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Giangregorio LM, Alexiuk MR, Tangri N, Bohm C, Leslie WD. Among people on osteoporosis medication, loss of appendicular or total body lean mass is an independent risk factor for hip and major osteoporotic fractures. Osteoporos Int 2024:10.1007/s00198-024-07240-z. [PMID: 39320415 DOI: 10.1007/s00198-024-07240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/21/2024] [Indexed: 09/26/2024]
Abstract
People with prior lean mass loss had a ~ 10% higher risk of MOF and ~ 22-26% higher risk of hip fracture, and the results were similar in people on anti-osteoporosis medications. Loss of lean mass is associated with increased fracture risk. Patients should be encouraged to pursue strategies to prevent loss of lean mass. BACKGROUND Sarcopenia increases fracture risk. If the risk persists after starting osteoporosis medication, patients may need to be encouraged to pursue strategies to prevent loss of lean mass. OBJECTIVE To estimate the effects of loss in appendicular lean mass (ALM) or total body lean mass (TBLM) on subsequent fracture risk and effect modification with anti-osteoporosis medication use. METHODS We conducted a registry-based cohort study linked to population-based data. We identified individuals ≥ 40 years of age with two DXA assessments ≥ 1 year apart and minimum 0.5 years of observation. ALM and TBLM were estimated from weight, sex, and percent fat from DXA (R2 = 0.91 and 0.84 vs total body DXA, respectively). We report hazard ratios (HR) from Cox regression models estimating time to first incident major osteoporotic fracture (MOF) and hip fracture, adjusted for fracture risk; osteoporosis medication was included as an interaction term and used to stratify analyses. RESULTS We included 21,249 individuals (mean 67 [SD 10] years, 95% female, 37% on osteoporosis medication). The mean follow-up was 7 years (SD 4). A total of 1868 and 548 people had incident MOF and hip fracture, respectively. People with prior ALM loss (HR per SD 1.09, 95% CI 1.04-1.15) or TBLM loss (HR per SD 1.09, 95% CI 1.42-1.14) had a higher risk of MOF. Hip fracture risk was greater in people with prior ALM loss (HR per SD 1.22, 95% CI 1.12-1.33) and TBLM loss (HR per SD 1.26, 95% CI 1.16-1.38). There were no interactions with anti-osteoporosis medication use (all p > 0.3). When restricted to people on anti-osteoporosis medication, each SD in ALM or TBLM loss was associated with 8-9% increased MOF risk and 18-23% increased hip fracture risk. CONCLUSIONS Loss of lean mass is associated with increased fracture risk among individuals on anti-osteoporosis medication. Patients should be encouraged to pursue strategies to prevent sarcopenia.
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Affiliation(s)
- Lora M Giangregorio
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada.
| | - Mackenzie Ryann Alexiuk
- Chronic Disease Innovation Centre, Winnipeg, MB, Canada
- University of Manitoba, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Winnipeg, MB, Canada
- University of Manitoba, Winnipeg, MB, Canada
| | - Clara Bohm
- Chronic Disease Innovation Centre, Winnipeg, MB, Canada
- University of Manitoba, Winnipeg, MB, Canada
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Nielsen BR, Andersen HE, Hovind P, Jørgensen NR, Schwarz P, Kristensen SH, Suetta C. Sarcopenia and self-reported markers of physical frailty in patients with osteoporosis. Arch Osteoporos 2024; 19:77. [PMID: 39152303 PMCID: PMC11329389 DOI: 10.1007/s11657-024-01437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
Bone and muscle impairment, named osteoporosis and sarcopenia, may co-occur with age, and patients with both disorders might exhibit physical frailty. One-hundred sixty-three patients were included. 14.2% had both disorders and presented more frequent with previous fall, reduced daily activity level, walk/balance challenges, and need of walking aid, indicating overall frailty. PURPOSE In older adults, sarcopenia (muscle impairment) and physical frailty may accompany osteoporosis (bone brittleness), yet osteoporosis is typically assessed without evaluating these conditions, even though coexistence may contribute to exacerbated negative health outcomes. We aimed at evaluating the prevalence of sarcopenia and impaired muscle domains in osteoporotic patients and explore the risk of osteosarcopenia from markers of physical frailty. METHODS In Copenhagen, Denmark, osteoporotic patients aged 65 + were assessed cross-sectionally in 2018-2019. Evaluations included muscle mass, strength, and function; bone mineral density; and self-reported physical activity, fall, balance challenges, dizziness, and the need of walking aid. Low bone mass, low-energy fracture, or treatment with anti-osteoporotic medication defined patient with osteoporosis, and sarcopenia was defined by low muscle strength and mass. Osteosarcopenia was defined from the coexistence of both conditions. RESULTS One-hundred sixty-three patients with osteoporosis were included. Of those, 23 (14.2%) exhibited sarcopenia, hence osteosarcopenia. Hand-grip-strength, 30-s-chair-stand-test, relative-appendicular-lean-muscle-mass, and gait-speed were below cut-off levels in 21.0%, 30.9%, 28.8%, and 23.6% of the patients, respectively. Previous fall, activity level, walk and balance challenges, and need of walking aid were statistically (or borderline) significantly more often affected in the osteosarcopenic group compared with the solely osteoporotic. Logistic regression analysis, however, revealed that only the need for walking aid significantly increased the risk of an osteosarcopenia diagnosis (odds ratio 5.54, 95% CI (1.95-15.76), p < 0.01). CONCLUSIONS Sarcopenia and impaired muscle domains were frequent in osteoporotic patients, as were markers of physical frailty, indicating the need of thorough examination of osteoporotic patients.
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Affiliation(s)
- B R Nielsen
- Department of Geriatric Medicine, Amager and Hvidovre Hospital, Copenhagen, Denmark.
| | - H E Andersen
- Department of Geriatric Medicine, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - P Hovind
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Glostrup, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - N R Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Faculty of Medical and Health Sciences, Copenhagen University, Copenhagen, Denmark
- Translational Research Centre, Rigshospitalet, Copenhagen, Denmark
| | - P Schwarz
- Faculty of Medical and Health Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - S H Kristensen
- Department of Geriatric Medicine, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - C Suetta
- Faculty of Medical and Health Sciences, Copenhagen University, Copenhagen, Denmark
- Geriatric Research Unit, Department of Geriatric Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Vendrami C, Shevroja E, Gonzalez Rodriguez E, Gatineau G, Elmers J, Reginster J, Harvey NC, Lamy O, Hans D. Muscle parameters in fragility fracture risk prediction in older adults: A scoping review. J Cachexia Sarcopenia Muscle 2024; 15:477-500. [PMID: 38284511 PMCID: PMC10995267 DOI: 10.1002/jcsm.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/28/2023] [Indexed: 01/30/2024] Open
Abstract
Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA-ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of 'fragility fractures', 'muscle health assessment' and 'risk'. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community-dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty-seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person-years (MPY). The median (interquartile range) sample size was 1642 (921-5756), age 69.2 (63.5-73.6) years, follow-up 10.0 (4.4-12.0) years and number of incident fragility fractures 166 (88-277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in-depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3-creatine dilution test, lean mass indexes and artificial intelligence methods.
