Osteosarcopenia: beyond age-related muscle and bone loss

Gut microbiome and bone health: update on mechanisms, clinical correlations, and possible treatment strategies

The intestinal microbiome is increasingly regarded as a relevant modulator of the pathophysiology of several age-related conditions, including frailty, sarcopenia, and cognitive decline. Aging is in fact associated with alteration of the equilibrium between symbiotic bacteria and opportunistic pathogens, leading to dysbiosis. The microbiome is able to regulate intestinal permeability and systemic inflammation, has a central role in intestinal amino acid metabolism, and produces a large number of metabolites and byproducts, with either beneficial or detrimental consequences for the host physiology. Recent evidence, from both preclinical animal models and clinical studies, suggests that these microbiome-centered pathways could contribute to bone homeostasis, regulating the balance between osteoblast and osteoclast function. In this systematic review, we provide an overview of the mechanisms involved in the gut-bone axis, with a particular focus on microbiome function and microbiome-derived mediators including short-chain fatty acids. We also review the current evidence linking gut microbiota dysbiosis with osteopenia and osteoporosis, and the results of the intervention studies on pre-, pro-, or post-biotics targeting bone mineral density loss in both animal models and human beings, indicating knowledge gaps and highlighting possible avenues for future research.

Host-specific effects of Eubacterium species on Rg3-mediated modulation of osteosarcopenia in a genetically diverse mouse population

BACKGROUND

Osteosarcopenia, characterized by the simultaneous loss of bone and muscle mass, is a serious health problem in the aging population. This study investigated the interplay between host genetics, gut microbiota, and musculoskeletal health in a mouse model of osteosarcopenia, exploring the therapeutic potential of gut microbiota modulation.

METHODS

We examined the effects of Rg3, a phytochemical, on osteosarcopenia and its interactions with host genetics and gut microbiota in six founder strains of the Collaborative Cross (CC) population. Subsequently, we evaluated the therapeutic potential of Eubacterium nodatum (EN) and Eubacterium ventriosum (EV), two gut microbes identified as significant correlates of Rg3-mediated osteosarcopenia improvement, in selected C57BL/6 J (B6) and 129S1/SvImJ (129S1) mouse strains.

RESULTS

Rg3 treatment altered gut microbiota composition aligned with osteosarcopenia phenotypes, which response varied depending on host genetics. This finding enabled the identification of two microbes in the Eubacterium genus, potential mediator of Rg3 effect on osteosarcopenia. Oral administration of EN and EV differentially impacted bone density, muscle mass, exercise performance, and related gene expression in a mouse strain-specific manner. In 129S1 mice, EN and EV significantly improved these parameters, effectively reversing osteosarcopenic phenotypes. Mechanistic investigations revealed that these effects were mediated through the modulation of osteoblast differentiation and protein degradation pathways. In contrast, EN and EV did not significantly improve osteosarcopenic phenotypes in B6 mice, although they did modulate mitochondrial biogenesis and microbial diversity.

CONCLUSIONS

Our findings underscore the complex interplay between host genetics and the gut microbiota in osteosarcopenia and emphasize the need for personalized treatment strategies. EN and EV exhibit strain-specific therapeutic effects, suggesting that tailoring microbial interventions to individual genetic backgrounds may be crucial for optimizing treatment outcomes. Video Abstract.

Genetic and environmental determinants of bone quality: a cross-sectional analysis of the Hungarian Twin Registry

There is abundant evidence that bone mineral content is highly heritable, while the heritability of bone quality (i.e. trabecular bone score [TBS] and quantitative ultrasound index [QUI]) is rarely investigated. We aimed to disentangle the role of genetic, shared and unique environmental factors on TBS and QUI among Hungarian twins. Our study includes 82 twin (48 monozygotic, 33 same-sex dizygotic) pairs from the Hungarian Twin Registry. TBS was determined by DXA, QUI by calcaneal bone ultrasound. To estimate the genetic and environmental effects, we utilized ACE-variance decomposition. For the unadjusted model of TBS, an AE model provided the best fit with > 80% additive genetic heritability. Adjustment for age, sex, BMI and smoking status improved model fit with 48.0% of total variance explained by independent variables. Furthermore, there was a strong dominant genetic effect (73.7%). In contrast, unadjusted and adjusted models for QUI showed an AE structure. Adjustments improved model fit and 25.7% of the total variance was explained by independent variables. Altogether 70-90% of the variance in QUI was related to additive genetic influences. We found a strong genetic heritability of bone quality in unadjusted models. Half of the variance of TBS was explained by age, sex and BMI. Furthermore, the adjusted model suggested that the genetic component of TBS could be dominant or an epistasis could be present. In contrast, independent variables explained only a quarter of the variance of QUI and the additive heritability explained more than half of all the variance.

