to PCa (15%) and healthy (7%) controls. Men treated with ADT had 15-36% (P < 0.05) greater storage of fat within subcutaneous depots when compared to controls, whereas visceral and intermuscular fat was similar. The majority of subcutaneous fat depots (excluding android region) were shown to be positively associated with ADT duration (P < 0.05). Forearm muscle density was shown to negatively correlate with ADT duration (P < 0.05). The RCT had a high participant retention rate (96%). Adherence was high for the supplement (mean, 92-93%) and modest for the exercise program (mean, 60%). A relatively high proportion (81%) of men in the intervention group reported an adverse event, although only 16% were confirmed to be related to the intervention and the vast majority (97%) were determined to be mild or moderate in terms of severity. Across the ten separate recruitment pathways considered, clinician referral (43%) and PCa support groups (29%) yielded the greatest proportion of enrolled participants. A total of 149 potential participants were screened, which resulted in 42 participants at the time of write up for this thesis. Among the first 28 participants to complete the 26-week intervention, 21-50% were unable to complete at least one measure of muscle strength due to pre-existing comorbidities. Data from the initial 28 participants tended to show that when compared to usual care, Ex+ProCaD led to net improvements in lean mass (0.2-1.4 kg), fat mass (-0.1 to -0.9 kg), muscle strength (8.0-19%), functional muscle power (8.6%) and functional capacity (12-14%). Conclusions: The following key themes emerged from this thesis and may be used to guide clinical practice guidelines and future research: 1) Men treated with ADT for PCa had greater amounts of fat when compared to non-ADT counterparts, 2) Current definitions of sarcopenia and sarcopenic obesity were limited in men treated with ADT for PCa, 3) The greater amounts of fat observed in men treated with ADT for PCa tended to be stored in subcutaneous depots and supersede age-related plateaus/losses, 4) The recruitment of men treated with ADT for PCa into a lifestyle intervention was challenging, and 5) Men treated with ADT for PCa tended to respond positively to a multi-modal exercise training combined with multi-nutrient supplementation.

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“…Greater soft-tissue thickness over the lateral hip dissipates fall impact, and so may continue to protect against hip fracture at high body weight even when load-to-strength ratio is exceeded [12,14]. Intramuscular fat content is increased in obesity, and may be associated with poorer muscle function and increased fracture risk ('dynapenic obesity') [15,16]. Poorer muscle function could increase falls and injury when falling, and there are data showing an excess of falls in obese people [17].…”

Section: Obesity Fracture and Bmdmentioning

confidence: 99%

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

cho¹,

Lee²,

Kang³

2017

Exerc Sci

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clinicians. However, the limited available evidence suggests that osteoporosis treatment does reduce fracture risk in obesity and T2DM with generally similar efficacy to other patients.Keywords Bone · Obesity · Diabetes · Fat · Fracture Obesity, Type 2 Diabetes and BoneObesity is a major and growing public health problem; for example, in the UK, 40% of adults will be obese by 2025 [1]. Obesity is the most important risk factor for type 2 diabetes (T2DM), and the global prevalence of T2DM is likely to be 592 million by 2035 [2]. As the population ages, the burden of osteoporosis and fragility fracture also increases. Obesity and T2DM have effects on fracture risk, and fractures in T2DM are associated with greater morbidity than in the general population. Understanding how to assess and treat fracture risk in these groups is important for health care planning and individual patients. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable in the broader study of osteoporosis, such as the effects of adipokines on bone cells and the effects of collagen glycation on material properties of bone. There are some similarities in the effect of obesity and T2DM on bone, but some important differences such as cortical porosity and collagen glycation.In this review, we describe the effects of obesity and T2DM on fracture risk and discuss possible mechanisms of their effects. We also consider the validity of existing fracture risk prediction tools and efficacy of osteoporosis treatment in these patient groups. AbstractIn an increasingly obese and ageing population, type 2 diabetes (T2DM) and osteoporotic fracture are major public health concerns. Understanding how obesity and type 2 diabetes modulate fracture risk is important to identify and treat people at risk of fracture. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable to osteoporosis in the general population. Most available evidence indicates lower risk of proximal femur and vertebral fracture in obese adults. However the risk of some fractures (proximal humerus, femur and ankle) is higher, and a significant number fractures occur in obese people. BMI is positively associated with BMD and the mechanisms of this association in vivo may include increased loading, adipokines such as leptin, and higher aromatase activity. However, some fat depots could have negative effects on bone; cytokines from visceral fat are pro-resorptive and high intramuscular fat content is associated with poorer muscle function, attenuating loading effects and increasing falls risk. T2DM is also associated with higher bone mineral density (BMD), but increased overall and hip fracture risk. There are some similarities between bone in obesity and T2DM, but T2DM seems to have additional harmful effects and emerging evidence suggests that glycation of collagen may be an important factor. Higher BMD but higher fracture risk presents challenges i...

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Fall and Fracture Risk in Sarcopenia and Dynapenia With and Without Obesity: the Role of Lifestyle Interventions

Cited by 99 publications

References 116 publications

Physical Activity and Sarcopenic Obesity: Definition, Assessment, Prevalence and Mechanism

Physical Activity and Sarcopenic Obesity: Definition, Assessment, Prevalence and Mechanism

Muscle, fat and performance during androgen deprivation for prostate cancer

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

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