Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis

Nielsen, Barbara Rubek; Abdulla, Jawdat; Andersen, Hanne Elkjær; Schwarz, Peter; Suetta, Charlotte

doi:10.1007/s41999-018-0079-6

Cited by 99 publications

(78 citation statements)

References 63 publications

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“…The risk of incurring a minimal‐trauma or no trauma fracture when sarcopenic was also found to be much greater than in non‐sarcopenic older persons (relative risk 1.37, 95% CI 1.18–1.58) . A recent meta‐analysis corroborates this finding with the odds of a fracture in sarcopenic compared with non‐sarcopenia older persons reported as 1.84 (95% CI 1.30–2.62) …”

Section: Epidemiologymentioning

confidence: 73%

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

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

276

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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Section: Epidemiologymentioning

confidence: 73%

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

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

276

245

View full text Add to dashboard Cite

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“…In the meta-analysis by Nielsen et al [8], the prevalence of sarcopenia in patients with low energy fracture was 46%, with a relative risk of fracture of 1.37 in patients with sarcopenia. In addition, they found a difference of 0.07 g/ cm 2 in bone mineral density and −0.34 in the T score in patients with sarcopenia compared to patients without sarcopenia [8]. is relationship is similar to that found in this study, where the T score of patients with sarcopenia was significantly lower than that of patients without sarcopenia.…”

Section: Discussionmentioning

confidence: 98%

“…Fahimfar et al [7] found a prevalence of osteosarcopenia of 34% in men and 34% in women. In a meta-analysis, the prevalence of this condition varied between 5 and 37% [8]. Likewise, Huo et al [9] reported a prevalence of 40% in a cohort of patients with a history of falls.…”

Section: Introductionmentioning

confidence: 98%

Bone Mass Loss and Sarcopenia in Ecuadorian Patients

Intriago

Maldonado

Guerrero

et al. 2020

Journal of Aging Research

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Introduction. An intimate relationship between osteoporosis and sarcopenia has been established. At present, there are few epidemiological studies about osteosarcopenia due to the recent use of this term, especially in Latin America. Objective. To study the association between osteoporosis and sarcopenia and determine the prevalence of osteosarcopenia in patients who attended a rheumatology center in Ecuador. Methods. A cross-sectional study was conducted in a population of patients who had a densitometric study. The diagnosis of sarcopenia was determined by the DXA standard gold test, screening, and conventional methods (bioimpedance, anthropometric measurements, SARC-F, muscle function, and gait test). Results. A total of 92 patients were studied. The median age was 66 ± 10, 90% females. Using the criteria of SMI, 65% had sarcopenia of which 9% had only sarcopenia and 56% had osteosarcopenia; 22% had only osteopenia/osteoporosis; and 13% none of these conditions. The prevalence of sarcopenia according to handgrip strength was 60%, gait speed 45%, and SARC-F score 40%. The prevalence of osteosarcopenia according to handgrip strength was 51%, gait speed 34%, and SARC-F score 32%. Osteoporosis was associated with a higher prevalence of sarcopenia using the criteria of SMI since 40% had sarcopenia in the normal DXA group, 64% in the osteopenia group, and 76% in the osteoporosis group (p=0.017). Of the women, 69% had sarcopenia compared to 33% of the men (p=0.034). The BMI was lower in the group with sarcopenia (25.1 ± 4.1 kg/m2) compared to the group without sarcopenia (29.4 ± 4.1 kg/m2, p<0.001). Patients with osteosarcopenia and sarcopenia had lower BMI, handgrip strength, ASM, SMI, and total-body skeletal muscle mass than those with osteopenia/osteoporosis or normal patients. Conclusion. 65% of the studied population had sarcopenia. It is clear that the prevalence of sarcopenia is higher in patients with greater loss of bone mass. Identifying pathways that affect both bone and muscle could facilitate the development of treatments that simultaneously improve osteoporosis and sarcopenia.

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“…The prevalence of osteosarcopenia in our study lies within previous estimates in Asian populations, which ranges from 6.2% [ 24 ] to 19.6% [ 25 ]. In contrast, in individuals attending falls clinics or with osteoporotic fractures, prevalence estimates are substantially higher, ranging up to 58% [ 26 ]. These differences in the population studied may account for inconsistent associations between osteosarcopenia and negative outcomes.…”

Section: Discussionmentioning

confidence: 99%

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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Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis

Cited by 99 publications

References 63 publications

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

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

Bone Mass Loss and Sarcopenia in Ecuadorian Patients

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

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