MicroRNAs and their Modulatory Effect on the Hallmarks of Osteosarcopenia

PURPOSE OF THE REVIEW

Osteosarcopenia is a geriatric syndrome associated with disability and mortality. This review summarizes the key microRNAs that regulate the hallmarks of sarcopenia and osteoporosis. Our objective was to identify components similarly regulated in the pathology and have therapeutic potential by influencing crucial cellular processes in both bone and skeletal muscle.

RECENT FINDINGS

The simultaneous decline in bone and muscle in osteosarcopenia involves a complex crosstalk between these tissues. Recent studies have uncovered several key mechanisms underlying this condition, including the disruption of cellular signaling pathways that regulate bone remodeling and muscle function and regeneration. Accordingly, emerging evidence reveals that dysregulation of microRNAs plays a significant role in the development of each of these hallmarks of osteosarcopenia. Although the recent recognition of osteosarcopenia as a single diagnosis of bone and muscle deterioration has provided new insights into the mechanisms of these underlying age-related diseases, several knowledge gaps have emerged, and a deeper understanding of the role of common microRNAs is still required. In this study, we summarize current evidence on the roles of microRNAs in the pathogenesis of osteosarcopenia and identify potential microRNA targets for treating this condition. Among these, microRNAs-29b and -128 are upregulated in the disease and exert adverse effects by inhibiting IGF-1 and SIRT1, making them potential targets for developing inhibitors of their activity. MicroRNA-21 is closely associated with the occurrence of muscle and bone loss. Conversely, microRNA-199b is downregulated in the disease, and its reduced activity may be related to increased myostatin and GSK3β activity, presenting it as a target for developing analogues that restore its function. Finally, microRNA-672 stands out for its ability to protect skeletal muscle and bone when expressed in the disease, highlighting its potential as a possible therapy for osteosarcopenia.

Sarcopenia

Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality. Although prevalence estimates vary because sarcopenia has been defined in different ways, even using a conservative approach, the prevalence is between 5% and 10% in the general population. A life course framework has been proposed for understanding not only the occurrence of sarcopenia in later life but also influences operating at earlier life stages with potentially important implications for preventive strategies. Harnessing progress in understanding the hallmarks of ageing has been key to understanding sarcopenia pathophysiology. Considerable convergence in approaches to diagnosis of sarcopenia has occurred over the last 10 years, with a growing emphasis on the central importance of muscle strength. Resistance exercise is currently the mainstay of treatment; however, it is not suitable for all. Hence, adjunctive and alternative treatments to improve quality of life are needed. An internationally agreed approach to definition and diagnosis will enable a step change in the field and is likely to be available in the near future through the Global Leadership Initiative in Sarcopenia.

The effectiveness of intravenous zoledronic acid in elderly patients with osteoporosis after rotator cuff repair: a retrospective study

The aim of this study was to investigate the effect of zoledronic acid (ZA) on postoperative healing and functional rehabilitation in osteoporotic patients with rotator cuff (RC) injury. 96 Patients were divided into three groups according to bone mineral density and ZA use (Group A: normal BMD; Group B: osteoporosis and intravenous ZA use; Group C: osteoporosis, without ZA use). Radiologic, functional and Serological outcomes were evaluated 6 months after surgery. The functional scores in all groups exhibited significant improvement 6 months after surgery. Inter-group comparison showed that Constant Shoulder joint function Score (CSS) of group A not significantly differing from that of group B, the other indicators were significantly better than those of group B and C. There were no significant differences in shoulder forward flexion, abductive Range of Motion between group B and C. Other indicators of group B were significantly improved compared to group C. The retear rate in group C (30.3%, 10/33) was higher than group A (6.1%, 2/33) and group B (13.3%, 4/30). In conclusion, the application of ZA can significantly reduce the rate of RC retear in elderly patients with osteoporosis after surgery, which is significant for postoperative shoulder joint functional rehabilitation.

Changes in Bone Mineral Density in Patients With Non-dialysis-Dependent Chronic Kidney Disease Are Associated With Body Composition

OBJECTIVE

Chronic kidney disease (CKD) and low bone mineral density (BMD) are highly prevalent and can co-exist. Parameters of mineral metabolism are associated with BMD in CKD, but other contributing factors may contribute. The aim of this study was to assess changes in BMD and its determinants in patients with nondialysis-dependent CKD (NDD-CKD).