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Affiliation(s)
- Colin Vendrami
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
- Internal Medicine Unit, Department of Internal MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Enisa Shevroja
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Guillaume Gatineau
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jolanda Elmers
- University Library of Medicine, Faculty of Biology and MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jean‐Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculo‐Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Olivier Lamy
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
- Internal Medicine Unit, Department of Internal MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Didier Hans
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
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Chen S, Xu X, Gong H, Chen R, Guan L, Yan X, Zhou L, Yang Y, Wang J, Zhou J, Zou C, Huang P. Global epidemiological features and impact of osteosarcopenia: A comprehensive meta-analysis and systematic review. J Cachexia Sarcopenia Muscle 2024; 15:8-20. [PMID: 38086772 PMCID: PMC10834350 DOI: 10.1002/jcsm.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/04/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024] Open
Abstract
Osteosarcopenia is defined as the concurrent occurrence of osteopenia/osteoporosis and sarcopenia. The aim of the current study was to perform a systematic review with meta-analysis to determine the global prevalence, risk factors and clinical outcomes of osteosarcopenia. This review was registered in PROSPERO (CRD42022351229). PubMed, Cochrane, Medline and Embase were searched from inception to February 2023 to retrieve eligible observational population-based studies. Pooled osteosarcopenia prevalence was calculated with 95% confidence interval (CI), and subgroup analyses were performed. The risk factor of osteosarcopenia and its association with clinical outcomes were expressed as odds ratio (OR) and hazard ratio (HR), respectively. Heterogeneity was estimated using the I2 test. Study quality was assessed using validated instruments matched to study designs. The search identified 55 158 studies, and 66 studies (64 404 participants, mean age from 46.6 to 93 years) were analysed in the final analysis, including 48 cross-sectional studies, 17 cohort studies and 1 case-control study. Overall, the pooled prevalence of osteosarcopenia was 18.5% (95% CI: 16.7-20.3, I2 = 98.7%), including 15.3% (95% CI: 13.2-17.4, I2 = 97.6%) in men and 19.4% (95% CI: 16.9-21.9, I2 = 98.5%) in women. The prevalence of osteosarcopenia diagnosed using sarcopenia plus osteopenia/osteoporosis was 20.7% (95% CI: 17.1-24.4, I2 = 98.55%), and the prevalence of using sarcopenia plus osteoporosis was 16.1% (95% CI: 13.3-18.9, I2 = 98.0%). The global osteosarcopenia prevalence varied in different regions with 22.9% in Oceania, 21.6% in Asia, 20.8% in South America, 15.7% in North America and 10.9% in Europe. A statistically significant difference was found in the subgroups of the study population between the hospital (24.7%) and community (12.9%) (P = 0.001). Frailty (OR = 4.72, 95% CI: 2.71-8.23, I2 = 61.1%), malnutrition (OR = 2.35, 95% CI: 1.62-3.40, I2 = 50.0%), female sex (OR = 5.07, 95% CI: 2.96-8.69, I2 = 73.0%) and higher age (OR = 1.10, 95% CI: 1.06-1.15, I2 ==86.0%) were significantly associated with a higher risk for osteosarcopenia. Meta-analysis of cohort studies showed that osteosarcopenia significantly increased the risk of fall (HR = 1.54, 95% CI: 1.20-1.97; I2 = 1.0%, three studies), fracture (HR = 2.13, 95% CI: 1.61-2.81; I2 = 67.8%, seven studies) and mortality (HR = 1.75, 95% CI: 1.34-2.28; I2 = 0.0%, five studies). Despite the heterogeneity arising from varied definitions and criteria, our findings highlight a significant global prevalence of osteosarcopenia and its negative impact on clinical health. Standardizing diagnostic criteria for osteosarcopenia would be advantageous in the future, and early detection and management should be emphasized in this patient population.
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Affiliation(s)
- Shanping Chen
- Department of Gerontology and Geriatric, Chengdu Fifth People's Hospital, Chengdu, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Diseases Institute of Chengdu, Chengdu, China
| | - Xiao Xu
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an, China
- Department of Medicine, Jinggangshan University, Ji'an, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Ji'an, China
| | - Huping Gong
- College of Nursing, Gannan Medical University, Ganzhou, China
| | - Ruzhao Chen
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an, China
- Department of Medicine, Jinggangshan University, Ji'an, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Ji'an, China
| | - Lijuan Guan
- Department of Gerontology and Geriatric, Chengdu Fifth People's Hospital, Chengdu, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Diseases Institute of Chengdu, Chengdu, China
| | - Xuedan Yan
- Department of Gerontology and Geriatric, Chengdu Fifth People's Hospital, Chengdu, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Diseases Institute of Chengdu, Chengdu, China
| | - Lihua Zhou
- Department of Gerontology and Geriatric, Chengdu Fifth People's Hospital, Chengdu, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Diseases Institute of Chengdu, Chengdu, China
| | - Yongxue Yang
- Department of Gerontology and Geriatric, Chengdu Fifth People's Hospital, Chengdu, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Diseases Institute of Chengdu, Chengdu, China
| | - Jiang Wang
- Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an, China
- Department of Medicine, Jinggangshan University, Ji'an, China
- Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, Jinggangshan University Branch, Ji'an, China
| | - Jianghua Zhou
- Department of Cardiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chuan Zou
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Diseases Institute of Chengdu, Chengdu, China
- Department of General Practice, Chengdu Fifth People's Hospital, Chengdu, China
| | - Pan Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
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Kursat Kara G, Ozturk C. Effect of osteosarcopenia on the development of a second compression fracture and mortality in elderly patients after vertebroplasty. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2023; 57:271-276. [PMID: 37909684 PMCID: PMC10724833 DOI: 10.5152/j.aott.2023.23099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty because of osteoporotic vertebral compression fracture (OVCF). METHODS A retrospective evaluation was conducted on 104 patients treated by vertebroplasty because of OVF between 2016 and 2021. The L3 vertebra Hounsfield unit values and the psoas muscle index (PMI) values measured at the L3 vertebra level were obtained from the patients' medical data and computed tomography images. Using these measurements, the patients were divided into 3 groups: only osteoporosis (OO group), only sarcopenia (OS group), and osteosarcopenia (OSP group). Differences between the groups were evaluated regarding second OVCF development and mortality. RESULTS The study included 104 patients, comprising 30 males and 74 females aged 60-92 years. The OS group included 10 patients, the OO group included 54 patients, and the OSP group consisted of 40 patients. A single vertebral fracture occurred in 72 patients, and 2 vertebral fractures occurred in 32 patients. The chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Kaplan-Meier survival analysis results showed no statistically significant difference between the 3 groups for the risk of second vertebral fracture. Sarcopenia, either alone or in combination with osteoporosis, was seen to have a negative effect on the survival of patients who underwent vertebro- plasty following a vertebral fracture. CONCLUSION This study has shown that osteosarcopenia did not increase the risk of developing a second vertebral fracture, but it increased mortality 2.8-fold for those who underwent vertebroplasty after vertebral fracture. LEVEL OF EVIDENCE Level III, Prognostic study.
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Affiliation(s)
- Gokhan Kursat Kara
- Department of Orthopaedics and Traumatology, Liv Hospital Ulus Istanbul, Istanbul, Turkey
| | - Cagatay Ozturk
- Department of Orthopaedics and Traumatology, Istinye University, Istanbul, Turkey
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Alajlouni DA, Bliuc D, Tran TS, Blank RD, Center JR. Muscle strength and physical performance contribute to and improve fracture risk prediction in older people: A narrative review. Bone 2023; 172:116755. [PMID: 37028582 DOI: 10.1016/j.bone.2023.116755] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/20/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
Osteoporotic fractures present a major health problem with an increasing prevalence in older people. Fractures are associated with premature mortality, reduced quality of life, subsequent fracture, and increased costs. Hence, it is crucial to identify those at higher risk of fracture. Fracture risk assessment tools incorporated clinical risk factors to improve fracture predictive power over BMD alone. However, fracture risk prediction using these algorithms remains suboptimal, warranting further improvement. Muscle strength and physical performance measurements have been associated with fracture risk. In contrast, the contribution of sarcopenia, the composite condition of low muscle mass, muscle strength and/or physical performance, to fracture risk is unclear. It is uncertain whether this is due to the problematic definition of sarcopenia per se or limitations of the diagnostic tools and cut-off points of the muscle mass component. The recent position statement from the Sarcopenia Definition and Outcomes Consortium confirmed the inclusion of muscle strength and performance in the definition of sarcopenia but not DXA-assessed lean mass. Therefore, clinicians should focus on functional assessment (muscle strength and performance) rather than muscle mass, at least as assessed by DXA, as predictors of fractures. Muscle strength and performance are modifiable risk factors. Resistance exercise improves muscle parameters in the elderly, potentially leading to reduced risk of falls and fractures in the general population and in those who sustained a fracture. Therapists may consider exercise intervention to improve muscle parameters and potentially reduce the risk of fractures. The aim of this review was to explore 1) the contribution of muscle parameters (i.e., muscle mass, strength, and physical performance) to fracture risk in older adults, and 2) the added predictive accuracy of these parameters beyond the existing fracture assessment tools. These topics provide the rationale for investigating strength and physical performance interventions to reduce fracture risk. Most of the included publications showed that muscle mass is not a good predictor of fracture risk, while poor muscle strength and performance are associated with an increased risk of fracture, particularly in men, independent of age, BMD, and other risk factors for fractures. Muscle strength and performance can potentially improve the predictive accuracy in men beyond that obtained by the fracture risk assessment tools, Garvan FRC and FRAX.
