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Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, Sato K, Hotta K, Morishita S, Tsubaki A. Related Factors and Clinical Outcomes of Osteosarcopenia: A Narrative Review. Nutrients 2021; 13:nu13020291. [PMID: 33498519 PMCID: PMC7909576 DOI: 10.3390/nu13020291] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
Osteopenia/osteoporosis and sarcopenia are common geriatric diseases among older adults and harm activities of daily living (ADL) and quality of life (QOL). Osteosarcopenia is a unique syndrome that is a concomitant of both osteopenia/osteoporosis and sarcopenia. This review aimed to summarize the related factors and clinical outcomes of osteosarcopenia to facilitate understanding, evaluation, prevention, treatment, and further research on osteosarcopenia. We searched the literature to include meta-analyses, reviews, and clinical trials. The prevalence of osteosarcopenia among community-dwelling older adults is significantly higher in female (up to 64.3%) compared to male (8–11%). Osteosarcopenia is a risk factor for death, fractures, and falls based on longitudinal studies. However, the associations between osteosarcopenia and many other factors have been derived based on cross-sectional studies, so the causal relationship is not clear. Few studies of osteosarcopenia in hospitals have been conducted. Osteosarcopenia is a new concept and has not yet been fully researched its relationship to clinical outcomes. Longitudinal studies and high-quality interventional studies are warranted in the future.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan; (T.I.); (K.H.); (S.M.); (A.T.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-78-6364
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan;
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wago-kita, Naka-ku, Hamamatsu, Shizuoka 433-8127, Japan;
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan;
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahimachi, Kurume 830-0011, Japan;
| | - Keisuke Sato
- Okinawa Chuzan Hospital Clinical Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Kazuki Hotta
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan; (T.I.); (K.H.); (S.M.); (A.T.)
| | - Shinichiro Morishita
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan; (T.I.); (K.H.); (S.M.); (A.T.)
| | - Atsuhiro Tsubaki
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan; (T.I.); (K.H.); (S.M.); (A.T.)
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Atlihan R, Kirk B, Duque G. Non-Pharmacological Interventions in Osteosarcopenia: A Systematic Review. J Nutr Health Aging 2021; 25:25-32. [PMID: 33367459 DOI: 10.1007/s12603-020-1537-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Osteosarcopenia is a geriatric syndrome defined by the concomitant presence of osteopenia/osteoporosis (loss of bone mineral density (BMD)) and sarcopenia (loss of muscle mass and/or function), which increases the risk of falls, fractures, and premature mortality. OBJECTIVE To examine the efficacy of non-pharmacological (exercise and/or nutritional) interventions on musculoskeletal measures and outcomes in osteosarcopenic adults by reviewing findings from randomized controlled trials (RCTs). METHODS This review was registered at PROSPERO (registration number: CRD42020179292) and conducted in accordance with the PRISMA guidelines. Electronic databases were searched for RCTs assessing the effect of at least one non-pharmacological intervention (any form of exercise and/or supplementation with protein, vitamin D, calcium or creatine) on any musculoskeletal measure/outcome of interest (BMD, bone strength/turnover, muscle mass and strength, physical performance, falls/fractures) in adults with osteosarcopenia as defined by any proposed criteria. RESULTS Two RCTs (of n=106 older osteosarcopenic adults (≥65 years)) assessing the effects of progressive resistance training (RT) (via resistance bands or machines; 2-3 times/week; ~60 minutes in duration) were eligible for inclusion. The two RCTs demonstrated moderate quality evidence that RT increases muscle mass, strength, and quality, with changes in strength and quality occurring before muscle mass (12 vs 28 weeks). There was low quality evidence that RT increases lumbar spine BMD and maintains total hip BMD when performed for 12 and 18 months, respectively, and moderate quality evidence that RT has no effect on markers of bone turnover or physical performance. No major adverse effects were recorded in either of the RCTs. There were no eligible RCTs examining the impact of nutritional interventions. CONCLUSION Chronic RT is safe and effective at potentiating gains in muscle mass, strength, and quality, and increasing or maintaining BMD in older osteosarcopenic adults. No RCT has examined the effects of protein, vitamin D, calcium, or creatine against a control/placebo in this high-risk population.
