Sarcopenia, osteoporosis and frailty

Association of serum neurofilament light chain and bone mineral density in adults

BACKGROUND

Serum neurofilament light chain (sNFL) is a blood-based marker of neuroaxonal damage increasingly used in neurological research. Although sNFL has been linked to systemic aging and chronic disease, its relationship with bone mineral density (BMD) remains unclear.

METHODS

We analyzed data from 1,344 participants aged ≥ 20 years in the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Serum sNFL concentrations were measured using a high-sensitivity immunoassay. Lumbar BMD was assessed by dual-energy X-ray absorptiometry. Multivariable linear regression models were used to evaluate associations between log-transformed sNFL and BMD, adjusting for demographic, lifestyle, metabolic, renal, cognitive, and bone-related covariates. Sensitivity analyses examined osteoporosis, defined as physician diagnosis or T-score ≤ - 2.5, as a binary outcome.

RESULTS

Higher sNFL levels were significantly associated with lower lumbar BMD (fully adjusted β = - 0.02 g/cm² per 1-unit increase in ln-sNFL; 95% CI: - 0.04, - 0.01; P = 0.0089). Compared with the lowest quartile, participants in the highest quartile had a 0.04 g/cm² lower BMD (P for trend = 0.011). Sensitivity analyses confirmed higher odds of osteoporosis with increasing sNFL levels (Q4 vs. Q1 OR = 2.70, 95% CI: 1.69, 4.31, P < 0.001).

CONCLUSION

Elevated serum sNFL concentrations are independently associated with lower lumbar spine BMD in U.S. adults. These findings suggest that sNFL may serve as an exploratory marker of systemic vulnerability relevant to bone health, warranting further longitudinal and mechanistic investigation.

Osteosarcopenia, osteoarthritis and frailty: a two-sample Mendelian randomization study

BACKGROUND

Musculoskeletal disease, which has a complicated relationship with frailty, is a common clinical problem among elderly individuals.

AIMS

This study evaluated the potential causal relationships between osteosarcopenia, osteoarthritis and frailty by Mendelian Randomization (MR) analysis.

METHODS

This study employed a two-sample MR approach to investigate the causal relationships among osteosarcopenia, osteoarthritis and frailty. Published summary statistics were used to obtain instrumental variables at the genome-wide significance level.

RESULTS

Among the age groups with osteoporosis, high total bone mineral density (TBMD) (45-60, OR = 0.966, 95% CI 0.940-0.993, P = 0.013) and TBMD (over 60, OR = 0.974, 95% CI 0.954-0.994, P = 0.011) reduced the risk of frailty. Similarly, high forearm BMD (FA-BMD), high ultradistal forearm BMD (UFA-BMD), and high Heel-BMD at different sites also reduced the risk of frailty (OR = 0.966, 95% CI 0.936-0.996, P = 0.028; OR = 0.975, 95% CI 0.953-0.997, P = 0.029; OR = 0.981, 95% CI 0.967-0.995, P = 0.008). Among the characteristics related to sarcopenia, grip strength in the left hand, grip strength in the right hand, appendicular lean mass, and walking pace were all protective factors for frailty (OR = 0.788, 95% CI 0.721-0.862, P < 0.001; OR = 0.800, 95% CI 0.737-0.869, P < 0.001; OR = 0.955, 95% CI 0.937-0.974, P = 0.000; OR = 0.480, 95% CI 0.388-0.593, P < 0.001), with low grip strength in those over 60 years of age significantly positively correlated with frailty (OR = 1.168, 95% CI 1.059-1.289, P = 0.002). The MR results of osteoarthritis and frailty revealed a causal relationship between specific joint sites and frailty, including KOA (OR = 1.086, 95% CI 1.017-1.160, P = 0.014), HOA (OR = 1.028, 95% CI 1.007-1.049, P = 0.009), and KOA/HOA (OR = 1.082, 95% CI 1.053-1.113, P = 0.000), increasing the risk of frailty.

CONCLUSION

Osteosarcopenia, osteoarthritis and frailty exhibit significant causal effects, rendering them risk factors for frailty. Therefore, in clinical practice, patients with osteosarcopenia and osteoarthritis should be required to undergo relevant interventions to reduce the risk of frailty.

Cardiometabolic index is negatively associated with the risk of sarcopenia in the middle aged and elderly Chinese: the first longitudinal evidence from CHARLS

BACKGROUND

The association between sarcopenia and cardiometabolic index (CMI) among the Chinese elderly adults remains unclear. The present study aimed to examine the association based on a national survey.

METHODS

Data from China Health and Retirement Longitudinal Study (CHARLS, wave 2011 and 2015) were employed. All subjects met the inclusion criteria were classified by the median of CMI. Four logistic regression models were established to explore the cross-sectional and longitudinal associations between CMI and sarcopenia. Subgroups analysis, tendency analysis, etc. were conducted to testify the robustness of the association. The non-linear relationship was explored using restricted cubic spline (RCS).

RESULTS

5,016 participants were enrolled in this study. The ORs of the longitudinal analysis in the models were 0.42(0.34,0.53), 0.37(0.29,0.46), 0.40(0.31,0.51) and 0.42(0.33,0.53)), respectively. Similar results were also found after propensity score matching (PSM), inverse probability weighting (IPTW) and cross-sectional analysis. Moreover, a non-linear relationship was found between CMI and sarcopenia in the total participants (both p for overall and p for non-linear < 0.001).

CONCLUSION

A U-shaped relationship between CMI and sarcopenia risk was found in the middle aged and elderly Chinese, with both deficient and excessive CMI levels showing detrimental effects. Maintaining a moderate CMI significantly diminishes the risk of sarcopenia.

Changes and trends in mortality, disability-adjusted life years, life expectancy, and healthy life expectancy in China from 1990 to 2021: a secondary analysis of the global burden of disease 2021

BACKGROUND

The aging population in China is increasingly evident, leading to a shift in the patterns of disease burden. This study aims to investigate changes and trends in mortality, disability-adjusted life years (DALYs), life expectancy (LE), and health-adjusted life expectancy (HALE) in China from 1990 to 2021.

METHODS

This study presents a secondary analysis of data from the Global Burden of Disease Study 2021, with a focus on mortality, DALYs, LE, and HALE. We examined changes in these indicators in China from 1990 to 2021, comparing them with global averages and across five SDI regions. Using Joinpoint Regression Software, we analyzed trends in the top ten cause-specific DALY rates in 2021. Furthermore, we employed the Bayesian Age-Period-Cohort model to forecast age-standardized rates (ASR) of mortality for the next decade.

RESULTS

China witnessed a decrease in the ASRs of mortality (1198.16/100,000 [1098.61-1294.10] to 644.68/100,000 [555.12-735.51]) and DALYs (43085.42/100,000 [39330.62-47273.39] to 22717.19/100,000 [19748.18-25903.34]) from 1990 to 2021. During the COVID-19 pandemic, the ASRs of mortality and DALY declined in China (23009.47/100,000 [19661.21-26495.58] in 2019), but global rates and those across the five SDI (Socio-demographic Index) regions increased. Projections indicate a continued decline in the ASRs of mortality over the next decade, from 2019 to 2035 and 2021 to 2035. Notably, DALY rates for the top 10 level 2 causes in 2021 decreased over the past three decades, except for musculoskeletal disorders (AAPC% 95%CI, 0.10 [0.07-0.14], men; 0.05 [-0.02-0.13], women) and sense organ diseases (AAPC% 95%CI, 0.38 [0.33-0.43], men; 0.35 [0.30-0.41], women). LE and HALE increased across all age groups in China over the same period, although there was no significant change in the HALE/LE ratio.

CONCLUSION

Effective policy implementation and technological advancements could play a crucial role in alleviating disease burdens associated with aging in China, thereby reducing the country's all-cause mortality rate and enhancing the quality of life for its residents.

Narrative review: nutritional strategies for ageing populations - focusing on dysphagia and geriatric nutritional needs

The increase in elderly populations worldwide highlights the urgency of addressing age-related problems through effective nutritional management to enhance the well-being of the elderly and for the prevention and treatment of various diseases. The trend towards an increasing elderly population brings with it an increase in conditions such as sarcopenia, osteosarcopenia and frailty, emphasising the importance of regular checks for malnutrition in the elderly and the implementation of personalised nutritional therapies. The importance of nutrition in addressing geriatric syndromes such as frailty, sarcopenia, osteosarcopenia, obesity and metabolic syndrome is highlighted. Dysphagia, frequent in the elderly, requires special attention to prevent malnutrition and complications. It is essential to maintain muscle mass and bone health in old age. In this review we investigate the fundamental role of nutrition in geriatrics, focusing on promoting healthy ageing and managing problems such as malnutrition and overeating. The importance of protein intake and healthy dietary patterns such as the Mediterranean diet are then discussed. Finally, the challenges of personalised nutritional care, including the need for artificial nutrition or oral supplements, to improve quality of life and health care in an ageing society are addressed.

Osteosarcopenia in Chronic Kidney Disease: An Overlooked Syndrome?

BACKGROUND

Healthy ageing relies on maintaining physiological systems, particularly the musculoskeletal system (MKS). After 50, declines in bone density, muscle mass and strength increase the risk of osteoporosis and sarcopenia, leading to frailty, fractures and higher healthcare costs. Osteosarcopenia, combining osteoporosis and sarcopenia, is rising because of the ageing population. Chronic kidney disease (CKD) exacerbates this condition through disruptions in mineral metabolism, hormonal imbalances and inflammation, further compromising musculoskeletal health.

AIMS

This review examines the pathophysiology of osteosarcopenia associated with CKD, focusing on the role of mineral and hormonal disturbances, chronic inflammation and endocrine dysfunction. It aims to increase clinical awareness and highlight the need for early diagnosis and intervention to mitigate the burden of osteosarcopenia on the quality of life and healthcare systems in ageing CKD populations.

METHODS

A narrative review of the current literature was conducted, summarising evidence on the mechanisms underlying osteosarcopenia in CKD, including mineral metabolism alterations, inflammatory processes and hormonal imbalances.