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Affiliation(s)
- Dima A Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
| | - Dana Bliuc
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
| | - Thach S Tran
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia; School of Biomedical Engineering, University of Technology, Sydney, New South Wales, Australia.
| | - Robert D Blank
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
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Ustevic C, Rajovic N, Stanisavljevic D, Tiosavljevic D, Pavlovic A, Tasic R, Rajovic T, Grupkovic J, Pilipovic F, Pejin V, Milcanovic P, Mazic S, Milic N. From Sarcopenia to Depressive Symptoms in Elderly: A Path Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:972. [PMID: 36673727 PMCID: PMC9859183 DOI: 10.3390/ijerph20020972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Sarcopenia is an age-related progressive, generalized skeletal muscle disorder involving the accelerated loss of muscle function and muscle mass. The aim of this study was to assess the complex relationship between sarcopenia, malnutrition, cognitive impairment, physical activity, and depression in the elderly, with the potential role of quality of life as a mediator in these associations. METHODS A cross-sectional study was conducted on a sample (n = 298) of elderly patients admitted to Special Hospital for Rehabilitation "Termal", Vrdnik, Serbia. Sarcopenia, the risk for malnutrition, cognitive impairment, physical activity, quality of life, and depressive symptoms were measured by standardized instruments. Additional data included sociodemographic characteristics. Simultaneous assessment of the direct and indirect relationships of all determinants was performed by path analysis. RESULTS A total of 40% (n = 120) of the elderly were diagnosed with sarcopenia, and 42.6% had depression symptoms. The risk of malnutrition was present in 23.5%, cognitive impairment in 5.4%, and a low level of physical activity was reported in 26.2% of elderly participants. The mean reported quality of life measured by Sarcopenia and Quality of Life Questionnaire was 60 (on the scale ranging from 0 to 100; where a higher score reflects a higher quality of life). The best-fitted model (χ2/DF = 1.885, NFI = 0.987, CFI = 0.993, GFI = 0.997, RMSEA = 0.055) highlighted the mediating effect of quality of life between sarcopenia, malnutrition, cognitive impairment, lower level of physical activities and depression. According to the model, quality of life was a direct negative predictor of depressive symptoms in the elderly, while malnutrition positively affected depression. CONCLUSIONS The presented path model may assist rehabilitation centers in developing strategies to screen for sarcopenia and risk of malnutrition, and promote physical activity in elderly, aiming to prevent their negative effects on mental health. For the elderly currently affected by sarcopenia, we consider regenerative medicine and stem cell therapy, which, in view of their etiology, could be a potential therapeutic strategy for sarcopenia.
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Affiliation(s)
- Cedomir Ustevic
- Special Hospital for Medical Rehabilitation “Termal”, 22408 Vrdnik, Serbia
- Laboratory for Sports Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Danijela Tiosavljevic
- Department of Humanities, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Psychiatry, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Andrija Pavlovic
- Department of Humanities, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Radica Tasic
- Medical School, College of Vocational Studies, 11080 Belgrade, Serbia
| | - Tatjana Rajovic
- Special Hospital for Medical Rehabilitation “Termal”, 22408 Vrdnik, Serbia
| | - Jovana Grupkovic
- Department for Orthopedic and Trauma Surgery, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Filip Pilipovic
- Institute for Orthopedic Surgery “Banjica”, 11040 Belgrade, Serbia
| | | | - Petar Milcanovic
- Laboratory for Sports Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sanja Mazic
- Laboratory for Sports Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55902, USA
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Harvey NC, Orwoll E, Cauley JA, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cawthon PM, Ensrud K, Liu E, Laskou F, Ward KA, Dennison EM, Cooper C, Kanis JA, Vandenput L, Lorentzon M, Ohlsson C, Mellström D, Johansson H, McCloskey E. Greater pQCT Calf Muscle Density Is Associated with Lower Fracture Risk, Independent of FRAX, Falls and BMD: A Meta-Analysis in the Osteoporotic Fractures in Men (MrOS) Study. JBMR Plus 2022; 6:e10696. [PMID: 36530188 PMCID: PMC9751652 DOI: 10.1002/jbm4.10696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72-1.0 and 0.78; 95% CI, 0.66-0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88-1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59-0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, School of MedicineOregon Health & Science UniversityPortlandORUSA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public HealthThe Chinese University of Hong KongShatinChina
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences MalmoLund University and Department of Orthopedics, Skane University HospitalMalmoSweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences MalmoLund University and Department of Orthopedics, Skane University HospitalMalmoSweden
| | - Eva Ribom
- Department of Surgical SciencesUniversity of UppsalaUppsalaSweden
| | - Peggy M. Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - Kristine Ensrud
- Medicine and Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMNUSA
- Center for Care Delivery and Outcomes ResearchMinneapolis VA Health Care SystemMinneapolisMNUSA
| | - Enwu Liu
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Faidra Laskou
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Kate A. Ward
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - John A. Kanis
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Dan Mellström
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Johansson
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Eugene McCloskey
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal ResearchUniversity of SheffieldSheffieldUK
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9
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Chen FP, Lin YJ, Chao AS, Lin YC, Sung CM, Chen JF, Wong AMK. Utilizing nomograms to predict prevalent vertebral fracture risk: An analysis of dysmobility syndrome in a community-dwelling population. Biomed J 2022; 45:931-939. [PMID: 34801764 PMCID: PMC9795362 DOI: 10.1016/j.bj.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/22/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To determine a reliable method to predict prevalent vertebral fractures (VF) by assessing the association between dysmobility syndrome (DS) and VF in a community-dwelling population. METHODS This cross-sectional study enrolled 518 participants from fracture-prevention educational activities held in multiple communities in Taiwan. Assessments included questionnaires, fracture risk assessment tool (FRAX), bone mineral density (BMD) and body composition using dual-energy x-ray absorptiometry (DXA), lateral thoracolumbar spine x-rays (specifically T8-S1), grip strength (GS), walking speed, and fall history. RESULTS DS was noted in 257 participants (49.6%) and VF was identified in 196 participants (37.8%). A higher prevalence of VF was noted in those with DS. The prevalence of VF was significantly associated with age, gender, FRAX both with and without BMD, osteoporosis, low GS, and DS. In multivariate models accounting for age and sex, the c-index was greater in those with low GS plus osteoporosis as compared to DS alone. Low GS, osteoporosis, and pre-BMD FRAX all had similar c-indexes. Pre-BMD FRAX plus low GS and osteoporosis was superior in predicting VF compared to pre-BMD FRAX plus low GS or osteoporosis alone. Besides the inclusion of age and gender, the nomogram with pre-BMD FRAX major osteoporosis fracture probability (MOF) plus low GS had improved correlation between the estimated and actual VF probability than those with pre-BMD FRAX MOF plus osteoporosis. CONCLUSIONS The constructed nomogram containing pre-BMD FRAX MOF plus low GS may be considered as a first-line prevalent VF screening method. Those with high-risk scores should subsequently undergo vertebral radiography and/or BMD.
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Affiliation(s)
- Fang-Ping Chen
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Corresponding author. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, 222 Mai-Chin Rd., Keelung 204, Taiwan.
| | - Yu-Jr Lin
- Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - An-Shine Chao
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yu-Ching Lin
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Radiology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chen-Ming Sung
- Department of Radiology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Jung-Fu Chen
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Endocrinology and Metabolism, Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan
| | - Alice MK. Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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10
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Su YC, Chang SF, Tsai HC. The Relationship between Sarcopenia and Injury Events: A Systematic Review and Meta-Analysis of 98,754 Older Adults. J Clin Med 2022; 11:6474. [PMID: 36362701 PMCID: PMC9654071 DOI: 10.3390/jcm11216474] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 10/25/2023] Open
Abstract
The main purpose of this study was to investigate the relationship between sarcopenia and injury events (falls, fractures, hospitalization, disability, and death). This study systemically searched the literature from Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library and analyzed the collected literature using the random effects model to demonstrate the relationship between sarcopenia and injury events. This study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and collected a total of 38 prospective studies, and the results showed that, when compared to robust individuals, the risk of injury events for older individuals with sarcopenia was significantly higher for fractures (HR = 9.66, CI: 5.07-18.38), hospital admissions (HR = 11.80, CI: 4.86-28.65), and death (HR = 9.57, CI: 3.17-28.94). In consideration of the negative impact of sarcopenia on the subsequent health of older adults, professional nursing personnel should assess older adults for sarcopenia as early as possible and propose relevant care policies to further reduce negative health impacts.