METHODS

Body composition and biochemical profiles were assessed in a retrospective hospital-based cohort study of patients with NDD-CKD. BMD, lean soft tissue (LST), appendicular LST (ALST), and percentage fat mass were assessed by dual-energy X-ray absorptiometry. The ALST index (ALSTI, ALST/height2) and load-capacity index (LCI, fat mass/LST) were calculated. Low BMD was defined as T-score ≤ -1.0.

RESULTS

The mean time between assessments was 2.8 ± 1.3 years; 46 patients were included. A reduction in renal function was observed. Changes in body composition included reductions in ALST (P = .031), ALSTI (P = .021), a trend for BMD (P = .053), and an increase in percentage fat mass (P = .044) and LCI (P = .032). Females had a reduction in BMD (P = .034), ALST (P = .026), and ALSTI (P = .037). Patients with low BMD at baseline had lower LST (P = .013), ALST (P = .023), and percentage fat mass (P = .037) than those with normal BMD. Additionally, reductions in LST (P = .041), ALST (P = .006), and ALSTI (P = .008) were observed in patients who had low BMD at baseline, while no significant changes in body composition were observed in those with normal BMD at baseline. The following body composition parameters at baseline were determinants of BMD status at follow-up: LST (odds ratio [OR]: 0.899, 95% confidence interval [CI]: 0.829-0.976, P = .010), ALST (OR: 0.825, 95% CI: 0.704-0.967, P = .017), and ALSTI (OR: 0.586, 95% CI: 0.354-0.968, P = .037), independent of fat mass and LCI.

CONCLUSIONS

Detrimental body composition changes were observed without changes in body weight; these were more significant in females. Moreover, this is the first longitudinal study showing a protective effect of LST against BMD loss in patients with NDD-CKD.

Sarcopenia and self-reported markers of physical frailty in patients with osteoporosis

Bone and muscle impairment, named osteoporosis and sarcopenia, may co-occur with age, and patients with both disorders might exhibit physical frailty. One-hundred sixty-three patients were included. 14.2% had both disorders and presented more frequent with previous fall, reduced daily activity level, walk/balance challenges, and need of walking aid, indicating overall frailty.

PURPOSE

In older adults, sarcopenia (muscle impairment) and physical frailty may accompany osteoporosis (bone brittleness), yet osteoporosis is typically assessed without evaluating these conditions, even though coexistence may contribute to exacerbated negative health outcomes. We aimed at evaluating the prevalence of sarcopenia and impaired muscle domains in osteoporotic patients and explore the risk of osteosarcopenia from markers of physical frailty.

METHODS

In Copenhagen, Denmark, osteoporotic patients aged 65 + were assessed cross-sectionally in 2018-2019. Evaluations included muscle mass, strength, and function; bone mineral density; and self-reported physical activity, fall, balance challenges, dizziness, and the need of walking aid. Low bone mass, low-energy fracture, or treatment with anti-osteoporotic medication defined patient with osteoporosis, and sarcopenia was defined by low muscle strength and mass. Osteosarcopenia was defined from the coexistence of both conditions.

RESULTS

One-hundred sixty-three patients with osteoporosis were included. Of those, 23 (14.2%) exhibited sarcopenia, hence osteosarcopenia. Hand-grip-strength, 30-s-chair-stand-test, relative-appendicular-lean-muscle-mass, and gait-speed were below cut-off levels in 21.0%, 30.9%, 28.8%, and 23.6% of the patients, respectively. Previous fall, activity level, walk and balance challenges, and need of walking aid were statistically (or borderline) significantly more often affected in the osteosarcopenic group compared with the solely osteoporotic. Logistic regression analysis, however, revealed that only the need for walking aid significantly increased the risk of an osteosarcopenia diagnosis (odds ratio 5.54, 95% CI (1.95-15.76), p < 0.01).

CONCLUSIONS

Sarcopenia and impaired muscle domains were frequent in osteoporotic patients, as were markers of physical frailty, indicating the need of thorough examination of osteoporotic patients.

The role of thiol-disulfide homeostasis and ischemia-modified albumin in osteosarcopenia

BACKGROUND

Oxidative stress results from an imbalance between the induction of reactive oxygen species and the ability of cells to metabolize them. Numerous markers can be used to assess the level of oxidative stress. Thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA) are some of them. The aim of this study is to investigate the role of TDH and IMA, which are indicators of oxidative stress, in older patients with osteosarcopenia (OS).

