Osteosarcopenic obesity in women: impact, prevalence, and management challenges

Abstract

Osteosarcopenic obesity syndrome (OSO) has recently been identified as a condition encompassing osteopenia/osteoporosis, sarcopenia and obesity. OSO is especially deleterious in older adults (even if they are not obese by conventional measures), due to age-related redistribution of fat and its infiltration into bone and muscle. Osteoporosis and bone fractures in elderly increase the risk of sarcopenia, which, through decreased mobility, increases the risk of more falls and fractures, creating a vicious cycle. Obesity plays a dual role: to a certain extent, it promotes bone and muscle gains through mechanical loading; in contrast, increased adiposity is also a source of pro-inflammatory cytokines and other endocrine factors that impair bone and muscle. As the elderly population increases, changes in lifestyle to delay the onset of OSO, or prevent OSO, are warranted. Among these changes, dietary patterns and physical activity modifications are the first ones to be implemented. The typical Western diet (and lifestyle) promotes several chronic diseases including OSO, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 fatty acid ratio and low-fiber and high-processed food consumption. Nutritional modifications to prevent and/or alleviate the OSO syndrome include adequate intake of protein, calcium, magnesium and vitamin D and increasing consumptions of foods containing omega-3 polyunsaturated fatty acids and fiber. Certain types of physical activity, often decreased in overweight/obese women and in elderly, might preserve bone and muscle, as well as help in reducing body fat accrual and fat infiltration. Habitual daily activities and some alternative modes of exercise may be more appropriate for older adults and play a crucial role in preventing bone and muscle loss and maintaining optimal weight. In conclusion, older adults who suffer from OSO syndrome may benefit from combined efforts to improve diet and physical activity, and such recommendations should be fostered as part of public health programs.

Aging human body: changes in bone, muscle and body fat with consequent changes in nutrient intake

“…A recent analysis of National Health and Nutrition Examination Survey (NHANES) data 234:1 revealed that energy imbalance, lower protein intakes, high level of simple carbohydrates and low omega-3 (n-3) PUFA may contribute to osteosarcopenic obesity syndrome (Kelly et al 2017). This analysis confirmed the paradox regarding energy intake: the latter is reduced with aging in both men and women and across all survey years, yet there is a gain in weight with aging.…”

“…As aging uniquely influences many physiological functions, the most observable are those regarding body composition changes, including loss of bone, loss of muscle mass and strength, and increased body fat leading to osteosarcopenic obesity syndrome (Ilich et al 2014b, JafariNasabian et al 2017. These changes in body phenotype will be discussed in this review, addressing also the hormonal influences and cellular mechanisms leading to tissue and whole-organism changes.…”

“…Recently, a triad encompassing the simultaneous deterioration in bone, muscle and adipose tissues has been identified and named osteosarcopenic obesity syndrome (Ilich et al 2014b, JafariNasabian et al 2017. Although the original identification of osteosarcopenic obesity syndrome was based on the changes in body composition phenotype in older women, it has recently been shown that such phenotype might exist even in young (18-21 years) overweight adults (Stefanaki et al 2016).…”

“…Reduced energy ultimately results in reduced protein consumption in elderly (Rousset et al 2003). Regarding the carbohydrate intake, simple sugars account for up to 54% of kcal from carbohydrates or up to 30% of total kcal (versus less than 10% of recommendations), across all ages and all survey years, contributing to the unhealthy diet (Ilich et al 2014a, Kelly et al 2017. Omega-3 PUFA, particularly rich in fish, are generally recognized as having protective anti-inflammatory properties that contribute to the prevention of pathological conditions associated with aging (Ubeda et al 2012).…”

Bone Marrow and Muscle Fat Infiltration Are Correlated among Postmenopausal Women With Osteoporosis: The AMBERS Cohort Study

“…Based on evidence for an increase in not only bone adiposity but also muscle adiposity with osteoporosis and aging, Ilich and colleagues further suggested the idea of obesity (as an accumulation of fat rather than overall body mass index [BMI]) within bone and muscle, termed osteosarcopenic obesity . JafariNasabian and colleagues further noted the potential of this source of fat to generate pro‐inflammatory cytokines and other endocrine players to contribute toward the deterioration of bone and muscle . However, no studies have drawn a link between muscle adiposity and bone adiposity in the context of osteoporosis, making the present investigation a unique approach to better understanding part of the bone‐muscle interactions paradigm.…”