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Affiliation(s)
- Yu-Chen Su
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Pei-Tou, Taipei 112303, Taiwan
| | - Shu-Fang Chang
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Pei-Tou, Taipei 112303, Taiwan
| | - Hsiao-Chi Tsai
- Cardinal Tien Hospital, No.15, Chezi Rd., Xindian Dist., New Taipei City 112303, Taiwan
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11
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Lu L, He X, Ma L, Liu Y, Chen N. Effects of vibration training vs. conventional resistance training among community-dwelling older people with sarcopenia: three-arm randomized controlled trial protocol. Front Aging Neurosci 2022; 14:905460. [PMID: 36118696 PMCID: PMC9476828 DOI: 10.3389/fnagi.2022.905460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sarcopenia is a chronic and progressive disease, which is accompanied by the decline in muscle mass, muscle strength, and physical performance with aging, and it can lead to falls, fracture, and premature death. The prevention and treatment of sarcopenia mainly include exercise therapy and nutritional supplement. Exercise therapy is one of the most potential interventions to prevent and/or delay the progression of sarcopenia. Resistance training (RT), one of the most commonly used exercise types, is widely used in the treatment of sarcopenia, while vibration training (VT) is a prospective strategy for improving sarcopenia in older people. The aim of our study is to compare the effect of VT and RT in older people with sarcopenia on muscle mass, muscle strength, physical performance, blood biomarkers, and quality of life. Methods and analysis Our study is a 12-week, three-arm randomized controlled trial with assessor-blinded. The diagnosis criteria for subject recruitment adopt the guidelines for the Asian Working Group for Sarcopenia. A total of 54 subjects who met the criteria were randomized into one of the following three groups: VT group, RT group, and control group. The VT group and RT group received a 12-week whole-body vibration training and a resistance training program three times every week, respectively. The primary outcome is lower limb muscle strength, and the secondary outcomes include muscle mass, upper limb muscle strength, physical performance, blood biomarkers, and quality of life. We then performed assessments three times, at baseline (0 week), after intervention (12 weeks), and follow-up (24 weeks). The adverse events were also be reported. All outcome measurements were performed by the same researchers. Data were saved in the unified database, and the collected data of all subjects were analyzed by intention-to-treat analysis. Ethics and dissemination This study was reviewed and approved by the Ethical Committee of Xinhua Hospital Chongming Branch. The findings of the study were authorized in peer-reviewed journals with online access; meanwhile, it will be presented at domestic or international academic congresses. Clinical trial registration Chinese Clinical Trial Registry (ChiCTR2100051178), registered on 15 September 2021.
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Affiliation(s)
- Linqian Lu
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xiangfeng He
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Lin Ma
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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12
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López-Cervantes SP, Sánchez NS, Calahorra M, Mena-Montes B, Pedraza-Vázquez G, Hernández-Álvarez D, Esparza-Perusquía M, Peña A, López-Díazguerrero NE, Alarcón-Aguilar A, Luna-López A, Flores-Herrera Ó, Königsberg M. Moderate exercise combined with metformin-treatment improves mitochondrial bioenergetics of the quadriceps muscle of old female Wistar rats. Arch Gerontol Geriatr 2022; 102:104717. [DOI: 10.1016/j.archger.2022.104717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 01/03/2023]
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13
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Lu L, Mao L, Feng Y, Ainsworth BE, Liu Y, Chen N. Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis. BMC Geriatr 2021; 21:708. [PMID: 34911483 PMCID: PMC8672633 DOI: 10.1186/s12877-021-02642-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to clarify the effects of different exercise modes (resistance training [RT], whole body vibration training [WBVT], and mixed training [MT, resistance training combined with other exercises such as balance, endurance and aerobic training]) on muscle strength (knee extension strength [KES]) and physical performance (Timed Up and Go [TUG], gait speed [GS] and the Chair Stand [CS]) in older people with sarcopenia. METHOD All studies published from January 2010 to March 2021 on the effects of exercise training in older people with sarcopenia were retrieved from 6 electronic databases: Pubmed, Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), and Wanfang Database. Two researchers independently extracted and evaluated studies that met inclusion and exclusion criteria. Pooled analyses for pre- and post- outcome measurements were performed using Review Manager 5.4 with standardized mean differences (SMDs) and fixed-effect models. RESULT Twenty-six studies (25 randomized controlled trails [RCTs] and one non-randomized controlled trail) were included in this study with 1191 older people with sarcopenia (mean age 60.6 ± 2.3 to 89.5 ± 4.4). Compared with a control group, RT and MT significantly improved KES (RT, SMD = 1.36, 95% confidence intervals [95% CI]: 0.71 to 2.02, p < 0.0001, I2 = 72%; MT, SMD = 0.62, 95% CI: 0.29 to 0.95, p = 0.0002, I2 = 56%) and GS (RT, SMD = 2.01, 95% CI: 1.04 to 2.97, p < 0.0001, I2 = 84%; MT, SMD = 0.69, 95% CI: 0.29 to 1.09, p = 0.008, I2 = 81%). WBVT showed no changes in KES (SMD = 0.65, 95% CI: - 0.02 to 1.31, p = 0.06, I2 = 80%) or GS (SMD = 0.12, 95% CI: - 0.15 to 0.39, p = 0.38, I2 = 0%). TUG times were significantly improved with all exercise training modes (SMD = -0.66, 95% CI: - 0.94 to - 0.38, p < 0.00001, I2 = 60%). There were no changes in CS times with any of the exercise training modes (SMD = 0.11, 95% CI: - 0.36 to 0.57, p = 0.65, I2 = 87%). CONCLUSIONS In older people with sarcopenia, KES and GS can be improved by RT and MT, but not by WBVT. All three training modes improved TUG times, but not improved CS times.
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Affiliation(s)
- Linqian Lu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, 200438, China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, 202150, China
| | - Lin Mao
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuwei Feng
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, 200438, China
| | - Nan Chen
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, 200438, China.
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, 202150, China.
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14
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Teng Z, Zhu Y, Teng Y, Long Q, Hao Q, Yu X, Yang L, Lv Y, Liu J, Zeng Y, Lu S. The analysis of osteosarcopenia as a risk factor for fractures, mortality, and falls. Osteoporos Int 2021; 32:2173-2183. [PMID: 33877382 DOI: 10.1007/s00198-021-05963-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/14/2021] [Indexed: 12/14/2022]
Abstract
UNLABELLED Osteosarcopenia is defined as the concomitant occurrence of sarcopenia and osteoporosis/osteopenia. This study aimed to clarify whether osteosarcopenia implies a greater risk of fractures, mortality, and falls and to draw attention to osteosarcopenia. INTRODUCTION Osteosarcopenia, which is characterized by the co-existence of osteoporosis/osteopenia and sarcopenia, is one of the most challenging geriatric syndromes. However, the association between osteosarcopenia and the risk of falls, fractures, disability, and mortality is controversial. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from their inception to March 18, 2021, for cohort studies on the relationship between osteosarcopenia and fractures, falls, and mortality. Two reviewers independently extracted data and assessed study quality. A pooled analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) using fixed or random-effects models. RESULTS Eight cohort studies including 19,836 participants showed that osteosarcopenia significantly increased the risk of fracture (OR 2.46, 95% CI 1.83-3.30, Pheterogeneity = 0.006, I2 = 63.0%), three cohort studies involving 2601 participants indicated that osteosarcopenia significantly increased the risk of mortality (OR 1.66, 95% CI 1.23-2.26, Pheterogeneity = 0.214, I2 = 35.2%), and three cohort studies involving 3144 participants indicated that osteosarcopenia significantly increased the risk of falls (OR 1.62, 95% CI 1.28-2.04, Pheterogeneity = 0.219, I2 = 34.1%). No publication bias existed among the studies regarding the association between osteosarcopenia and fractures. The findings were robust according to the subgroup and sensitivity analyses. CONCLUSIONS This pooled analysis demonstrated that osteosarcopenia significantly increased the risk of fractures, falls, and mortality, thus highlighting its relevance in daily life. Therefore, we suggest that elderly persons should be aware of the risks associated with osteosarcopenia.
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Affiliation(s)
- Z Teng
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China
- Yunnan Key Laboratory of Digital Orthopedics, The First People's Hospital of Yunnan Province, Kunming, China
- Graduate School of Kunming Medical University, Kunming, China
| | - Y Zhu
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China
| | - Y Teng
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China
| | - Q Long
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China
| | - Q Hao
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China
| | - X Yu
- Graduate School of Kunming Medical University, Kunming, China
| | - L Yang
- Graduate School of Kunming Medical University, Kunming, China
| | - Y Lv
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China
| | - J Liu
- Graduate School of Kunming Medical University, Kunming, China
| | - Y Zeng
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yuxi, China.
| | - S Lu
- Yunnan Key Laboratory of Digital Orthopedics, The First People's Hospital of Yunnan Province, Kunming, China.
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15
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Bibliometric analysis of global research trends on male osteoporosis: a neglected field deserves more attention. Arch Osteoporos 2021; 16:154. [PMID: 34632530 DOI: 10.1007/s11657-021-01016-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We analyzed the knowledge structure, current status, and future directions of 3243 publications on male osteoporosis by employing bibliometric analysis. Our results indicated that Osteoporosis International was the most influential journal in this field. And the study of epidemiology and risk factors has been recognized as a hot research topic in recent years. This study also calls for more attention to be given on male osteoporosis research. INTRODUCTION Male osteoporosis is increasing as a serious health problem worldwide with the aging of population. However, a comprehensive understanding of the current status and future trends in this field is lacking to date. The goal of the present study was to summarize and visualize the knowledge framework, research hotspots, and emerging trends of male osteoporosis research based on the bibliometric method. METHODS Scientific publications regarding male osteoporosis from 1998 to 2020 were downloaded from the SCIE database. VOSviewer, CiteSpace, and online bibliometric website were used for this study. The main analyses include cooperative relationships between countries/institutions/authors, co-citation analysis of authors/journals, and co-occurrence analysis of keywords/subject categories, as well as analyses on keyword/reference bursts. RESULTS A total of 3243 publications with 128,751 citations were identified. Despite experiencing a period of increase in the number of publications, incentives for conducting male osteoporosis research seem to have decreased during recent years. The USA has the most prominent contributions, as reflected by most publications and the highest H-index value. Oregon Health and Science University was the most prolific institution within this domain. The most influential academic journal was Osteoporosis International. Keywords were categorized into four clusters: basic research, epidemiology and risk factors, diagnostic studies, treatment and fracture prevention. Burst keyword detection suggested that the following research directions including "obesity," "zoledronic acid," "DXA," "inflammation," "fall," "microarchitecture," and "sarcopenia" remain research hotspots in the near future and deserve our further attention. CONCLUSIONS This is the first bibliometric analysis that provides a comprehensive overview of male osteoporosis research, which may provide helpful references for investigators to further explore hot issues in this field.