METHODS

The study was conducted cross-sectionally in a geriatrics outpatient clinic. Patients who applied to the outpatient clinic for three months were included in the study. Patients with acute infection, delirium, malignancy, severe liver, heart or kidney dysfunction and who did not give their consent for the study were excluded from the study. The study was conducted with 136 patients. Sarcopenia was diagnosed according to muscle ultrasonography (USG) and handgrip strength (HGS) results. Osteopenia/osteoporosis was diagnosed according to bone mineral densitometry (BMD) results. The combination of osteopenia/osteoporosis and sarcopenia was accepted as OS.

RESULTS

Native thiol, total thiol value and nativethiol /totalthiol*100 values were significantly lower in the group with OS (respectively; value = 265 ± 53.8 standard deviation (SD) μmol/L, p =  ≤ 0.001; value = 295.33 ± 55.77 SD μmol/L, p = 0.001; value = 90.06 (2.8) interquartile ranges (IQR), p = 0.033). Disulfide/native thiol*100 and disulfide/total thiol*100 values were significantly higher in the group with OS (respectively; value = 5.5 (1.7) IQR, p = 0.033; value = 4.97 (1.4) IQR, p = 0.034).

CONCLUSION

In our study, the role of oxidative stress in OS was demonstrated by using TDH as an oxidative stress parameter.

The Role of the Kynurenine Pathway in the Pathophysiology of Frailty, Sarcopenia, and Osteoporosis

Tryptophan is an essential nutrient required to generate vitamin B3 (niacin), which is mainly involved in energy metabolism and DNA production. Alterations in tryptophan metabolism could have significant effects on aging and musculoskeletal health. The kynurenine pathway, essential in tryptophan catabolism, is modulated by inflammatory factors that are increased in older persons, a process known as inflammaging. Osteoporosis, sarcopenia, osteosarcopenia, and frailty have also been linked with chronically increased levels of inflammatory factors. Due to the disruption of the kynurenine pathway by chronic inflammation and/or changes in the gut microbiota, serum levels of toxic metabolites are increased and are associated with the pathophysiology of those conditions. In contrast, anabolic products of this pathway, such as picolinic acid, have demonstrated a positive effect on skeletal muscle and bone. In addition, physical activity can modulate this pathway by promoting the secretion of anabolic kynurenines. According to the evidence collected, kynurenines could have a promising role as biomarkers for osteoporosis sarcopenia, osteosarcopenia, and frailty in older persons. In addition, some of these metabolites could become important targets for developing new pharmacological treatments for these conditions.

Proceedings of the Post-Genome Analysis for Musculoskeletal Biology Workshop

PURPOSE OF THE REVIEW

Herein, we report on the proceedings of the workshop entitled "Post-Genome analysis for musculoskeletal biology" that was held in July of 2022 in Safed, Galilee, Israel. Supported by the Israel Science Foundation, the goal of this workshop was to bring together established investigators and their trainees who were interested in understanding the etiology of musculoskeletal disease, from Israel and from around the world.

RECENT FINDINGS

Presentations at this workshop spanned the spectrum from basic science to clinical studies. A major emphasis of the discussion centered on genetic studies in humans, and the limitations and advantages of such studies. The power of coupling studies using human data with functional follow-up studies in pre-clinical models such as mice, rats, and zebrafish was discussed in depth. The advantages and limitations of mice and zebrafish for faithfully modelling aspects of human disease were debated, specifically in the context of age-related diseases such as osteoporosis, osteoarthritis, adult-onset auto-immune disease, and osteosarcopenia. There remain significant gaps in our understanding of the nature and etiology of human musculoskeletal disease. While therapies and medications exist, much work is still needed to find safe and effective interventions for all patients suffering from diseases associated with age-related deterioration of musculoskeletal tissues. The potential of forward and reverse genetic studies has not been exhausted for diseases of muscles, joints, and bones.

Prevalence and associated factors of sarcopenia in community-dwelling older adults at risk of malnutrition

BACKGROUND

There is an increasingly strong association between sarcopenia and malnutrition in research findings. We aimed to determine the prevalence and factors associated with sarcopenia in community-dwelling older adults (≥ 65 years) at risk of malnutrition based on Malnutrition Universal Screening Tool (MUST).

METHODS

This was a cross-sectional study of 811 participants. Participants were recruited from the general population, community centers, senior activity centers, polyclinics, and hospital. Community-dwelling older adults at risk of malnutrition participated in the study. Participants' data and measurements were collected at the baseline visit. Data included socio-demographic information, anthropometric measurements, body composition, dietary intakes, and functional assessments. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 consensus.