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Affiliation(s)
- R Atlihan
- Prof. Gustavo Duque, MD, Ph.D., FRACP, FGSA, Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, Australia 3121, Tel: +61 3 8395 8121, E-mail:
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Duque G. Editorial: Osteosarcopenia: A Geriatric Giant of the XXI Century. J Nutr Health Aging 2021; 25:716-719. [PMID: 34179922 DOI: 10.1007/s12603-021-1640-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- G Duque
- Prof. Gustavo Duque, MD, PhD, FRACP, FGSA, Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia, T: +61 3 8395 8121 | E:
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Chew J, Yeo A, Yew S, Tan CN, Lim JP, Hafizah Ismail N, Lim WS. Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis. Nutrients 2020; 12:E2957. [PMID: 32992541 PMCID: PMC7601906 DOI: 10.3390/nu12102957] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
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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Affiliation(s)
- Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.P.L.); (N.H.I.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (A.Y.); (S.Y.); (C.N.T.)
| | - Audrey Yeo
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (A.Y.); (S.Y.); (C.N.T.)
| | - Suzanne Yew
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (A.Y.); (S.Y.); (C.N.T.)
| | - Cai Ning Tan
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (A.Y.); (S.Y.); (C.N.T.)
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.P.L.); (N.H.I.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (A.Y.); (S.Y.); (C.N.T.)
| | - Noor Hafizah Ismail
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.P.L.); (N.H.I.); (W.S.L.)
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.P.L.); (N.H.I.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (A.Y.); (S.Y.); (C.N.T.)
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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.
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical SchoolUniversity of MelbourneMelbourneAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)University of Melbourne and Western HealthMelbourneAustralia
| | - Jesse Zanker
- Department of Medicine, Western Health, Melbourne Medical SchoolUniversity of MelbourneMelbourneAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)University of Melbourne and Western HealthMelbourneAustralia
| | - Gustavo Duque
- Department of Medicine, Western Health, Melbourne Medical SchoolUniversity of MelbourneMelbourneAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)University of Melbourne and Western HealthMelbourneAustralia
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Prevalence of muscle dysfunction concomitant with osteoporosis in a home-dwelling Danish population aged 65-93 years - The Copenhagen Sarcopenia Study. Exp Gerontol 2020; 138:110974. [PMID: 32464171 DOI: 10.1016/j.exger.2020.110974] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION As life expectancy increases, a growing percentage of older individuals with age-related diseases such as osteoporosis and sarcopenia are expected. Patients with both conditions, i.e. patient with osteosarcopenia, are suggested to have a higher risk of fall and fracture compared to individuals with either condition. AIM To investigate the potential relationship between low bone mineral density (BMD) and muscle dysfunction in a Danish cohort of older home-dwelling individuals. Furthermore, to examine the prevalence of osteosarcopenia and alterations in prevalence depending on cut-off values chosen. METHOD Measures of BMD, relative appendicular lean mass and hand grip strength were assessed in 529 individuals aged 65+ from the population-based cross-sectional Copenhagen Sarcopenia Study (CSS). Osteoporosis was diagnosed according to the World Health Organization guidelines. Sarcopenia was diagnosed in accordance with the guidelines from the European Working Group on Sarcopenia in Older People (EWGSOP2) with application of cut-off values from the EWGSOP2 paper compared to cut-off values derived from a local cohort (CSS). RESULTS 19.2% had osteoporosis (66 women and 35 men), whereas 2.7% (6 women and 8 men) and 4.2% (7 women and 15 men) had sarcopenia with application of EWGSOP2 and CSS cut-off values, respectively. Using the EWGSOP2 cut-off values, 1.5% (4 women and 4 men) were diagnosed with osteosarcopenia compared to 1.4% (4 women and 3 men) using CSS cut-off values. In the osteoporosis sub-population, 8% (EWGSOP2) and 7% (CSS) had sarcopenia and within the sarcopenia sub-population, 61.5% (EWGSOP2) and 33.3% (CSS) had osteoporosis. At all sites, BMD was lower among individuals with sarcopenia and sarcopenia increased the risk of osteoporosis (odds ratios: EWGSOP2: 7.3 (p < 0.001) and CSS: 2.2 (ns)). CONCLUSION Osteosarcopenia was present in 1.5% of a group of healthy home-dwelling older individuals. Notably, individuals with sarcopenia had lower BMD and a higher risk of osteoporosis, whereas the opposite (prevalence of sarcopenia in individuals with osteoporosis) was not as frequent. Our data indicate that screening for sarcopenia and osteoporosis should be performed simultaneously in older individuals at high risk of falls and fractures. However, further studies with outcome-related results are needed to identify optimal measures of osteosarcopenia and cut-off values for sarcopenia.