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Zheng R, Byberg L, Larsson SC, Höijer J, Baron JA, Michaëlsson K. Prior loss of body mass index, low body mass index, and central obesity independently contribute to higher rates of fractures in elderly women and men. J Bone Miner Res 2021; 36:1288-1299. [PMID: 33784427 DOI: 10.1002/jbmr.4298] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022]
Abstract
We aimed to comprehensively evaluate the association of body composition with fracture risk using longitudinal data from a Swedish cohort of 44,366 women and men (mean age of 70 years) and a subcohort of 5022 women. We estimated hazard ratios (HRs) of fracture for baseline body mass index (BMI), BMI change during the prior 12 and 18 years, baseline waist-to-height ratio, total and regional distribution of fat and lean mass, with and without areal bone mineral density (BMD) adjustment. During follow-up (median 8.7 years), 7290 individuals sustained a fracture, including 4279 fragility fractures, of which 1813 were hip fractures. Higher baseline BMI and prior gain in BMI were inversely associated with all types of fracture. Lower fracture rate with higher baseline BMI was seen within every category of prior BMI change, whereas higher prior BMI gain conferred a lower rate of fracture within those with normal baseline BMI. Each standard deviation (SD) higher baseline waist-to-height ratio, after adjustment for BMI, was associated with higher rates of hip fracture in both women and men (HR 1.12; 95% CI, 1.05-1.19). In the subcohort (median follow-up 10 years), higher baseline fat mass index (FMI) and appendicular lean mass index (LMI) showed fracture-protective effects. After BMD adjustment, higher baseline BMI, total LMI, FMI, and higher prior BMI gain were associated with higher fracture rate. Baseline fat distribution also was associated with fracture rate; a 1-SD higher android to gynoid fat mass ratio in prior BMI gainers was associated with BMD-adjusted HRs of 1.16 (95% CI, 1.05-1.28) for any fracture and 1.48 (95% CI, 1.16-1.89) for hip fracture. This pattern was not observed among prior BMI losers. These findings indicate that for optimal fracture prevention, low baseline BMI, prior BMI loss and high baseline central obesity should be avoided in both women and men. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Rui Zheng
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Susanna C Larsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Jonas Höijer
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - John A Baron
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
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Harvey NC, Orwoll E, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cauley JA, Cawthon PM, Ensrud K, Liu E, Cruz-Jentoft AJ, Fielding RA, Cooper C, Kanis JA, Lorentzon M, Ohlsson C, Mellström D, Johansson H, McCloskey E. Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX ® , Falls, and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A Meta-Analysis. J Bone Miner Res 2021; 36:1235-1244. [PMID: 33831257 PMCID: PMC7611727 DOI: 10.1002/jbmr.4293] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height2 (ALM/ht2 ) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX® ) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht2 only), Morley, the International Working Group on Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP1 and 2), Asian Working Group on Sarcopenia, Foundation for the National Institutes of Health (FNIH) 1 and 2 (using ALM/body mass index [BMI], incorporating muscle strength and/or physical performance measures plus ALM/ht2 ), and Sarcopenia Definitions and Outcomes Consortium (gait speed and grip strength). Associations were adjusted for age and time since baseline and reported as hazard ratio (HR) for first incident fracture, here major osteoporotic fracture (MOF; clinical vertebral, hip, distal forearm, proximal humerus). Further analyses adjusted additionally for FRAX-MOF probability (n = 7531; calculated ± fnBMD), prior falls (y/n), or fnBMD T-score. Results were synthesized by meta-analysis. In 5660 men in USA, 2764 Sweden and 1987 Hong Kong (mean ages 73.5, 75.4, and 72.4 years, respectively), sarcopenia prevalence ranged from 0.5% to 35%. Sarcopenia status, by all definitions except those of FNIH, was associated with incident MOF (HR = 1.39 to 2.07). Associations were robust to adjustment for prior falls or FRAX probability (without fnBMD); adjustment for fnBMD T-score attenuated associations. EWGSOP2 severe sarcopenia (incorporating chair stand time, gait speed, and grip strength plus ALM) was most predictive, albeit at low prevalence, and appeared only modestly influenced by inclusion of fnBMD. In conclusion, the predictive value for fracture of sarcopenia definitions based on ALM is reduced by adjustment for fnBMD but strengthened by additional inclusion of physical performance measures. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Eric Orwoll
- Oregon Health & Science University, Portland, OR, USA
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Eva Ribom
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristine Ensrud
- Medicine and Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Dan Mellström
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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Scott D, Ebeling PR. Comment on: Osteosarcopenia: where osteoporosis and sarcopenia collide. Rheumatology (Oxford) 2021; 60:e216-e217. [PMID: 33502494 DOI: 10.1093/rheumatology/keab066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School-Western Campus, University of Melbourne, St Albans, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Teng Z, Zhu Y, Yu X, Liu J, Long Q, Zeng Y, Lu S. An analysis and systematic review of sarcopenia increasing osteopenia risk. PLoS One 2021; 16:e0250437. [PMID: 33909650 PMCID: PMC8081219 DOI: 10.1371/journal.pone.0250437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia is a progressive generalized skeletal muscle disorder, which may increase the risk of osteopenia. The aim of this study was to systematically review studies on the association between sarcopenia and osteopenia by pooled analysis. The PubMed and Embase databases were searched from inception to October 2020 for studies focusing on the association between sarcopenia and osteopenia. Two reviewers independently extracted data and assessed study quality. A pooled analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) using random-effects models. Subgroup analysis was conducted to explore the source of heterogeneity and the stability of outcome. A total of 25 independent studies involving 47,744 participants fulfilled the inclusion criteria. Sarcopenia significantly increased the risk of osteopenia (OR, 2.08; 95% CI, 1.66–2.60); Sensitivity analyses indicated the outcome was stable. Subgroup analyses showed that sarcopenia significantly increased osteopenia risk in each subgroup. No evidence of publication bias among the studies existed. In this study, our findings showed that sarcopenia significantly increased the risk of osteopenia. Thus, we suggest that sarcopenia can be a predictor of osteopenia risk.