RESULTS

Of the 694 participants with complete datasets, overall prevalence of sarcopenia was 76% (n = 530); 57% (n = 393) had severe sarcopenia. In the overall cohort, compared to participants without sarcopenia, those with sarcopenia were older, had lower physical activity scale for the elderly score, leg strength, handgrip endurance, mid-upper arm circumference, calf circumference, and bone mass, and had lower dietary protein intake and poorer nutritional status (all p ≤ 0.015). After adjusting for confounders, sarcopenia was significantly associated with older age, male gender, higher risk of malnutrition, lower calf circumference, and lower bone mass (all p ≤ 0.044).

CONCLUSIONS

In community-dwelling older adults at risk of malnutrition, there is a high prevalence of sarcopenia and severe sarcopenia. As such, screening positive for either malnutrition risk or sarcopenia in older adults should prompt screening for the other risk factor, to allow early institution of disease modifying interventions to forestall adverse outcomes for both malnutrition and sarcopenia.

TRIAL REGISTRATION

The study was registered at clinicaltrials.gov as NCT03245047 .

Is sarcopenia associated with osteoporosis? A cross-sectional study of 262 women with hip fracture

BACKGROUND

Several lines of evidence support the view that sarcopenia and osteoporosis are strictly connected. However, the capability of the updated sarcopenia definition to capture the concomitant presence of osteoporosis has been scarcely investigated.

AIM

The main aim was to assess the association between sarcopenia defined according to the revised criteria from the European Working Group on Sarcopenia in Older People (EWGSOP2) and osteoporosis in women with a hip fracture. A second aim was to investigate the thresholds for low appendicular lean mass (aLM) and handgrip strength to optimize osteoporosis detection.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation hospital.

POPULATION

Women with subacute hip fracture.

METHODS

A scan by dual-energy X-ray absorptiometry (DXA) was performed to assess body composition. A Jamar dynamometer was used to measure handgrip strength. Sarcopenia was diagnosed with both handgrip strength <16 kg and aLM <15 kg. Osteoporosis was identified with femoral bone mineral density lower than 2.5 standard deviations below the mean of the young reference population.

RESULTS

We studied 262 of 290 women. Osteoporosis was found in 189 of the 262 women (72%; 95% CI: 67-78%) whereas sarcopenia in 147 (56%; 95% CI: 50-62%). After adjustment for age, time interval between fracture and DXA scan and body fat percentage the odds ratio to have osteoporosis for a sarcopenic woman was 2.30 (95% CI: 1.27-4.14; P=0.006). Receiver operating characteristic curve analyses showed that the best cut-off points to discriminate osteoporosis were 20 kg for handgrip strength and 12.5 kg for aLM. Adopting the optimized thresholds to define sarcopenia, the adjusted odds ratio to have osteoporosis for a sarcopenic woman was 3.68 (95% CI: 1.93-7.03; P<0.001).

CONCLUSIONS

This preliminary study shows a positive association between sarcopenia defined according to the EWGSOP2 criteria and osteoporosis in 262 women with hip fracture. The association may be bettered by refining the cut-off points for low aLM and handgrip strength.

CLINICAL REHABILITATION IMPACT

Sarcopenia seems to be a risk factor for osteoporosis in hip-fracture women. The issue, and the potential role of optimized thresholds should be addressed by robust longitudinal studies.

Osteosarcopenia: A Narrative Review on Clinical Studies

Osteosarcopenia (OS) is defined by the concurrent presence of osteopenia/osteoporosis and sarcopenia. The pathogenesis and etiology of OS involve genetic, biochemical, mechanical, and lifestyle factors. Moreover, an inadequate nutritional status, such as low intake of protein, vitamin D, and calcium, and a reduction in physical activity are key risk factors for OS. This review aims to increase knowledge about diagnosis, incidence, etiology, and treatment of OS through clinical studies that treat OS as a single disease. Clinical studies show the relationship between OS and the risk of frailty, falls, and fractures and some association with Non-communicable diseases (NCDs) pathologies such as diabetes, obesity, and cardiovascular disease. In some cases, the importance of deepening the related mechanisms is emphasized. Physical exercise with adequate nutrition and nutritional supplementations such as proteins, Vitamin D, or calcium, represent a significant strategy for breaking OS. In addition, pharmacological interventions may confer benefits on muscle and bone health. Both non-pharmacological and pharmacological interventions require additional randomized controlled trials (RCT) in humans to deepen the synergistic effect of exercise, nutritional interventions, and drug compounds in osteosarcopenia.