RESULTS

Osteosarcopenia is a recognised consequence of CKD, contributing to increased morbidity and mortality. The pathophysiology of osteosarcopenia in CKD is multifactorial, involving disruptions in mineral metabolism, inflammation, endocrine dysfunction and physical inactivity. CKD-mineral and bone disorder (CKD-MBD) leads to alterations in calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF-23) and vitamin D metabolism, resulting in impaired bone mineralisation and increased fracture risk. Simultaneously, CKD accelerates muscle wasting through systemic inflammation, anabolic resistance and metabolic derangements, increasing the risk of sarcopenia. Sarcopenic obesity, inflammaging and hormonal dysregulation further exacerbate bone muscle deterioration. Emerging evidence suggests that osteosarcopenia in CKD is a consequence of interconnected pathophysiological pathways rather than isolated conditions. Diagnosis remains challenging because of overlapping clinical features, necessitating integrated assessment tools. Targeted therapeutic strategies, including mineral metabolism correction, resistance exercise and anabolic interventions, are essential to mitigate osteosarcopenia's progression and improve patient outcomes in CKD.

CONCLUSIONS

Osteosarcopenia is a growing concern in ageing CKD populations. Early diagnostic strategies and targeted interventions are essential to mitigate the impact of osteosarcopenia on patient outcomes and reduce associated healthcare costs. Increased clinical awareness and research into effective therapies are crucial for improving the quality of life for individuals affected by CKD and osteosarcopenia.

Predictive efficacy of different diagnostic criteria for sarcopenia in osteoporosis and fractures

This study aims to compare the predictive efficacy of different diagnostic criteria for sarcopenia in forecasting the occurrence of osteoporosis (OP) and fractures. Utilizing data from the Global Health Data Exchange, the burden of musculoskeletal disorders (MSDs) was assessed through indicators including incidence, prevalence, and disability-adjusted life years. Trends in MSD burden were analyzed using the Joinpoint regression model to calculate the average annual percentage change. A retrospective cohort study was conducted on clinical data from 8180 patients who received care at the Endocrinology Department of the First Affiliated Hospital of Fujian Medical University between April 2008 and June 2024. Patients were categorized into four groups based on sarcopenia diagnostic criteria established by the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS), the Asian Working Group on Sarcopenia 2019 (AWGS 2019), and the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. We compared demographic data, chronic disease history, body composition, bone mineral density, FRAX fracture risk, and the incidence of osteoporosis to evaluate the predictive validity of each diagnostic criterion for osteoporosis and fracture risk in patients with sarcopenia. (1) The prevalence of sarcopenia, as defined by the IWGS, FNIH, EWGSOP, and AWGS 2019 diagnostic criteria, was 39.2%, 28.3%, 55.0%, and 30.1%, respectively. (2) After adjusting for age, gender, and body mass index (BMI), a significant association between osteoporosis and sarcopenia was observed across all four diagnostic criteria (all P < 0.05). Furthermore, sarcopenia, as determined by the EWGSOP and AWGS 2019 criteria, was associated with a moderate-to-high risk of major osteoporotic fractures and hip fractures within the next 10 years (P < 0.05). (3) Spearman's correlation coefficients for sarcopenia with Procollagen type I N-terminal propeptide (PINP), appendicular lean mass (ALM), ALM/height squared (Ht2), and ALM/BMI were - 0.034, - 0.308, - 0.261, and - 0.252, respectively. PINP, ALM, ALM/Ht2, and ALM/BMI were identified as significant factors influencing osteoporosis, with odds ratios of 0.996, 0.765, 0.535, and 0.010, respectively. The burden of MSDs is increasing in China and globally, driven primarily by population aging. Sarcopenia is significantly associated with osteoporosis and a moderate-to-high risk of fracture when diagnosed using the FNIH and EWGSOP criteria. PINP and ALM are protective factors against osteoporosis development in patients with sarcopenia.

ALM adjusted by BMI or weight predicts adverse health outcomes in middle-aged and elderly patients with type 2 diabetes

The role of skeletal muscle in the prognosis of patients with Type 2 Diabetes Mellitus (T2DM) remains unclear. This study aimed to systematically evaluate the impact of different muscle-mass adjustment standards on adverse health outcomes in middle-aged and elderly T2DM patients. Retrospective cohort study. A total of 1,818 T2DM patients aged 50 years or older were included in this study. The cohort comprised 45.7% females, with a median age of 63 years. Variables closely correlated with total lean mass (TLM) and appendicular lean mass (ALM) were selected as adjustment indicators. The primary composite endpoints were all-cause mortality, cardiovascular disease (CVD), and fragility fractures. Cox proportional hazards models were used to estimate the risk associated with each indicator, and phenotypic characteristics of high-risk patients were evaluated. During a median follow-up of 63 months, 436 patients reached the primary endpoint. ALM/BMI and ALM/weight were negatively correlated with adverse outcomes in both sexes, even after adjusting for confounding factors (males: ALM/BMI (hazard ratio [HR] = 0.998, 95% confidence interval [CI] = 0.996-0.999, P = 0.005) and ALM/weight (HR = 0.924, 95% CI = 0.864-0.987, P = 0.020); females: ALM/BMI (HR = 0.998, 95% CI = 0.996-1.000, P = 0.030) and ALM/weight (HR = 0.917, 95% CI = 0.860-0.978, P = 0.008), respectively). Individuals with lower ALM/BMI and ALM/weight have poorer metabolic status, greater fat accumulation, more complications, and a lower muscle-to-fat ratio. Our findings demonstrate that both ALM/BMI and ALM/weight can predict adverse health outcomes, suggesting their potential as practical, clinically relevant markers for sarcopenia in T2DM.

Longitudinal assessment of changes in muscle composition using proton density fat fraction and T2* in patients with and without incidental vertebral compression fractures

Objective

Chemical shift encoded-based water-fat separation magnetic resonance imaging (CSE-MRI) is an emerging noninvasive tool for the assessment of bone and muscle composition. This study aims to examine both the predictive value and the longitudinal change of proton density fat fraction (PDFF) and T2* in the paraspinal muscles (PSM) in patients with and without the development of an incidental vertebral compression fracture (VCFs) after 6 months of follow-up.

Methods

Patients (N=56) with CT and 3T CSE-MRI of the lumbar spine at baseline and CSE-MRI at 6 months follow-up were included in this retrospective study. Patients who, on average, developed an incidental VCF one year after baseline MRI (VCF: N=14, 9 males, 66.8 ± 7.9 years) were frequency matched by age and sex to patients without VCFs (non-VCF) at baseline and follow-up (non-VCF: N=42, 27 males, 64.6 ± 13.3 years). Mean PDFF, T2*, and cross-sectional area (CSA) values from the autochthonous PSM of the thoracolumbar spine (T11-L4) and opportunistic CT-based bone mineral density (BMD) measurements were obtained for each individual. The associations between baseline measurements, longitudinal changes in PDFF, T2*, CSA of the PSM and the occurrence of VCFs at follow-up were evaluated using linear and logistic multivariable regression models. ROC analyses were used to assess cutoff values for predicting the development of VCFs.

Results

No significant difference in PDFF of the PSM was found between the VCF and non-VCF group at baseline (VCF/non-VCF 8.5 ± 13.8% vs. 5.0 ± 4.6%; p=0.53). In multivariable linear regression models adjusted for sex, age and baseline BMD, PDFF values of the PSM increased significantly over 6 months in the VCF group (2.4 ± 2.8% vs. -1.0 ± 2.3%, p<0.001), while T2* values of the PSM showed a significant decrease (p ≤ 0.01). ROC analyses identified a PDFF increase of 0.2% in the PSM as the optimal cutoff value to distinguish between patients with and without VCF (AUC 0.86, 95% CI [0.74-0.98], p<0.001).

Conclusion

Longitudinal PDFF-based assessment of the PSM composition may be a useful indicator for the prediction of the development of vertebral compression fractures.

Low serum HSPA12B levels are associated with an increased risk of sarcopenia in a Chinese population of older adults

Sarcopenia is a geriatric syndrome characterized by progressive loss of muscle mass and function. Heat shock protein (HSP) A12B is essential for angiogenesis and endothelial function. However, the association of HSPA12B levels with sarcopenia remains unclear. A total of 936 community-dwelling elderly people were recruited, and serum HSPA12B was measured by enzyme-linked immunosorbent assay. Appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed were taken to assess sarcopenia. We found that serum HSPA12B levels in patients with sarcopenia (median [interquartile range] = 182.15 [137.58-225.86] ng/mL) were lower than those in elderly people without sarcopenia (228.96 [193.03-292.93] ng/mL, P < 0.001). Receiver operating characteristic curve analysis indicated that the optimal cut-off value of serum HSPA12B level for predicting sarcopenia was 185.50 ng/mL, with a sensitivity of 52.6% and a specificity of 80.8% (area under curve = 0.742, 95% confidence interval [CI] = 0.711-0.772, P < 0.001). Moreover, serum HSPA12B concentration was positively correlated with ASMI (r = 0.354, P < 0.001), grip strength (r = 0.381, P < 0.001), and gait speed (r = 0.169, P < 0.001). Multivariate logistic regression analysis showed that decreased serum HSPA12B levels (<185.50 ng/mL) were a risk factor for increased risk of sarcopenia (adjusted odds ratio = 4.335, 95% CI = 3.136-5.993, P < 0.001). In addition, serum HSPA12B level was also positively correlated with serum levels of angiogenesis markers, vascular endothelial growth factor (r = 0.080, P = 0.014), and angiopoietin-1 (r = 0.108, P = 0.001). In summary, our results indicate that low serum HSPA12B level is associated with an increased risk of sarcopenia in the elderly, suggesting a potential role of HSPA12B in the development of sarcopenia.

Circulating BMP-7 Level is Independent of Sarcopenia in Older Asian Adults

BACKGROUND

In vitro and animal studies have demonstrated that bone morphogenetic protein-7 (BMP-7), renowned for its osteogenic properties, also exerts beneficial effects on muscle metabolism by enhancing myogenesis and reversing muscle atrophy. Despite being proposed as a common regulatory factor for both muscle and bone, the impact of BMP-7 on human muscle health has not been thoroughly investigated.

METHODS

This cross-sectional study involved 182 community-dwelling older adults who underwent a comprehensive geriatric assessment in South Korea. Sarcopenia was diagnosed using Asian-specific cutoffs, and serum BMP-7 levels were quantified via enzyme immunoassay.