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Affiliation(s)
- Zhaowei Teng
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
- Yunnan Key Laboratory of Digital Orthopedics, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yun Zhu
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Xiaochao Yu
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Jie Liu
- Yunnan Key Laboratory of Digital Orthopedics, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Qing Long
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Yong Zeng
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
- * E-mail: (YZ); (SL)
| | - Sheng Lu
- Yunnan Key Laboratory of Digital Orthopedics, The First People’s Hospital of Yunnan Province, Kunming, China
- * E-mail: (YZ); (SL)
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20
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Harvey NC, Kanis JA, Liu E, Cooper C, Lorentzon M, Bea JW, Carbone L, Cespedes Feliciano EM, Laddu DR, Schnatz PF, Shadyab AH, Stefanick ML, Wactawski‐Wende J, Crandall CJ, Johansson H, McCloskey E. Predictive Value of DXA Appendicular Lean Mass for Incident Fractures, Falls, and Mortality, Independent of Prior Falls, FRAX, and BMD: Findings from the Women's Health Initiative (WHI). J Bone Miner Res 2021; 36:654-661. [PMID: 33450071 PMCID: PMC7610603 DOI: 10.1002/jbmr.4239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022]
Abstract
In the Women's Health Initiative (WHI), we investigated associations between baseline dual-energy X-ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density (BMD), prior falls, and Fracture Risk Assessment Tool (FRAX® ) probability. The WHI is a prospective study of postmenopausal women undertaken at 40 US sites. We used an extension of Poisson regression to investigate the relationship between baseline ALM (corrected for height2 ) and incident fracture outcomes, presented here for major osteoporotic fracture (MOF: hip, clinical vertebral, forearm, or proximal humerus), falls, and death. Associations were adjusted for age, time since baseline and randomization group, or additionally for femoral neck (FN) BMD, prior falls, or FRAX probability (MOF without BMD) and are reported as gradient of risk (GR: hazard ratio for first incident fracture per SD increment) in ALM/height2 (GR). Data were available for 11,187 women (mean [SD] age 63.3 [7.4] years). In the base models (adjusted for age, follow-up time, and randomization group), greater ALM/height2 was associated with lower risk of incident MOF (GR = 0.88; 95% confidence interval [CI] 0.83-0.94). The association was independent of prior falls but was attenuated by FRAX probability. Adjustment for FN BMD T-score led to attenuation and inversion of the risk relationship (GR = 1.06; 95% CI 0.98-1.14). There were no associations between ALM/height2 and incident falls. However, there was a 7% to 15% increase in risk of death during follow-up for each SD greater ALM/height2 , depending on specific adjustment. In WHI, and consistent with our findings in older men (Osteoporotic Fractures in Men [MrOS] study cohorts), the predictive value of DXA-ALM for future clinical fracture is attenuated (and potentially inverted) after adjustment for femoral neck BMD T-score. However, intriguing positive, but modest, associations between ALM/height2 and mortality remain robust. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - John A Kanis
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Enwu Liu
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Geriatric Medicine, Department of Internal Medicine and Clinical NutritionInstitute of Medicine, University of GothenburgGothenburgSweden
- Geriatric MedicineSahlgrenska University HospitalMölndalSweden
| | | | - Laura Carbone
- Department of Medicine, Division of Rheumatology, J Harold Harrison, MD, Distinguished University Chair in RheumatologyMedical College of Georgia at Augusta UniversityAugustaGAUSA
| | | | - Deepika R Laddu
- Department of Physical TherapyCollege of Applied Health Sciences, University of Illinois at ChicagoChicagoILUSA
| | | | | | - Marcia L Stefanick
- Department of Medicine (Stanford Prevention Research Center)Stanford School of Medicine, Stanford UniversityStanfordCAUSA
| | | | - Carolyn J Crandall
- David Geffen School of Medicine at the University of CaliforniaLos AngelesCAUSA
| | - Helena Johansson
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Eugene McCloskey
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA)Mellanby Centre for Bone Research, University of SheffieldSheffieldUK
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21
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Integrating Muscle Health in Predicting the Risk of Asymptomatic Vertebral Fracture in Older Adults. J Clin Med 2021; 10:jcm10051129. [PMID: 33800414 PMCID: PMC7962822 DOI: 10.3390/jcm10051129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The utility of muscle health for predicting asymptomatic vertebral fracture (VF) is uncertain. We aimed to determine the effects of muscle health on bone quantity and quality in the older adults and to integrate these factors into a predictive model for VF. Methods: We prospectively recruited participants with a body mass index <37 kg/m2. The total lean mass (TLM), appendicular skeletal muscle index, presence of sarcopenia, and bone mineral density were determined by dual-energy X-ray absorptiometry, and bone quality by the trabecular bone score (TBS). VF was diagnosed based on spine radiography. Results: A total of 414 females and 186 males were included; 257 participants had VF. Lower TLM was significantly associated with poorer bone quantity and quality in both males and females. A low TBS (OR: 11.302, p = 0.028) and sarcopenia (Odds ratio (OR): 2.820, p = 0.002) were significant predictors of VF in males, but not bone quantity. Moreover, integrating TBS and sarcopenia into the predictive model improved its performance. Conclusions: Although TLM was associated with bone quantity and quality in both sexes, sarcopenia and a low TBS were significant predictors of asymptomatic VF only in male participants.
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22
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Pang BWJ, Wee SL, Chen KK, Lau LK, Jabbar KA, Seah WT, Ng DHM, Tan QLL, Jagadish MU, Ng TP. Coexistence of osteoporosis, sarcopenia and obesity in community-dwelling adults - The Yishun Study. Osteoporos Sarcopenia 2021; 7:17-23. [PMID: 33869801 PMCID: PMC8044590 DOI: 10.1016/j.afos.2020.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To 1) report prevalence of 'osteosarcopenia' (OS) and osteosarcopenic obesity (OSO) entities using evidence-based diagnostic techniques and definitions, 2) examine if OSO offers additional predictive value of functional decline over its components, and 3) identify associated factors in a multi-racial Southeast Asian population. METHODS We performed a cross-sectional study of a representative sample of 542 community-dwelling adults (21-90 years old), and assessed anthropometry, cognition, functional performance, and self-report sociodemographic, health and lifestyle questionnaires. Low muscle mass, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, were used to assess sarcopenia. Obesity was defined using percentage body fat and fat mass index. Osteopenia/osteoporosis was determined using lumbar spinal bone mineral density. Associated factors were examined using logistic regression, and OSO's value investigated using linear regressions with functional performance. RESULTS OS and OSO prevalence were 1.8% and 0% (21-59 years), 12.9% and 2.8% (≥ 60 years), 17.3% and 4.1% (≥ 65 years), and 25.5% and 7.0% (≥75 years), respectively. OSO entity as defined was not a significant predictor (P > 0.05) and did not improve explanations for functional decline over sarcopenia or sarcopenic obesity. Age, sex, race and body mass index (BMI) were associated with OS, while age, sex, race and alcoholism were associated with OSO. CONCLUSIONS Our results do not support OSO as a distinct entity in relation to functional decline. Aside from biological age, sex, and race, amenable lifestyle factors such as BMI and alcohol intake are important variables that can influence the co-existence of osteopenia/osteoporosis, sarcopenia and obesity.
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Affiliation(s)
| | - Shiou-Liang Wee
- Geriatric Education and Research Institute, Singapore
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore
| | | | - Lay Khoon Lau
- Geriatric Education and Research Institute, Singapore
| | | | - Wei Ting Seah
- Geriatric Education and Research Institute, Singapore
| | | | | | - Mallya Ullal Jagadish
- Geriatric Education and Research Institute, Singapore
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute, Singapore
- Department of Psychological Medicine, National University of Singapore, Singapore
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23
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Skrzypczak D, Ratajczak AE, Szymczak-Tomczak A, Dobrowolska A, Eder P, Krela-Kaźmierczak I. A Vicious Cycle of Osteosarcopeniain Inflammatory Bowel Diseases-Aetiology, Clinical Implications and Therapeutic Perspectives. Nutrients 2021; 13:nu13020293. [PMID: 33498571 PMCID: PMC7909530 DOI: 10.3390/nu13020293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Sarcopenia is a disorder characterized by a loss of muscle mass which leads to the reduction of muscle strength and a decrease in the quality and quantity of muscle. It was previously thought that sarcopenia was specific to ageing. However, sarcopenia may affect patients suffering from chronic diseases throughout their entire lives. A decreased mass of muscle and bone is common among patients with inflammatory bowel disease (IBD). Since sarcopenia and osteoporosis are closely linked, they should be diagnosed as mutual consequences of IBD. Additionally, multidirectional treatment of sarcopenia and osteoporosis including nutrition, physical activity, and pharmacotherapy should include both disorders, referred to as osteosarcopenia.
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24
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Scott D, Hirani V, Waite LM, Blyth F, Le Couteur DG, Cumming R, Jones G. Letter to the Editor: 'Giant' Claims Require Strong Evidence: A Comment on 'Osteosarcopenia: A Geriatric Giant of the XXI Century'. J Nutr Health Aging 2021; 25:946-947. [PMID: 34409977 DOI: 10.1007/s12603-021-1659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Scott
- Associate Professor David Scott, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia 3125, , Telephone: +61 3 9246 8438
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25
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Huang P, Luo K, Xu J, Huang W, Yin W, Xiao M, Wang Y, Ding M, Huang X. Sarcopenia as a Risk Factor for Future Hip Fracture: A Meta-Analysis of Prospective Cohort Studies. J Nutr Health Aging 2021; 25:183-188. [PMID: 33491032 DOI: 10.1007/s12603-020-1474-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our study aims to determine whether sarcopenia is a predictive factor of future hip fractures. DESIGN Systematic review and meta-analysis. Set: We searched for potentially suitable articles in PubMed, Cochrane library, Medline and EMBASE from inception to March 2020. The quality of the research was assessed by the Newcastle-Ottawa Scale (NOS). Finally, a meta-analysis was conducted with the Stata software. PARTICIPANTS Older community-dwelling residents. MEASUREMENTS Hip fracture due to sarcopenia. RESULTS We retrieved 2129 studies through our search strategy, and five studies with 23,359 individuals were analyzed in our pooled analyses. Sarcopenia increases the risk of future hip fractures with a pooled hazard ratio (HR) of 1.42 (95% CI: 1.18-1.71, P <0.001, I2 = 37.7%). In addition, in subgroup analyses based on different definitions of sarcopenia, sarcopenia was associated with the risk of future hip fractures with the Asian Working Group for Sarcopenia (AWGS) criteria with a pooled HR of 2.13(95% CI: 1.33-3.43). When subgroup analyses were conducted by sex, sarcopenia was associated with the risk for future hip fractures in females with pooled HRs of 1.69 (95% CI: 1.18-2.43). Sarcopenia was associated with the risk of future hip fractures in the group with a follow-up period of more than 5 years, with a pooled HR of 1.32 (95% CI: 1.08-1.61), and in the group with a follow-up period of less than 5 years, with a pooled HR of 2.13 (95% CI: 1.33-3.43). CONCLUSIONS Sarcopenia could significantly increase the risk of future hip fracture in old people; thus, it is necessary to prevent hip fractures in individuals with sarcopenia.