Musculoskeletal Changes Across the Lifespan: Nutrition and the Life-Course Approach to Prevention

Aging is characterized by the progressive decline of muscle mass and function, the so-called sarcopenia. Also bone loss is widespread among older people. Sarcopenia and osteopenia/osteoporosis are associated with several adverse outcomes including falls, risk of fractures, functional decline, frailty, and mortality. Recently, the life-course approach to prevent or delay functional decline has become very popular. Regarding musculoskeletal health, there is suggestive evidence that acting during critical or sensitive periods of life in which each person build-up its biological reserves may influence the rate of functional decline in the later stages of life. A life-course approach to musculoskeletal health should take place during early life when plasticity allows more easily the attainment of the peak of the musculoskeletal system driven by environmental stimuli. The rate of the subsequent decline will depend on the peak previously reached. Nutrition and physical exercise are important environmental factors that can influence musculoskeletal development by favoring and maintaining peak bone and muscle mass and strength. Here we provide an overview of body composition changes occurring across the lifespan and strategies based on nutrition and physical exercise to support musculoskeletal health as well as minimizing losses during older life.

Impact of bone-active drugs and underlying disease on bone health after lung transplantation: A longitudinal study

INTRODUCTION

the effect of bone-active drugs on the risk of fragility fractures (Fx), bone mineral density (BMD) and trabecular bone score (TBS) changes in patients receiving lung transplantation (LTx) is largely unknown. This study assessed the bone-active drugs effect in patients undergoing LTx both with (CF) and without (nCF) cystic-fibrosis.

METHODS

We evaluated incident Fx, both clinical and morphometric vertebral Fx by spinal X-ray, BMD and trabecular bone score (TBS) in 117 patients (CF=50, nCF n = 67) before and 24-months after LTx. A bone-active therapy was proposed to all LTx candidates.

RESULTS

83.8% of patients started a bone-active drug. Lumbar-spine (LS) T-score improved significantly only in treated patients (-1.4 ± 1.0 vs -2.0±1.0, p = 0.0001), whereas femur BMD and TBS remained stable in treated and not treated subjects. The rate of incident Fx was 15.3%, with no difference between treated and not treated patients. After LTx, LS T-score improved significantly only in nCF group (-1.3 ± 1.0 vs -1.8 ± 1.1, p = 0.0001), while femur remained stable in both nCF and CF groups. Patients with CF showed a significant Z-TBS increase (-3.6 ± 1.7 vs -3.0 ± 1.7, p = 0.019) and a lower Fx incidence as compared with nCF patients (4.1% vs 24.2%, p  =0.003). Incident Fx were associated with nCF diagnosis (OR 7.300, CI95% 1.385-38.461, p = 0.019) regardless of prevalent Fx, previous glucocorticoid therapy and bone-active therapy introduced at least 6 months before LTx.

CONCLUSIONS

A prompt medical intervention helps in preventing BMD loss after LTx. As compared with nCF patients, CF patients show a TBS increase and a lower Fx risk after LTx.

Dietary calcium, phosphorus, and osteosarcopenic adiposity in Korean adults aged 50 years and older

Calcium and phosphorus intake showed a significant negative relationship with osteosarcopenia and osteosarcopenic adiposity in Korean adults aged 50 years or older.

PURPOSE

Osteosarcopenic adiposity (OSA) is a syndrome accompanied by low bone mass, low muscle mass, and adiposity, and the association of the individual OSA components with dietary factors is considerable. The aim of this study was to investigate the association between the intake of dietary calcium and phosphorus and individual and/or combined bone-, muscle-, and fat mass-related abnormalities in body composition (components of OSA).

METHODS

This study investigated the relationship between OSA-related components and the intake of calcium and phosphorus in subjects aged 50 years and older (n = 7007) using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011.

RESULTS

After adjusting for various confounding factors that affect OSA, the groups with a low calcium intake (below the median value) had a significantly higher risk of osteosarcopenia (OR = 1.768, 95% CI: 1.018-3.073; p = 0.0432) and OSA (OR = 1.505, 95% CI: 1.040-2.180; p = 0.0304) compared to the groups with a high calcium intake (equal to or above the median value). In addition, phosphorus intake showed a significant negative relationship with sarcopenic adiposity.

CONCLUSION

In conclusion, the intake of calcium is associated with a lower risk of osteosarcopenia and OSA in Korean adults aged 50 years and older. These results will serve as baseline data on mineral intake for the management of multiple OSA-related components.

Health Promoting Behaviors, Health Needs and Associated Factors among Older Adults in Jordan: A Cross-Sectional Study

BACKGROUND

Several factors affect older adults' engagement in HPBs. This study aimed to examine HPBs, health needs, and associated factors among older adults in Jordan.