RESULTS

The mean age of the participants was 72.2±7.3 years, with 62.6% being female. After adjustments for confounders, serum BMP-7 levels were not significantly different between individuals with and without sarcopenia, nor were there differences based on skeletal muscle mass, strength, or physical performance levels (p=0.423 to 0.681). Likewise, no correlations were detected between circulating BMP-7 levels and any sarcopenia assessment metrics such as skeletal muscle index, grip strength, gait speed, or chair stand completion times (p=0.127 to 0.577). No significant associations were observed between increases in serum BMP-7 concentrations and the risk of sarcopenia or poor muscle phenotypes (p=0.431 to 0.712). Stratifying participants into quartiles based on serum BMP-7 levels also indicated no differences in sarcopenia-related parameters (p=0.663 to 0.996).

CONCLUSION

Despite experimental evidence supporting BMP-7's role in muscle metabolism, this study found no significant association between serum BMP-7 levels and clinical indicators of muscle health in older adults. These findings challenge the utility of serum BMP-7 as a biomarker for sarcopenia in this demographic.

Blood-based biomarkers of frailty in older patients with cancer

PURPOSE OF REVIEW

This review aims to evaluate the current evidence on blood-based biomarkers for frailty detection in older cancer patients. It explores the potential of various biomarkers, including inflammatory markers and microRNAs (miRNAs), to serve as indicators of frailty and examines the limitations of existing studies. The review also highlights the need for further research to validate these biomarkers and improve their clinical applicability.

RECENT FINDINGS

Recent studies have examined blood biomarkers associated with frailty in older cancer patients. Findings suggest that elevated granulocyte levels and lower macrophage-derived stem cells and regulatory T cells are linked to frailty. Inflammatory biomarkers such as interleukin-6 and specific miRNAs, as well as higher neutrophil-to-lymphocyte ratios, have also been identified as potential indicators of frailty. While these biomarkers show promise, no single marker has proven sufficient, and combining them may improve frailty detection. Further research is needed to validate their clinical usefulness in this population.

SUMMARY

Blood-based biomarkers show potential for detecting frailty in older patients with cancer, but further research is needed, particularly beyond an inflammatory focus and with more robust study designs.

Vitamin D stimulates Il-15 synthesis in rodent muscle

Besides its classical skeletal function, vitamin D plays a critical role in both skeletal muscle and the immune system. Interleukin-15 (IL-15), which is highly expressed, and secreted complexed with its receptor, IL-15Rα, by skeletal muscle, stimulates the development of immune cells and affects myogenesis and muscle mass. However, little is known about possible regulators of this myokine. To test whether vitamin D could be a regulator of muscle IL-15 and IL-15Rα expression, C2C12 myotubes were treated with vitamin D3 metabolites and analysis were performed in gastrocnemius muscles of rats treated with a single intraperitoneal dose of 1,25(OH)2D3. The role of VDR was investigated by siRNA technique in C2C12 myotubes and in gastrocnemius muscles of vitamin D receptor knockout (Vdr-KO) mice. Treatment of C2C12 myotubes with 1,25(OH)2D3 or 25(OH)D3 increased Il-15 gene expression in a dose-dependent manner and 1,25(OH)2D3 also moderately increased the relative Il-15 protein amount. Rats treated with a single dose of 1,25(OH)2D3 demonstrated a higher mRNA abundance of muscle Il-15 than controls. The 1,25(OH)2D3 effect on Il-15 was considerably weaker in C2C12 myotubes treated with Vdr-specific siRNA. Vdr-KO mice showed significantly lower muscle Il-15 mRNA than WT mice. Il-15Ra mRNA and Il-15/Il-15Rα protein abundance were unaffected by 1,25(OH)2D3-treatment or VDR functionality, and Cyp27b1 activity is not required for 25(OH)D3-mediated Il-15 gene expression. The results provide evidence for a regulatory role of hydroxyvitamin D3 metabolites on the Il-15 synthesis in skeletal muscle cells, which is largely mediated by the VDR.

Development and Validation of a Risk Predictive Model for Adverse Postoperative Health Status of Elderly Patients Undergoing Major Abdominal Surgery Using Lasso-Logistic Regression

Background

The postoperative health status of elderly patients has a substantial impact on both the individuals themselves and their families, and this impact became more pronounced with advancing age. The aim of this study was to identify risk factors that can predict the health status of patients aged 80 and over after major abdominal surgery and to establish a nomogram model.

Methods

We conducted a retrospective study of elderly patients (aged 80+) who underwent major abdominal surgery at the First Affiliated Hospital of Soochow University from January 2017 to June 2023. Least absolute shrinkage and selection operator (lasso) regression analysis was employed to identify potential perioperative factors associated with the patients' health status one year post-surgery. Subsequently, logistic regression was then used to refine these factors for the model. The nomogram's performance was assessed through discriminative ability, calibration, and clinical utility in both training and validation datasets.

Results

In total, 576 and 145 individuals were allocated to the training and validation sets, respectively. Lasso regression first identified 10 variables as candidate risk factors. After further screening through univariate and multivariate logistic regression, it was confirmed that seven variables, including tumor, operative duration, left ventricular ejection fraction (LVEF), blood transfusion, direct bilirubin, erythrocyte, and self-care, were included in the final nomogram model. The Hosmer-Lemeshow test, with a P-value of 0.835, indicates that the model was well-fitted. The area under the Receiver Operating Characteristic curve (ROC-AUC) for the model on the training set was 0.81 (95% CI 0.764-0.855), and for the validation set, it was 0.83 (95% CI 0.751-0.91). Additionally, the calibration curves and decision curve analyses in both the training and validation sets demonstrated the accuracy and clinical applicability of the predictive model.

Conclusion

The nomogram has a good predictive ability for the health status of older patients aged 80 years and above after abdominal surgery for one year, which can help clinical doctors develop better treatment plans.

Sex differences in the association between sarcopenia index and sarcopenia: a cross-sectional study from a Chinese community-based population

PURPOSE

The sarcopenia index (SI) is a convenient method to screen for sarcopenia, but few studies have analysed whether there are sex differences. The aim of this study was to analyse sex differences in the relationship between SI and sarcopenia in a Chinese community-based population.

METHODS

This cross-sectional study included participants from 2011 China Health and Retirement Longitudinal Study. The SI was defined as 100 × creatinine / cystatin C. Diagnosis of sarcopenia based on the Asian Working Group for Sarcopenia 2019 consensus. Logistic regression model, linear regression model, and natural spline model were used to analyze the association between SI and sarcopenia.

RESULTS

A total of 7,118 participants with a mean age of 60.6 ± 10.1 were included, 53.4% females. In males, the prevalence of sarcopenia decreased by 25% for every 10 increase in SI, and skeletal muscle mass index (SMI) increased by 0.04, odds ratio (OR), β, and 95% confidence interval (CI) were 0.75 (0.65-0.87), 0.04 (0.02-0.05), both P < 0.001. In females, the SI was not significantly associated with sarcopenia, OR and 95% CI were 0.99 (0.9 ~ 1.08), P = 0.775; for every 10 increase in SI, the SMI in females decreased by 0.03, β and 95% CI were -0.03 (-0.04 ~ -0.01), P = 0.001.

CONCLUSION

In the Chinese community, the SI is negatively associated with sarcopenia in males and has moderate diagnostic test performance. It was not associated with sarcopenia in females, and using the SI to screen for sarcopenia in females may not be a reliable method.

The relationship between sarcopenia and mental health status in Chinese older adults: the mediating role of activities of daily living

BACKGROUND

Most existing studies focus on either the relationship between sarcopenia and depressive symptoms or sarcopenia and cognitive functions. Few studies have examined depressive symptoms and cognitive functions simultaneously. This study aimed to analyze the relationship between sarcopenia and both depressive symptoms and cognitive functions in the elderly by introducing activities of daily living to explore the mediating role of activities of daily living between sarcopenia and mental health.

METHODS

This study used data from the 2015 and 2018 China Health and Retirement Longitudinal Study, including a total of 3,552 older adults aged 60 and above. We conducted descriptive statistical analysis and correlation analysis on the data and used seemingly unrelated regression to examine the relationship between sarcopenia, depressive symptoms, and cognitive functions in older adults. Bootstrap mediation analysis was used to further explore the mediating role of activities of daily living in the relationship between sarcopenia and depressive symptoms and cognitive functions in the elderly.

RESULTS

After adjusting for confounding factors, sarcopenia was positively correlated with depressive symptoms (β = 0.663, p < 0.001) and negatively correlated with cognitive functions (β=-0.748, p < 0.001), indicating a negative impact of sarcopenia on mental health. Activities of daily living mediated the relationship between sarcopenia and mental health, with a stronger mediating effect between sarcopenia and depressive symptoms (18.77%, β = 0.125, 95%CI (0.035, 0.222)) than between sarcopenia and cognitive functions (12.82%, β=-0.099, 95%CI (-0.162, -0.035)).

CONCLUSIONS

Activities of daily living partially mediated the relationship between sarcopenia and mental health status in Chinese older adults. Interventions targeting sarcopenia and activities of daily living may be an effective way to prevent and improve the mental health status of older adults.

Association of Initial and Changes in Serum A-FABP Level With the Development and Improvement of Presarcopenia

CONTEXT

Several cross-sectional studies have reported the association between serum adipocyte fatty acid-binding protein (A-FABP) level and presarcopenia. However, data on the effects of serum A-FABP level and its changes over time on the development and improvement of presarcopenia are scarce.

OBJECTIVE

This study aimed to explore the association of serum A-FABP level with the incidence and improvement of presarcopenia in a community-based cohort, and further investigated the association of changes in serum A-FABP level with the incidence and improvement of presarcopenia.

METHODS

This longitudinal cohort study included 1496 adults (41.2% men; median age, 58 [53-63] years) in 2013 to 2014 and was followed up to 2015 to 2016. Participants underwent serum A-FABP level measurements at baseline and a follow-up visit. Visceral fat area (VFA) was measured using magnetic resonance imaging. Skeletal muscle mass (SMM) was estimated by bioelectrical impedance analysis and converted to a skeletal muscle index (SMI). Presarcopenia was defined as SMI less than 1 SD of the sex-specific mean for the young reference group.