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Affiliation(s)
- P Huang
- Mei Ding, Medical College Road, Ganzhou City, Jiangxi Province 341000, China, E-mail address:. Xiaofeng Huang, E-mail address :
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26
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Monteverdi S, Pedersini R, Gallo F, Maffezzoni F, Dalla Volta A, Di Mauro P, Turla A, Vassalli L, Ardine M, Formenti AM, Simoncini EL, Giustina A, Maroldi R, Amoroso V, Berruti A. The Interaction of Lean Body Mass With Fat Body Mass Is Associated With Vertebral Fracture Prevalence in Women With Early Breast Cancer Undergoing Aromatase Inhibitor Therapy. JBMR Plus 2020; 5:e10440. [PMID: 33615109 PMCID: PMC7872339 DOI: 10.1002/jbm4.10440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
Aromatase inhibitors (AIs) induce depletion of estrogen levels, causing bone loss and increased fracture risk in women with breast cancer. High‐fat body mass (FBM) emerged as an independent factor associated with the prevalence of morphometric vertebral fractures (VFs) in patients undergoing AIs. We explored the role of lean body mass (LBM) and the interaction of LBM with FBM in predicting the occurrence of VFs in postmenopausal women who were either AI‐naïve or AI‐treated. A total of 684 consecutive breast cancer patients were enrolled in this cross‐sectional study. Each woman underwent a dual‐energy X‐ray absorptiometry (DXA) scan, measuring bone mineral density (BMD), LBM, and FBM; VFs were assessed using a quantitative morphometric analysis of DXA images. After propensity score matching, the study population was restricted to 480 women, 240 AI‐naïve and 240 AI‐treated. We used multivariable logistic regression models to explore the associations between baseline characteristics, VF prevalence and the interaction between LBM, FBM and AI therapy. No interaction between LBM and AI therapy on VF prevalence was shown. Conversely, we reported a significant interaction between LBM, FBM and AI therapy (p = .0311). Among AI‐treated women having LBM below and FBM above or equal the median value, VF prevalence was numerically higher (15/31; 48.4%) than in other subgroups (VF prevalence: 35.7% in high‐LBM and low‐FBM group, 23.2% in high‐LBM and high‐FBM group, and 19.8% in low‐LBM and low‐FBM group). Among AI‐naïve women, the greatest VF proportion was observed in the subgroup with LBM and FBM below median value (25/92; 27.2%). This study suggests a synergism between LBM and FBM in predicting the morphometric VF in women with early breast cancer undergoing AIs. This observation is new and deserves further investigation. The assessment of body composition by DXA might be useful when estimating fracture risk in this population. © 2020 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sara Monteverdi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Rebecca Pedersini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy.,Breast Unit ASST-Spedali Civili Brescia Italy
| | - Fabio Gallo
- Clinical Epidemiology Unit, IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Filippo Maffezzoni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Radiology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Alberto Dalla Volta
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Pierluigi Di Mauro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Antonella Turla
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Lucia Vassalli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy.,Breast Unit ASST-Spedali Civili Brescia Italy
| | - Mara Ardine
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Anna Maria Formenti
- Department of Endocrinology, San Raffaele Vita-Salute University and Division of Endocrinology San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Hospital Milan Italy
| | | | - Andrea Giustina
- Department of Endocrinology, San Raffaele Vita-Salute University and Division of Endocrinology San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Hospital Milan Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Radiology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Vito Amoroso
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology University of Brescia, Aziende Socio Sanitarie Territoriali (ASST) Spedali Civili Brescia Italy
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27
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Krysztofiak H, Wleklik M, Migaj J, Dudek M, Uchmanowicz I, Lisiak M, Kubielas G, Straburzyńska-Migaj E, Lesiak M, Kałużna-Oleksy M. Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure. Clin Interv Aging 2020; 15:2041-2051. [PMID: 33173285 PMCID: PMC7646468 DOI: 10.2147/cia.s273967] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).
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Affiliation(s)
- Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Marta Wleklik
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | | | - Magdalena Lisiak
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Kubielas
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
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28
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Feasibility of computed tomography-based assessment of skeletal muscle mass in hemodialysis patients. J Nephrol 2020; 34:465-471. [PMID: 32996109 DOI: 10.1007/s40620-020-00871-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/18/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sarcopenia is a major health issue especially in patients on maintenance hemodialysis. Low skeletal muscle mass is included in the diagnostic criteria for sarcopenia. The skeletal muscle mass is usually evaluated by modalities such as bioimpedance analysis (BIA) or dual-energy X-ray absorptiometry, however the assessment of skeletal muscle mass using computed tomography (CT) images has not been established. The purpose of the study was to investigate the feasibility of the assessment of skeletal muscle mass using CT images in hemodialysis patients. METHODS Skeletal muscle mass index (SMI) was measured by BIA and psoas muscle index (PMI) was measured by cross-sectional CT images in 131 patients. The relationship between SMI and PMI and the diagnostic ability of PMI for low muscle mass were evaluated. Furthermore, the patients were followed up and long-term survival in patients with low and high PMI were compared. RESULTS PMI measured at the L3 vertebral level was strongly correlated with SMI (r = 0.597, p < 0.001). Age, sex, and SMI were the influencing factors for PMI. Patients with low PMI showed higher incidence rates of mortality during the follow up. CONCLUSIONS PMI assessed by CT image can be an alternative to BIA in patients on hemodialysis.
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29
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Alajlouni D, Bliuc D, Tran T, Eisman JA, Nguyen TV, Center JR. Decline in Muscle Strength and Performance Predicts Fracture Risk in Elderly Women and Men. J Clin Endocrinol Metab 2020; 105:5868761. [PMID: 32639571 DOI: 10.1210/clinem/dgaa414] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Muscle strength and performance are associated with fractures. However, the contribution of their rate of decline is unclear. OBJECTIVE To assess the independent contribution of the rate of decline in muscle strength and performance to fracture risk. DESIGN, SETTING, AND PARTICIPANTS Community-dwelling women (n = 811) and men (n = 440) aged 60 years or older from the prospective Dubbo Osteoporosis Epidemiology Study followed from 2000 to 2018 for incident fracture. Clinical data, appendicular lean mass/height2 (ht)2, bone mineral density, quadricep strength/ht (QS), timed get-up-and-go (TGUG), 5 times repeated sit-to-stand (5xSTS), and gait speed (GS) measured biennially. Rates of decline in muscle parameters were calculated using ordinary least squares regression and fracture risk was assessed using Cox's models. MAIN OUTCOME Incident low-trauma fracture ascertained by x-ray report. RESULTS Apart from lean mass in women, all muscle parameters declined over time. Greater rates of decline in physical performance were associated with increased fracture risk in women (Hazard ratios [HRs] ranging from 2.1 (95% CI: 1.5-2.9) for GS to 2.7 (95% CI: 1.9-3.6) for 5xSTS, while in men only the decline in GS was associated with fracture risk (HR: 3.4 [95% CI: 1.8-6.3]). Baseline performance and strength were also associated with increased fracture risk in men (HRs ranging from 1.8 (95% CI: 1.1-3.0) for QS to 2.5 (95% CI: 1.5-4.1) for TGUG, but not in women. CONCLUSION Rate of decline in physical performance in both genders, and baseline strength and performance in men, contributed independently to fracture risk. Sit-to-stand and GS were the tests most consistently associated with fractures. Further studies are required to determine whether muscle strength and/or performance improve the predictive accuracy of fracture prediction models.
