Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Abstract

Background Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia, is an emerging geriatric giant, which poses a serious global health burden. Methods and results The prevalence of osteosarcopenia ranges in community‐dwelling older adults [5–37% (≥65 years)] with the highest rates observed in those with fractures (low‐trauma fracture: ~46%; hip fracture: 17.1–96.3%). Among 2353 community‐dwelling adults, risk factors associated with osteosarcopenia include older age [men: 14.3% (60–64 years) to 59.4% (≥75 years); women: 20.3% (60–64 years) to 48.3% (≥75 years), P < 0.05], physical inactivity [inverse relationship: 0.64, 95% confidence interval (CI) 0.46–0.88 (sexes combined)], low body mass index (inverse relationship: men: 0.84, 95% CI 0.81–0.88; women: 0.77, 95% CI 0.74–0.80), and higher fat mass (men: 1.46, 95% CI 1.11–1.92; women: 2.25, 95% CI 1.71–2.95). Among 148 geriatric inpatients, osteosarcopenic individuals demonstrate poorer nutritional status (mini‐nutritional assessment scores: 8.50 ± 2.52 points, P < 0.001) vs. osteoporosis or sarcopenia alone, while among 253 older Australians, osteosarcopenia is associated with impaired balance and functional capacity [odds ratios (ORs): 2.56–7.19; P < 0.05] vs. non‐osteosarcopenia. Osteosarcopenia also associates with falls (ORs: 2.83–3.63; P < 0.05), fractures (ORs: 3.86–4.38; P < 0.05), and earlier death [hazard ratio (1‐year follow‐up): 1.84, 95% CI; 0.69–4.92, P = 0.023] vs. non‐osteosarcopenia. Conclusions This syndrome is expected to grow in age‐related and disease‐related states, a likely consequence of immunosenescence coinciding with increased sedentarism, obesity, and fat infiltration of muscle and bone. Evidence suggests the pathophysiology of osteosarcopenia includes genetic polymorphisms, reduced mechanical loading, and impaired endocrine functioning, as well as altered crosstalk between muscle, bone, and fat cells. Clinicians should screen for osteosarcopenia via imaging methods (i.e. dual‐energy X‐ray absorptiometry) to quantify muscle and bone mass, in addition to assessing muscle strength (i.e. grip strength) and functional capacity (i.e. gait speed). A comprehensive geriatric assessment, including medical history and risk factors, must also be undertaken. Treatment of this syndrome should include osteoporotic drugs [bone anabolics/antiresorptives (i.e. teriparatide, denosumab, bisphosphates)] where indicated, and progressive resistance and balance exercises (at least 2‐3 times/week). To maximize musculoskeletal health, nutritional recommendations [protein (1.2–1.5 g/kg/day), vitamin D (800–1000 IU/day), calcium (1300 mg/day), and creatine (3–5 g/day)] must also be met. It is anticipated that diagnosis and treatment for osteosarcopenia will become part of routine healthcare in the future. However, further work is required to identify biomarkers, which, in turn, may increase diagnosis, risk stratification, and targeted treatments to improve health outcomes.

Associations of Muscle Size and Density With Proximal Femur Bone in a Community Dwelling Older Population

“…Osteoporosis and sarcopenia are both associated with aging, contributing to an increased risk of fracture (1,2). Sarcopenia refers to reductions in muscle performance with the loss of skeletal muscle mass, while osteoporosis is characterized by deficits in both trabecular and cortical bone.…”

<p>Multifactorial Assessment of Risk of Falling in 753 Post-Menopausal Women: A Multicenter Cross-Sectional Study by the Italian Group for the Study of Metabolic Bone Diseases</p>

“…28 The concept of "osteosarcopenia" describes a subset of older persons affected by a combination of low bone density (osteopenia/osteoporosis) and low muscle mass, strength, and/or functional capacity (sarcopenia). [29][30][31] To manage this pathological condition, it is mandatory to diagnose it through adequate assessment of muscle function, particularly measuring gait speed. 31 Moreover, Bhasin et al 32 have recently shown that low gait speed might independently predict falls in community-dwelling older adults.…”

“…[29][30][31] To manage this pathological condition, it is mandatory to diagnose it through adequate assessment of muscle function, particularly measuring gait speed. 31 Moreover, Bhasin et al 32 have recently shown that low gait speed might independently predict falls in community-dwelling older adults. Our study also confirms the role of this outcome measure as a quick, safe, and highly reliable test for physical performance.…”

Disability, Frailty and Depression in the Community-dwelling Elderly with Osteosarcopenia

“…The comparison of WHODAS, Kaigo-Yobo, and GDSSF values among the four groups of study subjects occurred after adjustment for gender, age, marital status, economic level, smoking status, hypertension, diabetes, hemoglobin, uric acid, albumin, r-GTP, creatinine, and cholesterol. [22][23][24] Adjusted means and their 95% con dence intervals (CIs) were estimated by general linear model (GLM) and the post-hoc test is based on Turkey method. The SAS Version 9.4 program (SAS Institute Inc., Cary, NC) was used as the analysis tool, and the signi cance level was set to 0.05.…”