RESULTS

During an average follow-up period of 2.1 years, baseline serum A-FABP level was positively associated with the incidence of presarcopenia (standardized by weight: risk ratio [RR] 3.22; 95% CI, 1.96-5.38; standardized by VFA: RR 2.11, 95% CI, 1.29-3.51) and negatively associated with the improvement of presarcopenia (standardized by weight: RR 0.66; 95% CI, 0.45-0.97; standardized by VFA: RR 0.71; 95% CI, 0.54-0.94), regardless of whether SMM was standardized by weight or VFA. Moreover, changes in serum A-FABP level provided additional information on the incidence and improvement of presarcopenia, independent of baseline serum A-FABP level (all P < .05).

CONCLUSION

Baseline serum A-FABP level and its changes were positively associated with the incidence and negatively associated with the improvement of presarcopenia.

Puerarin Promotes the Migration and Differentiation of Myoblasts by Activating the FAK and PI3K/AKT Signaling Pathways

Puerarin, a flavonoid compound present in the roots of radix puerariae, contributes to the development of tissues such as bone and nerve, but its role in skeletal muscle regeneration remains unclear. In this study, we employed C2C12 myoblasts and barium chloride (BaCl2)-based muscle injury models to investigate the effects of puerarin on myogenesis. Our study showed that puerarin stimulated the migration and differentiation of myoblasts in vitro. For the mechanism study, we found that puerarin's influence on cell migration was associated with the activation of FAK signaling; additionally, puerarin induced myoblast differentiation by upregulating the PI3K/AKT pathway. We also found that puerarin treatment could improve muscle regeneration following muscle injury. Taken together, our data indicate that puerarin facilitated myogenesis by promoting migration and differentiation, which suggests puerarin as a new candidate drug for the treatment of muscle loss diseases.

Sarcopenia and Cardiogeriatrics: The Links Between Skeletal Muscle Decline and Cardiovascular Aging

Sarcopenia, an age-related decline in skeletal muscle mass, strength, and function, is increasingly recognized as a significant condition in the aging population, particularly among those with cardiovascular diseases (CVD). This review provides a comprehensive synthesis of the interplay between sarcopenia and cardiogeriatrics, emphasizing shared mechanisms such as chronic low-grade inflammation (inflammaging), hormonal dysregulation, oxidative stress, and physical inactivity. Despite advancements in diagnostic frameworks, such as the EWGSOP2 and AWGS definitions, variability in criteria and assessment methods continues to challenge standardization. Key diagnostic tools include dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) for muscle mass, alongside functional measures such as grip strength and gait speed. The review highlights the bidirectional relationship between sarcopenia and cardiovascular conditions such as heart failure, aortic stenosis, and atherosclerotic cardiovascular disease, which exacerbate each other through complex pathophysiological mechanisms. Emerging therapeutic strategies targeting the mTOR pathway, NAD+ metabolism, and senescence-related processes offer promise in mitigating sarcopenia's progression. Additionally, integrated interventions combining resistance training, nutritional optimization, and novel anti-aging therapies hold significant potential for improving outcomes. This paper underscores critical gaps in the evidence, including the need for longitudinal studies to establish causality and the validation of advanced therapeutic approaches in clinical settings. Future research should leverage multi-omics technologies and machine learning to identify biomarkers and personalize interventions. Addressing these challenges is essential to reducing sarcopenia's burden and enhancing the quality of life for elderly individuals with comorbid cardiovascular conditions. This synthesis aims to guide future research and promote effective, individualized management strategies.

Romosozumab adverse event profile: a pharmacovigilance analysis based on the FDA Adverse Event Reporting System (FAERS) from 2019 to 2023

OBJECTIVE

This study aims to analyze adverse drug events (ADE) related to romosozumab from the second quarter of 2019 to the third quarter of 2023 from FAERS database.

METHODS

The ADE data related to romosozumab from 2019 Q2 to 2023 Q3 were collected. After data normalization, four signal strength quantification algorithms were used: ROR (Reporting Odds Ratios), PRR (Proportional Reporting Ratios), BCPNN (Bayesian Confidence Propagation Neural Network), and EBGM (Empirical Bayesian Geometric Mean).

RESULTS

Screening for romosozumab-related AEs (adverse events) included 23 system organ categories (SOCs). PT (preferred terms) levels were screened for adverse drug reaction (ADR) signals. A total of 7055 reports with romosozumab as the primary suspect (PS) and 14,041 PTs induced by romosozumab as PS were identified. Common significant signals of general disorders and administration site conditions, musculoskeletal and connective tissue disorders have emerged. Specifically, unexpected AEs such as gastrointestinal disorder, respiratory, thoracic and mediastinal disorders also occur. Notably, fracture (n = 503, ROR = 107.8, PRR = 103.83, IC = 6.6, EBGM = 97.02) and bone density abnormal (n = 429, ROR = 343.65, PRR = 332.77, IC = 8.08, EBGM = 271.34) exhibited relatively high occurrence rates and signal strengths.

CONCLUSION

Our study identifies potential new AE signals and provides broader data support for the safety of romosozumab. In clinical application, doctors are provided with a warning to closely monitor adverse reactions to support their rational use in diseases such as osteoporosis.

Application of deep learning model based on unenhanced chest CT for opportunistic screening of osteoporosis: a multicenter retrospective cohort study

INTRODUCTION

A large number of middle-aged and elderly patients have an insufficient understanding of osteoporosis and its harm. This study aimed to establish and validate a convolutional neural network (CNN) model based on unenhanced chest computed tomography (CT) images of the vertebral body and skeletal muscle for opportunistic screening in patients with osteoporosis.

MATERIALS AND METHODS

Our team retrospectively collected clinical information from participants who underwent unenhanced chest CT and dual-energy X-ray absorptiometry (DXA) examinations between January 1, 2022, and December 31, 2022, at four hospitals. These participants were divided into a training set (n = 581), an external test set 1 (n = 229), an external test set 2 (n = 198) and an external test set 3 (n = 118). Five CNN models were constructed based on chest CT images to screen patients with osteoporosis and compared with the SMI model to predict the performance of osteoporosis patients.

RESULTS

All CNN models have good performance in predicting osteoporosis patients. The average F1 score of Densenet121 in the three external test sets was 0.865. The area under the curve (AUC) of Desenet121 in external test set 1, external test set 2, and external test set 3 were 0.827, 0.859, and 0.865, respectively. Furthermore, the Densenet121 model demonstrated a notably superior performance compared to the SMI model in predicting osteoporosis patients.

CONCLUSIONS

The CNN model based on unenhanced chest CT vertebral and skeletal muscle images can opportunistically screen patients with osteoporosis. Clinicians can use the CNN model to intervene in patients with osteoporosis and promptly avoid fragility fractures.

CRITICAL RELEVANCE STATEMENT

The CNN model based on unenhanced chest CT vertebral and skeletal muscle images can opportunistically screen patients with osteoporosis. Clinicians can use the CNN model to intervene in patients with osteoporosis and promptly avoid fragility fractures.

KEY POINTS

The application of unenhanced chest CT is increasing. Most people do not consciously use DXA to screen themselves for osteoporosis. A deep learning model was constructed based on CT images from four institutions.

Association between sarcopenic obesity and risk of frailty in older adults: a systematic review and meta-analysis

BACKGROUND

Age-related changes in body composition such as muscle loss can lead to sarcopenia, which is closely associated with frailty. However, the effect of body fat accumulation on frailty in old age remains unclear. In particular, the association between the combination of these two conditions, known as sarcopenic obesity, and frailty in older adults is unclear.

OBJECTIVE

To synthesise the association between sarcopenic obesity and the risk of frailty and to investigate the role of obesity in the risk of frailty in old age.

METHODS

Six databases were searched from inception to 29 September 2024. Two reviewers independently extracted the data and assessed the risk of bias for the included observational studies using the adapted Newcastle-Ottawa scale. The control groups consisted of robust, obese and sarcopenic individuals. Meta-analyses were performed to examine the risk of frailty due to sarcopenic obesity and the role of obesity in frailty amongst sarcopenic older adults.

RESULTS

Sixteen eligible studies were included in meta-analyses from 1098 records. Compared to robust individuals, older adults with sarcopenic obesity were more vulnerable to frailty [odds ratio (OR), 3.76; 95% confidence interval (CI), 2.62 to 5.39; I2 = 79.3%; P < .0001]. Obesity was not associated with the risk of frailty (OR, 1.23; 95% CI, 0.99 to 1.53; I2 = 0.0%; P = .501) in sarcopenic older adults.

CONCLUSIONS

Sarcopenic obesity is associated with a high risk of frailty. Sarcopenia and obesity may have synergistic effects on frailty in older adults.

Impact of osteoporosis on overall survival following endovascular repair for abdominal aortic aneurysms

OBJECTIVE

To evaluate the impact of osteoporosis on overall survival following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs).

METHODS

This was a retrospective, single-center cohort study on 172 patients who had undergone primary EVAR for AAA between 2016 and 2018. Bone mineral density (BMD) was assessed by measuring the Hounsfield units (HUs) of the 11th thoracic vertebra on preoperative computed tomography; a BMD value of <110 HU was considered osteoporosis. All patients were divided into those with osteoporosis and those without osteoporosis, and long-term outcomes were compared. In addition, hazard ratios of each variable for all-cause mortality were evaluated using univariate and multivariate analysis.

RESULTS

All 172 patients were divided into two groups: 72 patients (41.9%) with osteoporosis and 100 patients (58.1%) without osteoporosis. The mean age was older and the mean BMD was lower in patients with osteoporosis than patients without osteoporosis (mean, 79.2 ± 7.2 years vs 75.0 ± 8.7 years, respectively; P < .05; 78.1 ± 26.7 HU vs 155.1 ± 36.3 HU, respectively; P < .05). During the median follow-up period of 68 months, overall survival was significantly lower in patients with osteoporosis than patients without osteoporosis (osteoporosis: 63.9% and 36.7% at 5 years and 7 years; nonosteoporosis: 83.8% and 74.6% at 5 years and 7 years, respectively; log-rank P < .05); freedom from aneurysm-related mortality did not differ significantly between groups (osteoporosis: 94.3% and 89.0% at 5 years and 7 years; nonosteoporosis: 100.0% and 96.7% at 5 years and 7 years, respectively; log-rank P = .078). In a multivariate analysis for overall survival after EVAR, coexistence of osteoporosis was found to be an independent risk factor for all-cause mortality (hazard ratio, 1.76; 95% confidence interval, 1.01-3.06; P < .05), as well as variables including age, statin use, sarcopenia, and aneurysm diameter.

