Sarcopenia and osteoporosis are interrelated in geriatric inpatients

Reiss, Jens; Iglseder, Bernhard; Alzner, Reinhard; Mayr-Pirker, B.; Pirich, Christian; Kässmann, H.; Kreutzer, Martina L.; Dovjak, Peter; Reiter, Raphael

doi:10.1007/s00391-019-01553-z

Cited by 82 publications

(44 citation statements)

References 19 publications

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“…The present study reveals an association between osteosarcopenia, sarcopenia and osteoporosis with markers of nutritional status, with poorer nutritional status observed with osteosarcopenia, compared to isolated sarcopenia and osteoporosis. These findings are consistent with a previous study of geriatric inpatients [ 34 ] and individuals attending a falls and fractures clinic [ 35 ]. Our finding that nutrition mediates the association between osteosarcopenia and frailty further underscores the crucial role of nutrition in the development of frailty in at-risk individuals with osteosarcopenia.…”

Section: Discussionsupporting

confidence: 93%

Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis

et al. 2020

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Osteosarcopenia is associated with increased risk of adverse outcomes such as falls and fractures. Its association with frailty is less well-described, particularly in independent community-dwelling older adults. Although nutrition plays a crucial role in maintaining bone and muscle health, the complex relationship between osteosarcopenia and nutrition in the pathogenesis of frailty remains to be elucidated. In this cross-sectional analysis of 230 independent, community-dwelling individuals (mean age 67.2 ± 7.4 years), we examined the associations between osteosarcopenia with nutritional status and frailty, and the mediating role of nutrition in the association between osteosarcopenia and frailty. Osteosarcopenia was defined as fulfilling both the Asian Working Group for Sarcopenia 2019 consensus definition (low relative appendicular skeletal muscle mass adjusted for height, in the presence of either of either low handgrip strength or slow gait speed) and T-score ≤ −2.5 SD on bone mineral densitometry. We assessed frailty using the modified Fried criteria and nutrition using the Mini-Nutritional Assessment. We performed multiple linear regression, followed by pathway analysis to ascertain whether nutrition mediates the relationship between osteosarcopenia and frailty. Our study population comprised: 27 (11.7%) osteosarcopenic, 35 (15.2%) sarcopenic, 36 (15.7%) osteoporotic and 132 (57.4%) normal (neither osteosarcopenic, sarcopenic nor osteoporotic). Osteosarcopenia (β = 1.1, 95% CI 0.86–1.4) and sarcopenia (β = 1.1, 95% CI 0.90–1.4) were significantly associated with frailty, but not osteoporosis. Nutrition mediated the association between osteosarcopenia and frailty (indirect effect estimate 0.09, bootstrap 95% CI 0.01–0.22). In conclusion, osteosarcopenia is associated with frailty and poorer nutritional status, with nutrition mediating the association between osteosarcopenia and frailty. Our findings support early nutritional assessment and intervention in osteosarcopenia to mitigate the risk of frailty.

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Section: Discussionsupporting

confidence: 93%

Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis

et al. 2020

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“…Each year of schooling was also associated with a 3% lower prevalence of osteosarcopenia in men (0.97, 95% CI 0.95–0.99) . In other study among 148 geriatric inpatients, osteosarcopenic individuals were at greater risk of malnourishment (mini‐nutritional assessment scores: 8.50 ± 2.52 points, P < 0.001) compared with osteoporosis or sarcopenia alone, and among 253 older Australians, osteosarcopenia is associated with poorer balance and functional capacity [odds ratios (ORs) ranging from 2.56 to 7.19; P < 0.05] vs. osteopenia and osteoporosis alone . Others have noted that muscle strength and functional performance measures are also lower in those with osteosarcopenia vs. osteoporosis or sarcopenia alone …”

Section: Epidemiologymentioning

confidence: 99%

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

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

277

245

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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.

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“…Poor nutritional status can be a consequence of underlying comorbid conditions [8], which may increase the risk of falls due to clinical and adverse effects on cognitive, functional, and physical performance [9]. Poor nutritional status due to inadequate nutritional intake, especially of proteins, can also be detrimental for maintaining the integrity and function of skeletal muscle and bone [10,11,12], possibly increasing the risk for sarcopenia, osteoporosis or both [13,14,15,16]. Sarcopenia-associated risk of falling and increased bone vulnerability have a synergistic impact on falls and fractures occurrence [17,18].…”

Section: Introductionmentioning

confidence: 99%

Changes in Nutritional Status and Musculoskeletal Health in a Geriatric Post-Fall Care Plan Setting

et al. 2019

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Understanding how changes in nutritional status influence musculoskeletal recovery after falling remains unclear. We explored associations between changes in nutritional status and musculoskeletal health in 106 community-dwelling older adults aged ≥65 years, who attended the Falls and Fractures Clinic at Sunshine Hospital in St Albans, Australia after falling. At baseline and after 6 months, individuals were assessed for Mini Nutritional Assessment (MNA®), grip strength, gait speed, Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and bone turnover marker levels. Associations were examined using multiple linear regression, adjusted for baseline covariates and post-fall care plans. Over 6 months, the prevalence of malnutrition or risk thereof decreased from 29% to 15% using MNA <24/30. Specifically, 20 individuals (19%) improved, 7 (7%) deteriorated, and 73 (69%) maintained nutritional status, including 65 (61%) who remained well-nourished and 8 (8%) who remained malnourished/at risk. A 1-point increase in MNA score over 6 months was associated with an increase of 0.20 points (95% confidence interval 0.10, 0.31, p < 0.001) in SPPB score. Improvement in nutritional status was associated with improvement in physical performance, providing a basis for interventional studies to ascertain causality and evaluate nutritional models of care for post-fall functional recovery in older adults.

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Sarcopenia and osteoporosis are interrelated in geriatric inpatients

Cited by 82 publications

References 19 publications

Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis

Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis

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

Changes in Nutritional Status and Musculoskeletal Health in a Geriatric Post-Fall Care Plan Setting

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