METHODS

A cross-sectional study was conducted on 220 older adults at one governmental and one university hospital, which were selected using convenience sampling for geographical closeness to the researchers. All older adults with no cognitive or communication problems who attended the outpatient clinics of the two hospitals from December 2018 to April 2019 were included in the study. This time period was chosen based on the convenience of the participants and researchers. Data were collected by An Arabic version of the Health-Promoting Lifestyle Profile (HPLP) and a demographic questionnaire. The Statistical Package for Social Science (SPSS) 25.0 software was used for the descriptive and inferential analysis of the study data. The level of significance was set at P<0.05.

RESULTS

The mean score of the total HPLP was 125.33±19.09. The marital status and educational level of the participants were associated with the total HPLP (P<0.001) in all its dimensions, except for the dimension of interpersonal relations. Participants with chronic diseases had lower scores than those without diseases for the total HPLP (P<0.001) in all the six dimensions. Family income was positively correlated with the dimensions of nutrition (P=0.007) and exercise (P=0.002).

CONCLUSION

Despite the good overall mean score of older adults for total HPLP and some of its subscales, their levels of exercise and physical activity need to be promoted. The scores of older adults were related to various demographic and clinical factors.

Sarcopenia and Bone Mass Loss as Risks during Aging on Female Elderly with Light Activity

BACKGROUND: Aging is a normal physiological process. The aspect of aging can be delayed by a measurable activity that is carried out early and regularly also intake health nutrition. Measurement of body composition is needed to analyze physiological changes due to aging so it can be used to compile a program of activities also diet to delay the aging process. AIM: The aim of this study is to address the potential risks during aging process in people with light physical activity in Gamping, Patukan. METHODS: Method of this research is the cross-sectional method. Subjects were 190 females with light physical activity that divided into Group 1 (70 females) with an average age 43.71 ± 5.37 years old and Group 2 (120 females) with an average age 61.72 ± 6.82 years old. Body composition was measured by the whole body composition diagnostic scale BG21. RESULTS: The result showed that t-test between Group 1 and Group 2 was significant differences p < 0.05, CI = 0.95 in weight body, body mass index (BMI), muscle mass, bone mass, and active metabolism rate (AMR). The percentage decreasing number for body composition was 13.5%, 12.5%, 8.9%, 4.2%, 25.9%, and 12.8% on weight, BMI, muscle mass, bone mass, and AMR, respectively. CONCLUSION: Female with light activity has a risk as sarcopenia and bone loss during aging. The future programme of this community need to encourage of increasing the physic activity and improving life style to slow the bone loss and muscle loss.

Appendicular Muscle Mass, Thigh Intermuscular Fat Infiltration, and Risk of Fall in Postmenopausal Osteoporotic Elder Women

BACKGROUND

The association between the quantity and composition of skeletal muscle and the decline in physical function in elderly is poorly understood. Therefore, the primary aim of this cross-over study was to investigate the association between thigh intermuscular adipose tissue (IMAT) infiltration, appendicular muscle mass, and risk of fall in postmenopausal osteoporotic elder women. Second, we examined the differences in muscle mass, IMAT, and risk of fall in the same sample of older subjects after being classified as sarcopenic or nonsarcopenic on the basis of the dual-energy X-ray absorptiometry (DXA)-based Appendicular Skeletal Muscle Mass Index (ASMMI).

METHODS

Twenty-nine subjects (age: 72.4 ± 6.8; BMI: 23.0 ± 3.3; and T-score: -2.7 ± 0.2) completed the following clinical evaluations: (1) whole-body DXA to assess the ASMMI; (2) magnetic resonance to determine the cross-sectional muscle area (CSA) and IMAT of thigh muscles, expressed both in absolute (IMATabs) and relative (IMATrel) values; and (3) risk of fall assessment through the OAK system (Khymeia, Noventa Padovana, Italy). The existence of a correlation between the risk of fall (OAK scores, an automated version of the Brief-BESTest) and the clinical parameters (ASMMI, CSA, IMATrel, and IMATabs) was tested by the Pearson's correlation index while data homogeneity between sarcopenic and nonsarcopenic subjects was tested through unpaired Student t tests or with the Mann-Whitney rank test. Effect sizes (ES) were used to determine the magnitude of the effect for all significant outcomes.

RESULTS

Eleven subjects were classified as sarcopenic and 18 as nonsarcopenic based on their ASMMI (cutoff value: 5.5 kg/m2). A positive correlation between OAK and CSA was observed (r2 = 0.19; p = 0.033), whereas a negative correlation between OAK and IMATrel was detected (r2 = 0.27; p = 0.009). No correlations were observed between OAK and ASMMI and between ASMMI and IMATrel. Sarcopenic subjects showed significantly lower weight (p = 0.002; ES = 1.30, large), BMI (p = 0.0003; ES = 1.82, large), CSA (p = 0.010; ES = 1.17, moderate), and IMATabs (p = 0.022; ES = 1.63, large) than nonsarcopenic individuals, whereas OAK scores and IMATrel were similar between groups.