CONCLUSIONS

Patients with osteoporosis showed a higher all-cause mortality after EVAR than patients without osteoporosis. We believe that comorbidity of osteoporosis may be useful in estimating the life expectancy of patients with AAA.

Osteoporosis in axial radiographic spondyloarthritis: diagnostic limitations of bone mineral density and the need for comprehensive fracture risk assessment

Axial radiographic spondyloarthritis (r-axSpA) is a chronic inflammatory joint disease that leads to a considerable decline in the quality of life of patients by impairment of function and mobility, which, in turn, brings about a deterioration of both physical and mental health. Osteoporosis (OP) is a significant issue in the course of r-axSpA. Fractures resulting from OP complicate the treatment of the underlying disease and reduce the quality of life of patients. The aim of this paper is to discuss currently available diagnostic methods for OP and highlight why the gold standard for diagnosis - the assessment of bone mineral density via dual-energy X-ray absorptiometry - is not sufficient for patients with r-axSpA.

Development and validation of a predicative model for identifying sarcopenia in Chinese adults using nutrition indicators (AHLC)

Background

Sarcopenia, a condition characterized by low muscle mass, plays a critical role in the health of older adults. Early identification of individuals at risk is essential to prevent sarcopenia-related complications. This study aimed to develop a predictive model using readily available clinical nutrition indicators to facilitate early detection.

Methods

A total of 1,002 participants were categorized into two groups: 819 with normal skeletal muscle mass (SMM) and 183 with low muscle mass (sarcopenia). A predictive model was developed for sarcopenia risk via multivariate logistic regression, and its performance was assessed using four analyses: receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), a nomogram chart, and external validation. These methods were used to evaluate the model's discriminative ability and clinical applicability.

Results

In the low-SMM group, more females (55.73% vs. 40.42%) and older individuals (median 61 vs. 55 years) were observed. These patients had lower albumin (41.00 vs. 42.50 g/L) and lymphocyte levels (1.60 vs. 2.02 × 109/L) but higher HDL (1.45 vs. 1.16 mmol/L) and calcium levels (2.24 vs. 2.20 mmol/L) (all p < 0.001). Using LASSO regression, we developed a nutritional AHLC (albumin + HDL cholesterol + lymphocytes + calcium) model for sarcopenia risk prediction. AUROC and DCA analyses, as well as nomogram charts and external validation, confirmed the robustness and clinical relevance of the AHLC model for predicting sarcopenia.

Conclusion

Our study employs serum nutrition indicators to aid clinicians in promoting healthier aging. The AHLC model stands out for weight-independent evaluations. This novel approach could assess sarcopenia risk in the Chinese population, thereby enhancing aging and quality of life.

The implications of frailty in older adults with epilepsy

Older adults constitute a large proportion of people with epilepsy (PWE) due to the changing demographics worldwide and epilepsy's natural history. Aging-related pathophysiological changes lower the tolerance and increase our vulnerability to stressors, which manifests as frailty. Frailty is closely associated with adverse health outcomes. This narrative review examines the interplay between frailty and epilepsy, especially in older adults, emphasizing its clinical implications, including its role in managing PWE. Mechanistically, frailty develops through complex interactions among molecular and cellular damage, including genomic instability, mitochondrial dysfunction, and hormonal changes. These contribute to systemic muscle mass, bone density, and organ function decline. The concept of frailty has evolved from a primarily physical syndrome to include social, psychological, and cognitive dimensions. The "phenotypic frailty" model, which focuses on physical performance, and the "deficit accumulation" model, which quantifies health deficits, provide frameworks for understanding and assessing frailty. PWE are potentially more prone to developing frailty due to a higher prevalence of risk factors predisposing to frailty. These include, but are not limited to, polypharmacy, higher comorbidity, low exercise level, social isolation, low vitamin D, and osteoporosis. We lack commercial biomarkers to measure frailty but can diagnose it using self- or healthcare provider-administered frailty scales. Recent attempts to develop a PWE-specific frailty scale are promising. Unlike chronological age, frailty is reversible, so its management using multidisciplinary care teams should be strongly considered. Frailty can affect antiseizure medication (ASM) tolerance secondary to its impact on pharmacokinetics and pharmacodynamics. While frailty's effect on seizure control efficacy of ASM is poorly understood, its undoubted association with overall poor outcomes, including epilepsy surgery, behooves us to consider its presence and implication while treating older PWE. Incorporation of frailty measures in future research is essential to improve our understanding of frailty's role in PWE health. PLAIN LANGUAGE SUMMARY: Frailty is the declining state of the human body. People with epilepsy are more prone to it. It should be factored into their management.

Irisin in degenerative musculoskeletal diseases: Functions in system and potential in therapy

Degenerative musculoskeletal diseases are a class of diseases related to the gradual structural and functional deterioration of muscles, joints, and bones, including osteoarthritis (OA), osteoporosis (OP), sarcopenia (SP), and intervertebral disc degeneration (IDD). As the proportion of aging people around the world increases, degenerative musculoskeletal diseases not only have a multifaceted impact on patients, but also impose a huge burden on the medical industry in various countries. Therefore, it is crucial to find key regulatory factors and potential therapeutic targets. Recent studies have shown that irisin plays an important role in degenerative musculoskeletal diseases, suggesting that it may become a key molecule in the prevention and treatment of degenerative diseases of the musculoskeletal system. Therefore, this review provides a comprehensive description of the release and basic functions of irisin, and summarizes the role of irisin in OA, OP, SP, and IDD from a cellular and tissue perspective, providing comprehensive basis for clinical application. In addition, we summarized the many roles of irisin as a key information molecule in bone-muscle-adipose crosstalk and a regulatory molecule involved in inflammation, senescence, and cell death, and proposed the interesting possibility of irisin in degenerative musculoskeletal diseases.

Alignment considerations in degenerative spinal conditions: A narrative review

Background

With an aging population, degenerative spinal diseases are contributing significantly to the healthcare's burden. Spinal alignment in the context of adult spinal deformities has become an important domain of research.

Methods

We conducted a narrative review of the latest considerations in spinal alignment within the context of degenerative spinal conditions, discussed current strategies for morphological assessment and finally identified potential areas for future research.

Results

This review reported that degenerative spinal conditions lead to a complex disruption of spinal alignment. It also highlighted the importance of spino-pelvic alignment with specific attention to compensatory mechanisms that occur in response to spinal deformities. Emerging technologies including Artificial Intelligence and epigenetics are showing promises in terms of patient care.

Conclusions

Understanding spinal alignment in degenerative conditions underscores the importance of dynamic and individualized assessments. Future research should integrate emerging technologies along with traditional clinical practices in order to optimize patient outcomes and minimize complications for patients suffering from degenerative spinal diseases.

A study of the correlation between sarcopenia and cognitive impairment in older individuals over 60 years: cross-sectional and longitudinal validation

Objective

To validate the correlation between sarcopenia and cognition, and explore cognitive subdomains affected by sarcopenia.

Methods

A case-control study was designed to recruit 90 individuals aged 60 and above from June to October 2023 in the same community, all individuals meeting the inclusion criteria were categorized according to the 2019 Asian criteria for sarcopenia and divided into the sarcopenia group and non-sarcopenia group at baseline. After a 12-week follow-up recording, individuals were classified into the aggravation group and alleviation group based on the change of sarcopenia severity. Sarcopenia tests including muscle mass, calf circumference, grip strength and physical function assessment, using Montreal Cognitive Assessment (MoCA) of nine dimensions for cognitive assessment.

Results

(1) There was a significant positive correlation between cognitive function and grip strength in males (r = 0.42, p < 0.05). (2) There was a moderate correlation between sarcopenia grading and MoCA score (r = -0.4, p < 0.001). (3) Individuals with sarcopenia had significantly lower MoCA total scores and sub-scores in executive function, fluency, calculation and delayed recall compared to non-sarcopenia group (p < 0.05). (4) After 12 weeks, the mean value of the change in fluency in the alleviation group increased by 0.33 points, while the aggravation group decreased by 0.2 points (W = 128, p < 0.05).

Conclusion

There is a correlation between sarcopenia and cognitive function, individuals with sarcopenia performing poorly in overall cognition as well as refined dimensions. The degree of cognition like fluency degenerates over time with increasing severity of sarcopenia.

Relationship between Geriatric Nutritional Risk Index with all-cause and CVD mortality in osteopenia and osteoporosis

Purpose

This study investigated the relationship between Geriatric Nutritional Risk Index (GNRI), and all-cause, cardiovascular (CVD) mortality, in individuals with osteopenia and osteoporosis.

Methods

Using NHANES data from 2005 to 2019, 6,824 participants diagnosed with osteopenia and osteoporosis were analyzed. Participants were categorized based on GNRI tertiles, and statistical methods like the fitted curves, Kaplan-Meier curves, cox regression, and subgroup analyses were employed.

Results

Lower GNRI tertiles correlated with older age, male gender, and more comorbidities. Mortality rates differed significantly across GNRI tertiles over an average 7.9-year follow-up, with a notable inverse J-shaped association between GNRI and mortality. Adjusted HRs indicated a 1.6-2-fold increase in all-cause mortality for the lowest GNRI tertile, persisting across comprehensive adjustments. CVD mortality followed a similar trend.

Conclusions

This study illuminates a robust correlation between GNRI levels and mortality risks in osteopenia and osteoporosis. Its consistent dose-response relationship across all-cause, and CVD mortality underscores its pivotal role as a prognostic factor.

The association between HDL-c levels and computed tomography-based osteosarcopenia in older adults

OBJECTIVE

Associations between serum lipid levels and osteoporosis and sarcopenia have been reported. However, few studies have reported a link between serum lipid levels and osteosarcopenia. In the present study, we investigated the association between serum high-density lipoprotein cholesterol (HDL-c) and osteosarcopenia.