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Analysis of muscle, hip, and subcutaneous fat in osteoporosis patients with varying degrees of fracture risk using 3T Chemical Shift Encoded MRI. Bone Rep 2020; 12:100259. [PMID: 32322608 PMCID: PMC7163287 DOI: 10.1016/j.bonr.2020.100259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
Osteoporosis (OP) is a major disease that affects 200 million people worldwide. Fatty acid metabolism plays an important role in bone health and plays an important role in bone quality and remodeling. Increased bone marrow fat quantity has been shown to be associated with a decrease in bone mineral density (BMD), which is used to predict fracture risk. Chemical-Shift Encoded magnetic resonance imaging (CSE-MRI) allows noninvasive and quantitative assessment of adipose tissues (AT). The aim of our study was to assess hip or proximal femoral bone marrow adipose tissue (BMAT), thigh muscle (MUS), and subcutaneous adipose tissue (SAT) in 128 OP subjects matched for age, BMD, weight and height with different degrees of fracture risk assessed through the FRAX score (low, moderate and high). Our results showed an increase in BMAT and in MUS in high compared to low fracture risk patients. We also assessed the relationship between fracture risk as assessed by FRAX and AT quantities. Overall, the results of this study suggest that assessment of adipose tissue via 3T CSE-MRI provides insight into the pathophysiology fracture risk by showing differences in the bone marrow and muscle fat content in subjects with similarly osteoporotic BMD as assessed by DXA, but with varying degrees of fracture risk as assessed by FRAX.
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Kirk B, Phu S, Brennan-Olsen SL, Bani Hassan E, Duque G. Associations between osteoporosis, the severity of sarcopenia and fragility fractures in community-dwelling older adults. Eur Geriatr Med 2020; 11:443-450. [DOI: 10.1007/s41999-020-00301-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
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Cevei M, Onofrei RR, Cioara F, Stoicanescu D. Correlations between the Quality of Life Domains and Clinical Variables in Sarcopenic Osteoporotic Postmenopausal Women. J Clin Med 2020; 9:E441. [PMID: 32041186 PMCID: PMC7074486 DOI: 10.3390/jcm9020441] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
(1) Background: both sarcopenia and osteoporosis are major health problems in postmenopausal women. The aim of the study was to evaluate the quality of life (QoL) and the associated factors for sarcopenia in osteoporotic postmenopausal women, diagnosed according to EWGSOP2 criteria. (2) Methods: the study sample comprised 122 osteoporotic postmenopausal women with low hand grip strength and was divided into two groups: group 1 (probable sarcopenia) and group 2 (sarcopenia). QoL was assessed using the validated Romanian version of SarQol questionnaire. (3) Results: the D1, D4, D5, D7 and total SarQoL scores were significantly lower in women from group 2 compared to group 1. In group 2, women older than 70 years had significant lower values for D1, D3, D4, D6 and total SarQoL scores. Age, history of falls and the presence of confirmed and severe sarcopenia were predictors for overall QoL. (4) Conclusions: the frequency of sarcopenia was relatively high in our sample, with body mass index and history of falls as predictors for sarcopenia. Older osteoporotic postmenopausal women, with previous falls and an established sarcopenia diagnosis (low muscle strength and low muscle mass), were more likely to have a decreased quality of life.
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Affiliation(s)
- Mariana Cevei
- Psychoneuro Sciences and Rehabilitation Department, Faculty of Medicine & Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.C.); (F.C.)
| | - Roxana Ramona Onofrei
- Department of Rehabilitation, Physical Medicine and Rheumatology, “Victor Babeş” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Felicia Cioara
- Psychoneuro Sciences and Rehabilitation Department, Faculty of Medicine & Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.C.); (F.C.)
| | - Dorina Stoicanescu
- Microscopic Morphology Department, “Victor Babeş” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania;
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Changes in Nutritional Status and Musculoskeletal Health in a Geriatric Post-Fall Care Plan Setting. Nutrients 2019; 11:nu11071551. [PMID: 31324009 PMCID: PMC6682897 DOI: 10.3390/nu11071551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/29/2022] Open
Abstract
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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