Functional status and calcaneal quantitative ultrasound measurements among the oldest old people living in rural areas of Korea

The under-recognition and significance of frailty syndrome - a geriatric and forensic conundrum

Frailty syndrome occurs in elderly individuals with declining muscle mass (sarcopenia), unintentional weight loss, decreasing physical strength and activity, exhaustion, and slow ambulation. It significantly increases morbidity and mortality with cardiovascular, renal disease and neurological disorders, osteoporosis and fractures, endocrine and immunological dysfunction and a variety of malignancies. It is increasing in incidence as the population ages. However, unfortunately as identification relies on clinical and not pathological evaluations, its contribution to a wide range of comorbidities and its role in terminal episodes may not be recognized in a forensic context.

Dipstick Proteinuria and Reduced Estimated Glomerular Filtration Rate as Independent Risk Factors for Osteoporosis

BACKGROUND

Osteoporosis is associated with a poor quality of life and mortality. Proteinuria contributes to vitamin D deficiency and osteoblast dysfunction. The correlation between estimated glomerular filtration rate (eGFR) and bone density still remains elusive. Therefore, we sought to investigate whether reduced eGFR or proteinuria are independently associated with the osteoporotic risk.

METHODS

We conducted a cross-sectional study using community-based health survey data from January 2004 to December 2008 in southern Taiwan. Positive proteinuria was defined as presence of 1+ or more urinary proteins on the dipstick. The bone density was measured by calcaneal quantitative ultrasound (QUS). Subjects with T-score ≤ -2.5 were considered as osteoporotic.

RESULTS

A total of 21,271 subjects of whom 11.3% had proteinuria were analyzed. Proteinuric participants were older, predominantly male, and more likely to have diabetes, hypertension, or exercise less regularly (P < 0.001). Multiple linear regression analysis showed that male sex, body mass index, regular exercise, eGFR and high density lipoprotein-cholesterol were positively correlated with QUS T-scores, whereas age, systolic blood pressure and proteinuria were negatively associated with QUS T-scores (P < 0.01). Compared with subjects in the highest eGFR tertile, those in the middle and the lowest groups had adjusted ORs for osteoporosis of 1.31 (95% CI: 1.20-1.44) and 2.46 (1.73-3.48), respectively. Additionally, the fully adjusted ORs of osteoporosis were 1.15 (1.02-1.32) and 1.18 (1.05-1.33) for participants with 1+ and ≥2+ proteinuria, respectively.

CONCLUSIONS

Reduced eGFR and proteinuria are significantly associated with risk for osteoporosis.

Frailty syndrome - Medicolegal considerations

The frailty syndrome refers to the concurrence of a number of specific clinical manifestations that include unintentional weight loss, decreased muscle mass (sarcopenia), exhaustion, reduced physical strength and activity, and slow ambulation. It involves multiple systems, is an increasing problem in elderly populations, and is strongly associated with increases in both morbidity and mortality. Despite its recognition clinically, the frailty syndrome is not often identified in forensic situations and is only infrequently mentioned in the associated literature. As there is a direct relationship between the frailty syndrome and significant adverse health outcomes the syndrome has clear medicolegal significance.

The frailty syndrome: a comprehensive review

The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.