METHODS

A total of 1995 participants aged 50 years and above who underwent chest CT physical examinations from 2016 to 2019 were included. Demographic information, including age, sex, and body mass index, and laboratory data, including liver and kidney function, blood lipids (HDL-c, low-density lipoprotein cholesterol (LDL-c), triglyceride (TG), total cholesterol (TC), blood glucose, and serum albumin, were collected from the medical records system. Osteosarcopenia was defined on the basis of the presence of low bone mass (bone CT values < 110 HU) and low muscle mass of bilateral erector spinae (< 25.0 cm² in men and < 20.0 cm2 in women). The relationships between HDL-c (continuous data and categorical data) and osteosarcopenia were analyzed via multivariable logistic regression and restricted cubic spline analysis.

RESULTS

One hundred forty-one patients with osteosarcopenia (7.7%) were observed. The individuals with osteosarcopenia had significantly greater HDL-c levels than did those without osteosarcopenia (1.65 ± 0.30 vs. 1.49 ± 0.34 mmol/L, P < 0.001). Multivariate logistic regression revealed that HDL-c (odds ratio (OR) = 2.72, 95% confidence interval (CI): 1.30-5.69) was associated with osteosarcopenia. The third and fourth HDL-c quartiles were significantly related to a greater incidence of osteosarcopenia (OR = 3.36, 95% CI: 1.66-6.80; OR = 3.66, 95% CI: 1.67-8.01) than the first quartile was. Similar trends were observed in the male population. For female individuals, the fourth HDL-c quartile was significantly related to a greater incidence of osteosarcopenia than the first quartile was (OR = 2.73, 95% CI: 1.03-7.21). Restricted cubic splines revealed similar relationships between HDL-c and osteosarcopenia.

CONCLUSION

High serum HDL-c levels were associated with the risk of osteosarcopenia in older adults.

Sarcopenia and frailty among older Chinese adults: Findings from the CHARLS study

BACKGROUND

Sarcopenia and frailty are common among elderly individuals and present substantial health hazards. Exploring their relationship is essential for optimizing geriatric healthcare, particularly within the context of China.

METHODS

A population-based cross-sectional design was employed using data from the China Health and Retirement Longitudinal Study (CHARLS). The study enrolled 5,714 participants aged ≥60 years who underwent assessment for sarcopenia following the criteria established by the Asia Working Group for Sarcopenia (AWGS 2019) in 2019. Frailty status was determined using a frailty index that categorized participants into robustness, pre-frailty, and frailty stages. Multivariable logistic regression models were employed to examine the relationship between sarcopenia and frailty and pre-frailty conditions. Subgroup and interaction analyses were performed to explore the robustness of the associations between sarcopenia and frailty across different subgroups.

RESULTS

Among the participants, 1,028 (18.0%) were identified as frailty, 2,987 (52.3%) as pre-frailty, and 645 (11.3%) had sarcopenia. Sarcopenia demonstrated an independent association with higher risks of frailty (OR = 2.13, 95% CI: 1.52-2.99) and pre-frailty (OR = 1.42, 95% CI: 1.20-1.81) in the multivariable logistic analysis. Subgroup and interaction analyses consistently demonstrated significant associations across nearly all demographic and health-related subgroups.

CONCLUSIONS

This study highlights that sarcopenia is significantly and independently associated with frailty and pre-frailty among older adults in China. Early detection and targeted interventions for sarcopenia are crucial to mitigate frailty and its adverse health outcomes in aging populations, emphasizing the need for tailored healthcare strategies to promote healthy aging.

Identifying genetic determinants of sarcopenia-related traits: a Mendelian randomization study of druggable genes

BACKGROUND

Sarcopenia, characterized by progressive muscle mass and function loss, particularly affects the elderly, and leads to severe consequences such as falls and mortality. Despite its prevalence, targeted pharmacotherapies for sarcopenia are lacking. Utilizing large-sample genome-wide association studies (GWAS) data is crucial for cost-effective drug discovery.

METHODS

Herein, we conducted four studies to understand the putative causal effects of genetic components on muscle mass and function. Study 1 employed a two-sample Mendelian randomization (MR) on 15,944 potential druggable genes, investigating their potential causality with muscle quantity and quality in a European population (N up to 461,089). Study 2 validated MR results through sensitivity analyses and colocalization analyses. Study 3 extended validation across other European cohorts, and study 4 conducted quantitative in vivo verification.

RESULTS

MR analysis revealed significant causality between four genes (BLOC-1 related complex subunit 7, BORCS7; peptidase m20 domain containing 1, PM20D1; nuclear casein kinase and cyclin dependent kinase substrate 1, NUCKS1 and ubiquinol-cytochrome c reductase complex assembly factor 1, UQCC1) and muscle mass and function (p-values range 5.98 × 10-6 to 9.26 × 10-55). To be specific, BORCS7 and UQCC1 negatively regulated muscle quantity and quality, whereas enhancing PM20D1 and NUCKS1 expression showed promise in promoting muscle mass and function. Causal relationships remained robust across sensitivity analyses, with UQCC1 exhibiting notable colocalization effects (PP·H4 93.4 % to 95.8 %). Further validation and in vivo replication verified the potential causality between these genes and muscle mass as well as function.

CONCLUSIONS

Our druggable genome-wide MR analysis identifies BORCS7, PM20D1, NUCKS1, and UQCC1 as causally associated with muscle mass and function. These findings offer insights into the genetic basis of sarcopenia, paving the way for these genes to become promising drug targets in mitigating this debilitating condition.

Exploring the Relationship Between Gut Microbiota and Sarcopenia Based on Gut-Muscle Axis

Sarcopenia, as a disease characterized by progressive decline of quality, strength, and function of muscles, has posed an increasingly significant threat to the health of middle-aged and elderly individuals in recent years. With the continuous deepening of studies, the concept of gut-muscle axis has attracted widespread attention worldwide, and the occurrence and development of sarcopenia are believed to be closely related to the composition and functional alterations of gut microbiota. In this review, combined with existing literatures and clinical reports, we have summarized the role and impacts of gut microbiota on the muscle, the relevance between gut microbiota and sarcopenia, potential mechanisms of gut microbiota in the modulation of sarcopenia, potential methods to alleviate sarcopenia by modulating gut microbiota, and relevant advances and perspectives, thus contributing to adding more novel knowledge to this research direction and providing certain reference for future related studies.

Age-Related Changes in Insulin Resistance and Muscle Mass: Clinical Implications in Obese Older Adults

The older segment of the global population is increasing at a rapid pace. Advancements in public health and modern medicine lengthened life expectancy and reduced the burden of disease in communities worldwide. Concurrent with this demographic change is the rise in overweight people and obesity, which is evident in all age groups. There is also an aging-related reduction in muscle mass and function, or sarcopenia, that is exacerbated by sedentary lifestyle and poor nutrition. The coexistence of muscle loss and elevated body mass index, termed "sarcopenic obesity", has particularly deleterious consequences in older individuals. Worsening insulin resistance and a proinflammatory state operate at the pathophysiologic level and lead to adverse health outcomes such as a proclivity to cardiovascular disease, type 2 diabetes, and even cognitive dysfunction. Although the concept of sarcopenic obesity as a disease construct is being increasingly recognized, a clearer understanding is warranted in order to define its components and health impact. Research is needed at the molecular-cellular level to tie together derangements in insulin action, cytokines, myokines, and endothelial dysfunction with clinical outcomes. Lifestyle modifications as well as targeted nonpharmacologic approaches, such as supplements and antioxidants, appear to have a promising role in reducing the chronic burden of this emerging disorder. Breakthroughs in drug therapies that retard or even reverse the underlying dynamics of sarcopenia and obesity in older persons are being actively explored.

The causal relationship between sarcopenia-related traits and ECG indices - A mendelian randomization study

BACKGROUND

Sarcopenia is a common geriatric condition closely associated with cardiovascular diseases and other health issues. This study aims to investigate the causal relationship between sarcopenia-related traits and electrocardiogram(ECG) indices.

METHODS

We conducted a comprehensive analysis utilizing summary data from genome-wide association studies (GWAS) associated with sarcopenia-related traits, including hand grip strength, lean body mass, and walking pace. ECG indices included PR interval, PP interval, ST duration, QRS duration and T wave duration. The primary analytical method employed was the inverse variance-weighted method (IVW).

RESULTS

According to our study findings, we identified a significant association between sarcopenia-related traits and ECG indices. Specifically, we observed a positive correlation between increased muscle mass and certain ECG indices. For instance, increased limb muscle mass (including left arm, right arm, left leg, and right leg) was associated with prolonged PR interval and QRS duration. This suggests that enhancing muscle mass may impact the timing of cardiac electrical activity. Additionally, increased whole-body fat-free mass showed similar associations with cardiac electrical activity.

CONCLUSION

Sarcopenia-related traits have a unidirectional causal relationship with ECG indices, indicating that sarcopenia affects cardiac electrical activity.

Sarcopenic obesity and osteoporosis: Research progress and hot spots

Sarcopenic obesity (SO) and osteoporosis (OP) are associated with aging and obesity. The pathogenesis of SO is complex, including glucolipid and skeletal muscle metabolic disorders caused by inflammation, insulin resistance, and other factors. Growing evidence links muscle damage to bone loss. Muscle-lipid metabolism disorders of SO disrupt the balance between bone formation and bone resorption, increasing the risk of OP. Conversely, bones also play a role in fat and muscle metabolism. In the context of aging and obesity, the comprehensive review focuses on the effects of mechanical stimulation, mesenchymal stem cells (MSCs), chronic inflammation, myokines, and adipokines on musculoskeletal, at the same time, the impact of osteokines on muscle-lipid metabolism were also analyzed. So far, exercise combined with diet therapy is the most effective strategy for increasing musculoskeletal mass. A holistic treatment of musculoskeletal diseases is still in the preliminary exploration stage. Therefore, this article aims to improve the understanding of musculoskeletal -fat interactions in SO and OP, explores targets that can provide holistic treatment for SO combined with OP, and discusses current limitations and challenges. We hope to provide relevant ideas for developing specific therapies and improving disease prognosis in the future.

