Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

Abstract

Objectives: The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds. Subjects and methods: Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.575.3 years and 136 men aged 73.975.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry. Results: The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI o22 (OR ¼ 12) and a protein intake o65.7 g/day (OR ¼ 3.7). Women carried some risk already in the BMI 25-30 class (OR ¼ 5), and a much greater risk in the BMI o22 class (OR ¼ 26). Albumin o40 g/l also emerged as an independent risk factor (OR ¼ 2.6). Conclusions: BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values o22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Agerelated sarcopenia does not seem to be involved in bone mass loss.

Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men

“…However, studies have shown contradicting associations, in relation to presarcopenia and sarcopenia, with BMD and diagnosis of osteoporosis (17,18). Coin and cols., after evaluation of 136 men (mean age 73 years), found no significant association between BMD of the femoral neck and total hip with RASM < 7.26 kg/m², that is, diagnosed with pre-sarcopenia according to the EWGSOP (8,19). More recently, Verschueren and cols.…”

Appendicular skeletal muscle mass is the strongest independent factor associated with femoral neck bone mineral density in adult and older men

“…These factors include inflammatory factors since the age-related increase in pro-inflammatory cytokines is associated with sarcopenia (Schaap et al, 2006) and bone resorption (Lauretani et al, 2006) in older men. Nutritional factors, other than those measured herein, such as protein intake, or the intake of fatty acids for example, might also be involved in the relationship between RASM and FN BMD in adult men (Coin et al, 2008). …”

Características epidemiológicas y clínicas de las fracturas de cadera en adultos mayores en un hospital público chileno: Experience in 647 Chilean patients aged 60 years or more

“…La hipoalbuminemia es buen ejemplo, con valores en la presente muestra que concuerdan con la literatura 29,30 . Otro lo constituyen fármacos indicados para tratar enfermedades frecuentes en el mayor, pero que son osteolesivos 31,32 .…”