DISCUSSION/CONCLUSION

Increased IMAT and lower CSA in the thigh muscles are associated with higher risk of fall while ASMMI, a value of appendicular muscle mass, was not associated with physical performance in older adults.

Nutritional Orthopedics and Space Nutrition as Two Sides of the Same Coin: A Scoping Review

Since the Moon landing, nutritional research has been charged with the task of guaranteeing human health in space. In addition, nutrition applied to Orthopedics has developed in recent years, driven by the need to improve the efficiency of the treatment path by enhancing the recovery after surgery. As a result, nutritional sciences have specialized into two distinct fields of research: Nutritional Orthopedics and Space Nutrition. The former primarily deals with the nutritional requirements of old patients in hospitals, whereas the latter focuses on the varied food challenges of space travelers heading to deep space. Although they may seem disconnected, they both investigate similar nutritional issues. This scoping review shows what these two disciplines have in common, highlighting the mutual features between (1) pre-operative vs. pre-launch nutritional programs, (2) hospital-based vs. space station nutritional issues, and (3) post-discharge vs. deep space nutritional resilience. PubMed and Google Scholar were used to collect documents published from 1950 to 2020, from which 44 references were selected on Nutritional Orthopedics and 44 on Space Nutrition. Both the orthopedic patient and the astronaut were found to suffer from food insecurity, malnutrition, musculoskeletal involution, flavor/pleasure issues, fluid shifts, metabolic stresses, and isolation/confinement. Both fields of research aid the planning of demand-driven food systems and advanced nutritional approaches, like tailored diets with nutrients of interest (e.g., vitamin D and calcium). The nutritional features of orthopedic patients on Earth and of astronauts in space are undeniably related. Consequently, it is important to initiate close collaborations between orthopedic nutritionists and space experts, with the musculoskeletal-related dedications playing as common fuel.

Osteoporosis in older adults

The incidence of fragility fractures increases progressively with advance in age after 50 years, and the phenomenon of population ageing will lead to an increased proportion of the world population having osteoporosis and fractures. The consequences of fractures are more serious in older adults: all low-trauma fractures were associated with increased mortality risk and the risk of a second major osteoporotic fracture after a first one also increased with advance in age. Along with the decrease in bone mineral density, falls play an essential role in the occurrence of fragility fractures in older adults, and the assessment of the risk of falling is part of the fracture risk assessment. Despite advances in the diagnosis of osteoporosis, the assessment of fracture risk, and a wide range of effective anti-osteoporosis medications, with parenteral route which can improve observance, many data indicate that the therapeutic care gap is particularly wide in the elderly in whom the importance and impact of a treatment are high and even more in those living in institutions.

Vitamin D supplementation for improving children with bone mineral density: A protocol for systematic review and meta-analysis

BACKGROUND

Osteoporosis is usually one of the less perceived complications of chronic illness among children. Previous studies have shown that vitamin D supplementation may be valuable to bone density, especially among children with a deficiency of vitamin D. Yet, the results often remain inconsistent. Therefore, the present study investigates the clinical therapeutic effects of vitamin D supplementation to enhance children with bone mineral density.

METHODS

We will search the randomised controlled experiment literature of vitamin D supplementation for bone mineral density, focusing on children, in 3 distinct English databases (EMBASE, MEDLINE via PubMed, and Cochrane Library) and 2 specific Chinese databases (China National Knowledge Infrastructure (CNKI) and WanFang databases). Additionally, we intend to explore the Clinical Trials.gov, reference lists of identified publication and the grey literature. Accordingly, we will use 2 independent authors to screen the literature, extract data, and research quality assessment. We will carry out all statistical analyses using RevMan 5.3 software.

RESULTS

We will systematically evaluate the clinical therapeutic effects of vitamin D supplementation to enhance children with bone mineral density.

CONCLUSION

The present study will summarise the currently published pieces of evidence of vitamin D supplementation for bone mineral density in children to further comprehend its promotion and application.

ETHICS AND DISSEMINATION

The present study is a systematic review and meta-analysis founded upon existing or published studies; therefore, ethical approval is not applicable.

OSF REGISTRATION NUMBER

October 24, 2020. osf.io/7vtey. (https://osf.io/7vtey/).