Integrating transcriptomic and proteomic data for a comprehensive molecular perspective on the association between sarcopenia and osteoporosis

BACKGROUND

Osteoporosis and sarcopenia are common age-related conditions characterized by the progressive loss of bone density and muscle mass, respectively. Their co-occurrence, often referred to as osteosarcopenia, presents significant challenges in elderly care due to increased fragility and functional impairment. Existing studies have identified shared pathological mechanisms between these conditions, including inflammation, hormonal imbalances, and metabolic dysregulation, but a comprehensive understanding of their molecular interplay remains incomplete.

OBJECTIVE

This study aims to deepen our understanding of the molecular interactions between sarcopenia and osteoporosis through an integrated omics approach, revealing potential therapeutic targets and biomarkers.

METHODS

Employing a combination of proteomics and transcriptomics analyses, this study analyzed bone and muscle tissue samples from patients diagnosed with osteoporosis and osteosarcopenia. Techniques included high-throughput sequencing and label-free proteomics, supported by advanced bioinformatics tools for data analysis and functional annotation of genes and proteins.

RESULTS

The study found marked differences in gene and protein expressions between osteoporosis and osteosarcopenia tissues. Specifically, genes like PDIA5, TUBB1, and CYFIP2 in bone, along with MYH7 and NCAM1 in muscle, exhibited differential expression at both mRNA and protein levels. Pathway analyses revealed the significance of oxidative-reduction balance, cellular metabolism, and immune response in the progression of these conditions. Importantly, the study pinpointed osteoclast differentiation and NF-kappa B signaling pathways as critical in the molecular dynamics of osteosarcopenia, suggesting potential targets for therapy.

CONCLUSIONS

This study utilized transcriptomics and proteomics to identify key genes and proteins impacting sarcopenia and osteoporosis, employing advanced network tools to delineate interaction networks and crucial signaling pathways. It highlighted genes like PDIA5 and TUBB1, consistently expressed in both analyses, involved in pathways such as osteoclast differentiation and cytokine interactions. These insights enhance understanding of the molecular interplay in bone and muscle degeneration with aging, suggesting directions for future research into therapeutic interventions and prevention strategies for age-related degenerative diseases.

Impact of osteoporotic risk in men undergoing transcatheter aortic valve replacement: a report from the LAPLACE-TAVI registry

Low body weight and advanced age are among the best predictors of osteoporosis. Osteoporosis Self-Assessment Tool (OST) values are calculated by a simple formula [(body weight in kilograms - age in years) × 0.2] to identify patients at increased risk of osteoporosis. In our recent single-center study, we demonstrated an association between OST and poor outcomes in postmenopausal women after transcatheter aortic valve replacement (TAVR). We aimed to investigate the impact of osteoporotic risk in men with aortic stenosis who underwent TAVR in a large cohort. In this multi-center study, 1,339 men who underwent TAVR between April 2010 and July 2023 were retrospectively analyzed. Women were excluded from the present study. All patients were deemed appropriate for TAVR after a review by a multidisciplinary team. Baseline characteristics of patients were compared by dividing patients into three tertiles, based on the OST value: ≤ - 6.16, - 6.16 to - 4.14, and - 4.14 < for tertiles 1, 2, and 3, respectively. Primary endpoint was all-cause mortality after TAVR. Tertile 1 (patients with the lowest OST values) included older patients with smaller body mass index, lower hemoglobin and albumin levels. In addition, they had greater clinical frailty scale, slower 5-meter walk test, weaker hand grip strength, and more cognitive impairment, indicating increased frailty. They were more severely symptomatic, with lower ejection fractions, smaller aortic valve areas, and more tricuspid regurgitation than were patients in the other two groups. Multivariate analysis revealed that OST tertiles 3 was associated with decreased risk of all-cause mortality (hazard ratio, 0.66; 95% confidence interval, 0.48-0.90), compared with OST tertile 1 as a reference. For OST tertiles 1, 2, and 3, the estimated 1-year survival rates of all-cause mortality post-TAVR were 83.6% ± 1.9%, 91.1% ± 1.4%, and 93.1% ± 1.3%, respectively, (log-rank, p < 0.001).　In conclusions, in men as same as women, osteoporotic risk assessed by OST values was overlapped with increased frailty. The simple OST formula was useful for predicting all-cause mortality in patients undergoing TAVR in large registry datasets.

Shared molecular signatures between systemic lupus erythematosus and osteoporosis

This study explores the molecular interplay between systemic lupus erythematosus (SLE) and osteoporosis (OP), aiming to uncover shared gene signatures and pathways for better treatment approaches. Leveraging microarray data from the Gene Expression Omnibus (GEO) database, we employed weighted gene coexpression network analysis to identify coexpression modules in SLE and OP, with subsequent protein-protein interaction analysis clarifying the connections among shared genes. Key genes were pinpointed using CytoHubba and random forest algorithms, validated across independent GEO datasets, and further analyzed through gene set enrichment analysis (GSEA) and immune infiltration studies. We discovered two highly correlated modules in SLE and OP, isolating 30 shared genes and identifying GBP1, SOCS1, IFI16, and XAF1 as central to both conditions. Notably, XAF1 and GBP1 mRNA levels were significantly elevated in the peripheral blood of SLE patients compared with healthy and RA counterparts, underscoring their potential as biomarkers. GSEA and immune infiltration analyses indicated pronounced immune and inflammatory responses, especially in interferon signaling pathways, implicating these core-shared gene networks in the diseases' pathogenesis. The findings highlight the involvement of GBP1, SOCS1, IFI16, and XAF1 in SLE with concurrent OP and suggest that targeting immune and inflammatory responses, particularly through interferon pathways, may offer therapeutic promise for these intertwined conditions.

Vitamin D combined with whole-body vibration training for the treatment of osteo-sarcopenia: study protocol for a randomized controlled trial

BACKGROUND

Osteo-sarcopenia (OS) has become a global public health problem and a frontier research problem, as a combination of sarcopenia (SP) and osteoporosis (OP) diseases. The clinical performances include muscle weakness, systemic bone pain, standing difficulty, even falls and fractures, etc., which seriously affect the patient's life and work. The pathological mechanism of the OS may be the abnormal metabolism which disrupts the equilibrium stability of the musculoskeletal system. Therefore, this study combined vitamin D (Vit. D) and whole-body vibration training (WBVT) to intervene in subjects of OS, aiming to evaluate the effectiveness and safety of the diagnosis and treatment protocol and to explore the efficacy mechanism.

METHODS

We propose a multicenter, parallel-group clinical trial to evaluate the efficacy and safety of Vit. D combined with WBVT intervention in OS. Subjects who met the inclusion or exclusion criteria and signed the informed consent form would be randomly assigned to the WBVT group, Vit. D group, or WBVT+ Vit. D group. All subjects will be treated for 1 month and followed up after 3 and 6 months. The primary outcomes are lumbar bone mineral density (BMD) and appendicular skeletal muscle mass (ASM) measured by dual-energy X-ray absorptiometry (DXA) and handgrip strength measured by grip strength meter. Secondary outcomes include serum markers of myostatin (MSTN), irisin and bone turnover markers (BTM), SARC-CalF questionnaire, 1-min test question of osteoporosis risk, patient health status (evaluated by the SF-36 health survey), physical performance measurement that includes 5-time chair stand test, 6-m walk, and the short physical performance battery (SPPB).

DISCUSSION

If Vit. D combined with WBVT can well relieve OS symptoms without adverse effects, this protocol may be a new treatment strategy for OS. After therapeutic intervention, if the serum marker MSTN/irisin is significant, both have the potential to become sensitive indicators for screening OS effective drugs and treatments, which also indicates that WBVT combined with Vit. D plays a role in improving OS by regulating MSTN/irisin.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400082269 . Registered on March 26, 2024.

The association between oxidative balance score and muscular dystrophies

Introduction

This research utilized data from the NHANES 2011-2018 study to investigate the connection between the Oxidative Balance Score (OBS) and muscular dystrophies.

Methods

This study is a cross-sectional, observational, secondary analysis utilizing data from the NHANES 2011-2018. Spearman's correlation, chi-square tests, logistic regression, and restricted cubic spline plots were employed for statistical analyses.

Results

This association remained significant after adjustment for various demographic and medical history factors (For continuous OBS: crude model, odds ratio [OR], 0.95, 95% confidence interval [CI:] 0.94, 0.97, p < 0.001; Model 1, OR, 0.94, 95% CI: 0.92, 0.96, p < 0.001; Model 2, OR, 0.95, 95% CI: 0.93, 0.97, p < 0.001; Model 3, OR, 0.95, 95% CI: 0.93, 0.97, p < 0.001; In quartile Q4 vs. Q1: Crude model, OR, 0. 42, 95% CI: 0.26, 0.66, p < 0.001; Model 1, OR, 0.33, 95% CI: 0.21, 0.52, p < 0.001; Model 2, OR, 0.37, 95% CI: 0.23, 0.58, p < 0.001; Model 3, OR, 0.38, 95% CI: 0.23, 0.60, p < 0.001). Restricted cubic spline (RCS) analysis further supported this inverse relationship, suggesting that OBS values above 10 may confer protection against muscular dystrophies (p for overall <0.001, p for non-linear = 0.536). However, the relationship between OBS and muscular dystrophies was not statistically significant in the subgroups with education level below high school, presence of cancer, or diabetes (p = 0.735, p = 0.574, p = 0.409, respectively).

Conclusion

The study found a significant inverse correlation between the OBS and muscular dystrophies, suggesting that individuals with higher oxidative balance had a lower risk of developing muscular dystrophies. The study highlights the potential role of oxidative balance in muscular dystrophies prevention and management.

VO2MAX, 6-minute walk, and muscle strength each correlate with frailty in US veterans

Introduction

Frailty often manifests as an increased vulnerability to adverse outcomes, and detecting frailty is useful for informed healthcare decisions. Veterans are at higher risk for developing frailty and at younger ages. The goal of this study was to investigate approaches in Veterans that can better inform the physiologic underpinnings of frailty, including maximal oxygen uptake (VO2max), 6-min walk, muscle strength, and inflammatory biomarkers.

Methods

Participants (N = 42) were recruited from the Buffalo VA Medical Center. Inclusion criteria: ages 60-85, male or female, any race, and not having significant comorbidities or cognitive impairment. Outcome measures included: the Fried frailty phenotype, the short physical performance battery (SPPB), quality of life (QOL) using the Q-LES-Q-SF, and the following physiologic assessments: VO2max assessment on an upright stationary bicycle, 6-min walk, and arm and leg strength. Additionally, inflammatory biomarkers (C-reactive protein, IL-6, IL-10, interferon-γ, and TNF-α) were measured using ELLA single and multiplex ELISA.

Results

Participants: 70.3 ± 7.4 years of age: 34 males and 8 females, BMI = 30.7 ± 5.4 kg/m2, 26 white and 16 African American. A total of 18 (42.8%) were non-frail, 20 (47.6%) were pre-frail, and 4 (9.5%) were frail. VO2max negatively correlated with Fried frailty scores (r = -0.40, p = 0.03, N = 30), and positively correlated with SPPB scores (r = 0.50, p = 0.005), and QOL (r = 0.40, p = 0.03). The 6-min walk test also significantly correlated with VO2max (r = 0.57, p = 0.001, N = 42) and SPPB (r = 0.55, p = 0.0006), but did not quite reach a significant association with frailty (r = -0.28, p = 0.07). Arm strength negatively correlated with frailty (r = -0.47, p = 0.02, N = 26), but not other parameters. Inflammatory profiles did not differ between non-frail and pre-frail/frail participants.

Conclusion

Objectively measured cardiorespiratory fitness was associated with important functional outcomes including physical performance, QOL, and frailty in this group of older Veterans. Furthermore, the 6-min walk test correlated with VO2max and SPPB, but more validation is necessary to confirm sensitivity for frailty. Arm strength may also be an important indicator of frailty, however the relationship to other indicators of physical performance is unclear.

Opportunistic Assessment of Hip Fracture Risk Based on Chest CT

OBJECTIVE

Hip fracture (HF) has been described as the "last fracture of life" in the elderly, so the assessment of HF risk is extremely important. Currently, few studies have examined the relationship between imaging data from chest computed tomography (CT) and HF. This study demonstrated that pectoral muscle index (PMI) and vertebral body attenuation values could predict HF, aiming to opportunistically assess the risk of HF in patients without bone mineral density (BMD) based on chest CT for other diseases.

METHODS

In the retrospective study, 800 participants who had both BMD and chest CT were enrolled from January 2021 to January 2024. After exclusion, 472 patients were finally enrolled, divided into the healthy control (HC) group and the HF group. Clinical data were collected, and differences between the two groups were compared. A predictive model was constructed based on the PMI and CT value of the fourth thoracic vertebra (T4HU) by logistic regression analysis, and the predictive effect of the model was analyzed by using the receiver operating characteristic (ROC) curve. Finally, the clinical utility of the model was analyzed using decision curve analysis (DCA) and clinical impact curves.

RESULTS

Both PMI and T4HU were lower in the HF group than in the HC group (p < 0.05); low PMI and low T4HU were risk factors for HF. The predictive model incorporating PMI and T4HU on the basis of age and BMI had excellent diagnostic efficacy with an area under the curve (AUC) of 0.865 (95% confidence interval [CI]: 0.830-0.894, p < 0.01), sensitivity and specificity of 0.820 and 0.754, respectively. The clinical utility of the model was validated using calibration curves and DCA. The AUC of the predictive model incorporating BMD based on age and BMI was 0.865 (95% CI: 0.831-0.895, p < 0.01), with sensitivity and specificity of 0.698 and 0.711, respectively. There was no significant difference in diagnostic efficacy between the two models (p = 0.967).

CONCLUSIONS

PMI and T4HU are predictors of HF in patients. In the absence of dual-energy x-ray absorptiometry (DXA), the risk of HF can be assessed by measuring the PMI and T4HU on chest CT examination due to other diseases, and further treatment can be provided in time to reduce the incidence of HF.

AI-based opportunistic quantitative image analysis of lung cancer screening CTs to reduce disparities in osteoporosis screening

Osteoporosis is underdiagnosed, especially in ethnic and racial minorities who are thought to be protected against bone loss, but often have worse outcomes after an osteoporotic fracture. We aimed to determine the prevalence of osteoporosis by opportunistic CT in patients who underwent lung cancer screening (LCS) using non-contrast CT in the Northeastern United States. Demographics including race and ethnicity were retrieved. We assessed trabecular bone and body composition using a fully-automated artificial intelligence algorithm. ROIs were placed at T12 vertebral body for attenuation measurements in Hounsfield Units (HU). Two validated thresholds were used to diagnose osteoporosis: high-sensitivity threshold (115-165 HU) and high specificity threshold (<115 HU). We performed descriptive statistics and ANOVA to compare differences across sex, race, ethnicity, and income class according to neighborhoods' mean household incomes. Forward stepwise regression modeling was used to determine body composition predictors of trabecular attenuation. We included 3708 patients (mean age 64 ± 7 years, 54 % males) who underwent LCS, had available demographic information and an evaluable CT for trabecular attenuation analysis. Using the high sensitivity threshold, osteoporosis was more prevalent in females (74 % vs. 65 % in males, p < 0.0001) and Whites (72 % vs 49 % non-Whites, p < 0.0001). However, osteoporosis was present across all races (38 % Black, 55 % Asian, 56 % Hispanic) and affected all income classes (69 %, 69 %, and 91 % in low, medium, and high-income class, respectively). High visceral/subcutaneous fat-ratio, aortic calcification, and hepatic steatosis were associated with low trabecular attenuation (p < 0.01), whereas muscle mass was positively associated with trabecular attenuation (p < 0.01). In conclusion, osteoporosis is prevalent across all races, income classes and both sexes in patients undergoing LCS. Opportunistic CT using a fully-automated algorithm and uniform imaging protocol is able to detect osteoporosis and body composition without additional testing or radiation. Early identification of patients traditionally thought to be at low risk for bone loss will allow for initiating appropriate treatment to prevent future fragility fractures. CLINICALTRIALS.GOV IDENTIFIER: N/A.

Targeting senescence induced by age or chemotherapy with a polyphenol-rich natural extract improves longevity and healthspan in mice

Accumulating senescent cells within tissues contribute to the progression of aging and age-related diseases. Botanical extracts, rich in phytoconstituents, present a useful resource for discovering therapies that could target senescence and thus improve healthspan. Here, we show that daily oral administration of a standardized extract of Salvia haenkei (Haenkenium (HK)) extended lifespan and healthspan of naturally aged mice. HK treatment inhibited age-induced inflammation, fibrosis and senescence markers across several tissues, as well as increased muscle strength and fur thickness compared with age-matched controls. We also found that HK treatment reduced acutely induced senescence by the chemotherapeutic agent doxorubicin, using p16LUC reporter mice. We profiled the constituent components of HK by mass spectrometry, and identified luteolin-the most concentrated flavonoid in HK-as a senomorphic compound. Mechanistically, by performing surface plasmon resonance and in situ proximity ligation assay, we found that luteolin disrupted the p16-CDK6 interaction. This work demonstrates that administration of HK promotes longevity in mice, possibly by modulating cellular senescence and by disrupting the p16-CDK6 interaction.

Association between sarcopenia and frailty in middle-aged and elder population: Findings from the China health and retirement longitudinal study

Background

The relationship between sarcopenia and frailty among middle-aged and elder adults remains unclear. This study conducted a cross-sectional and longitudinal analysis to investigate the association of sarcopenia and frailty in the middle-aged and elder Chinese population.

Methods

Our data were drawn from the China Health and Retirement Longitudinal Study. Sarcopenia status was assessed according to the Asian Working Group for Sarcopenia 2019 criteria and categorised into: no sarcopenia, possible sarcopenia, sarcopenia, and severe sarcopenia. A 38-item deficit-accumulation frailty index was constructed to assess frailty trajectories at each visit. Generalised linear regression models were performed to analyse the cross-sectional associations between sarcopenia and frailty index. The Group-based trajectory modelling was adopted to identify potential frailty trajectories, and we then examined the associations of sarcopenia and frailty trajectories using logistic regression analysis.

Results

A total of 13 218 participants were enrolled in the cross-sectional analysis and 4200 individuals were included in the longitudinal study. The cross-sectional study found that possible sarcopenia (regression coefficient (β) = 0.76; 95% confidence interval (CI) = 0.64-0.87, P < 0.001), sarcopenia (β = 0.56; 95% CI = 0.37-0.75, P < 0.001) and severe sarcopenia (β = 1.35; 95% CI = 0.97-1.73, P < 0.001) were significantly associated with higher frailty index. The longitudinal study indicated that participants with possible sarcopenia (odds ratio (OR) = 2.46; 95% CI = 1.77-3.42, P < 0.001), sarcopenia (OR = 1.87; 95% CI = 1.27-2.74, P < 0.001) and severe sarcopenia (OR = 6.57; 95% CI = 3.14-13.77, P < 0.001) had a higher risk of accelerated progression of frailty compared to those with no sarcopenia.

Conclusions

Possible sarcopenia, sarcopenia, and severe sarcopenia were associated with higher levels of frailty and accelerated progression of frailty. Therefore, clinical medical professionals should pay more attention to frailty status in individuals who have possible sarcopenia and sarcopenia.

Exploring neuronal mechanisms of osteosarcopenia in older adults

Until recently, research on the pathogenesis and treatment of osteoporosis and sarcopenia has primarily focused on local and systemic humoral mechanisms, often overlooking neuronal mechanisms. However, there is a growing body of literature on the neuronal regulation of bone and skeletal muscle structure and function, which may provide insights into the pathogenesis of osteosarcopenia. This review aims to integrate these neuronal regulatory mechanisms to form a comprehensive understanding and inspire future research that could uncover novel strategies for preventing and treating osteosarcopenia. Specifically, the review explores the functional adaptation of weight-bearing bone to mechanical loading throughout evolutionary development, from Wolff's law and Frost's mechanostat theory to the mosaic hypothesis, which emphasizes neuronal regulation. The recently introduced bone osteoregulation reflex points to the importance of the osteocytic mechanoreceptive network as a receptor in this neuronal regulation mechanism. Finally, the review focuses on the bone myoregulation reflex, which is known as a mechanism by which bone loading regulates muscle functions neuronally. Considering the ageing-related regressive changes in the nerve fibres that provide both structural and functional regulation in bone and skeletal muscle tissue and the bone and muscle tissues they innervate, it is suggested that neuronal mechanisms might play a central role in explaining osteosarcopenia in older adults.