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Affiliation(s)
- Dima Alajlouni
- Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Dana Bliuc
- Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Thach Tran
- Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - John A Eisman
- Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Tuan V Nguyen
- Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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30
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Hernández-Arciga U, Hernández-Álvarez D, López-Cervantes SP, López-Díazguerrero NE, Alarcón-Aguilar A, Luna-López A, Königsberg M. Effect of long-term moderate-exercise combined with metformin-treatment on antioxidant enzymes activity and expression in the gastrocnemius of old female Wistar rats. Biogerontology 2020; 21:787-805. [PMID: 32749628 DOI: 10.1007/s10522-020-09894-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Abstract
Oxidative stress is known to be involved in the etiology of sarcopenia, a progressive loss of muscle mass and force related to elderly incapacity. A successful intervention to prevent this condition has been exercise-based therapy. Metformin (MTF), an anti-diabetic drug with pleiotropic effects, is known to retain redox homeostasis. However, the combined use of MTF with exercise has shown controversial experimental results. Our research group has shown that MTF-treatment does not limit the benefits provided by exercise, probably by inducing a hormetic response. Hence, our aim was to evaluate the effect of exercise in combination with MTF-treatment on the redox state of old female Wistar rats. Animals were divided into six groups; three groups preformed exercise on a treadmill for 5 days/week for 20 months and the other three were sedentary. Also, two groups of each, exercised and sedentary animals were treated with MTF for 6 or 12 months correspondingly, beside the untreated groups. Rats were euthanized at 24 months. Muscular functionality was analyzed as the relation between the lean mass free of bone with respect to the grip strength. Superoxide dismutase, catalase, and glutathione peroxidase content, enzymatic activity and redox state were determined in the gastrocnemius muscle. Our results showed that the exercised group treated with MTF for 12 months presented higher GSH/GSSG rate and high antioxidant scavenging power in contrast to the MTF-treatment for 6 months, where the beneficial effect was less noticeable.
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Affiliation(s)
- Ulalume Hernández-Arciga
- Lab. Bioenergética y Envejecimiento Celular, Depto de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, A.P. 55-535, C.P. 09340, Ciudad de México, Mexico
| | - David Hernández-Álvarez
- Lab. Bioenergética y Envejecimiento Celular, Depto de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, A.P. 55-535, C.P. 09340, Ciudad de México, Mexico
- Posgrado en Ciencias Biológicas, Universidad Autónoma Metropolitana, Ciudad de México, Mexico
| | - Stefanie Paola López-Cervantes
- Lab. Bioenergética y Envejecimiento Celular, Depto de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, A.P. 55-535, C.P. 09340, Ciudad de México, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México, Mexico
| | - Norma Edith López-Díazguerrero
- Lab. Bioenergética y Envejecimiento Celular, Depto de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, A.P. 55-535, C.P. 09340, Ciudad de México, Mexico
| | - Adriana Alarcón-Aguilar
- Lab. Bioenergética y Envejecimiento Celular, Depto de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, A.P. 55-535, C.P. 09340, Ciudad de México, Mexico
| | | | - Mina Königsberg
- Lab. Bioenergética y Envejecimiento Celular, Depto de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, A.P. 55-535, C.P. 09340, Ciudad de México, Mexico.
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Su Y, Lam FMH, Leung J, Cheung WH, Ho SC, Kwok T. The Predictive Value of Sarcopenia and Falls for 2-Year Major Osteoporotic Fractures in Community-Dwelling Older Adults. Calcif Tissue Int 2020; 107:151-159. [PMID: 32472390 PMCID: PMC7382674 DOI: 10.1007/s00223-020-00709-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/19/2020] [Indexed: 12/26/2022]
Abstract
To evaluate the associations of sarcopenia and previous falls with 2-year major osteoporotic fractures (MOFs) in community-dwelling older adults. Four thousand Chinese men and women ≥ 65 years recruited from Hong Kong communities were prospectively followed up. Measures of muscle mass, grip strength, gait speed and falls in the previous year were recorded at baseline, the 2nd year and the 4th year visit for each subject. The associations of fall history, sarcopenia and its components with 2-year MOFs were evaluated using generalized linear mixed models. Poor grip strength and poor gait speed were significantly associated with a higher 2-year MOFs risk, with an adjusted OR (95% CI) per one SD decrease of 1.48 (1.17, 1.87) and 1.17 (1.00, 1.36), respectively. Falls in the previous year was a significant predictor for 2-year MOFs risk, with an adjusted OR (95% CI) per one added fall of 1.85 (1.40, 2.44) in men and 1.26 (1.01, 1.58) in women. The adjusted OR (95% CI) of height adjusted appendicular lean muscle mass (ALM/height2) per one SD decrease and sarcopenia for 2-year MOFs risk were 1.34 (0.87, 2.06) and 1.72 (0.92, 3.21) in men, and were 0.73 (0.57, 0.93) and 0.76 (0.39, 1.47) in women, respectively (P for interaction by gender = 0.012 and 0.017, respectively). Poor sarcopenia-related physical performance and falls in the previous year were significant predictors for 2-year MOFs in community-dwelling older adults. The predictive value of ALM by DXA for near-term fracture risk is limited and different across genders.
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Affiliation(s)
- Yi Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Freddy M H Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Suzanne C Ho
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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32
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Cauley JA, Crandall C. The Women's Health Initiative: A Landmark Resource for Skeletal Research Since 1992. J Bone Miner Res 2020; 35:845-860. [PMID: 32286708 DOI: 10.1002/jbmr.4026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/31/2020] [Accepted: 04/05/2020] [Indexed: 01/01/2023]
Abstract
The Women's Health Initiative (WHI) is a large longitudinal study designed to investigate strategies for the prevention and control of common chronic diseases in postmenopausal women, including cardiovascular disease, cancer, and osteoporotic fractures. The WHI consisted of three overlapping clinical trials of hormone therapy, diet modification to reduce total dietary fat, and calcium/vitamin D supplementation. Women who were ineligible for the hormone therapy or diet modification trials or not interested were invited to participate in the observational study. Women were recruited into WHI from 1993 to 1998 at 40 US clinical centers. WHI enrolled 26,046 underrepresented minority women and 135,762 white women. Women could participate in each trial if eligible. The final enrollment included 27,347 women in the hormone trial; 48,835 women in the diet modification trial; 36,282 women in the calcium/vitamin D trial, and 93,676 in the observational study. After the main study ended in 2005, women were invited to continue follow-up for exposures and outcomes through two extensions to 2020. Proposals were recently submitted to continue follow-up through 2027. Information was collected on an extensive number of risk factors for fractures at baseline and over the follow-up, including fall and fracture history, weight patterns, comorbidities, diet, reproductive history, medications, anthropometry, and biomarkers. Bone mineral density was measured at three WHI clinical centers (n = 11,020) chosen to maximize race/ethnic diversity. WHI encourages outside investigators to make use of the publicly available WHI data and to access the biobank of specimens (www.whi.org). © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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Chen H, Ma J, Liu A, Cui Y, Ma X. The association between sarcopenia and fracture in middle-aged and elderly people: A systematic review and meta-analysis of cohort studies. Injury 2020; 51:804-811. [PMID: 32115209 DOI: 10.1016/j.injury.2020.02.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The association between sarcopenia and risk of fracture remained controversial. This systematic review and meta-analysis was conducted to evaluate the association between sarcopenia and fracture incidence in the middle-aged and elderly people. MATERIALS AND METHODS Web of Science, PubMed, EMBASE, and the Cochrane Library were searched. Weighted averages were reported as hazard risk (HR) values with 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran's Q test and the I2 statistic. RESULTS A total of 5 cohort studies involving 27 990 participants were included in our study. The crude and adjusted effect sizes between sarcopenia and fracture were extracted from 2 and 5 studies, respectively. Sarcopenia was significantly associated with fracture incidence without adjusting covariates (crude HR, 1.69; 95% CI, 1.34-2.13). After adjusting for potential confounders, sarcopenia still demonstrated significant positive association with fracture (adjusted HR, 1.50;95%CI, 1.08-2.08). The sensitivity analysis confirmed the stability of the results. In the subgroup analysis of studies after adjusting covariates, there were significant associations between sarcopenia and fracture in the subgroups of male, older people, American and hip fracture patients. CONCLUSION Our meta-analysis found that sarcopenia was significantly associated with fracture in middle aged and elderly people. However, more homogeneous studies are needed to fully clarify the relationship between sarcopenia and fracture.
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Affiliation(s)
- Hengting Chen
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Heping District Munan Road NO 155, Tianjin, 300050, China; Tianjin Medical University, Heping District Qixiangtai Road NO 22, Tianjin, 300070, China
| | - Jianxiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Heping District Munan Road NO 155, Tianjin, 300050, China
| | - Aifeng Liu
- The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Nankai District Anshanxi Road NO 314, Tianjin, 300110, China
| | - Yuhong Cui
- Tianjin University, Nankai District Weijin Road NO 92, Tianjin, 300072, China
| | - Xinlong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Heping District Munan Road NO 155, Tianjin, 300050, China.
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Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Hirani V. Does Combined Osteopenia/Osteoporosis and Sarcopenia Confer Greater Risk of Falls and Fracture Than Either Condition Alone in Older Men? The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2020; 74:827-834. [PMID: 30032209 DOI: 10.1093/gerona/gly162] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is unclear whether older men with osteopenia/osteoporosis and sarcopenia (so-called osteosarcopenia) are at greater risk of falls and fractures than those with either condition alone. METHODS One thousand five hundred seventy-five community-dwelling men aged ≥70 years had appendicular lean mass, total hip and lumbar spine bone mineral density determined by dual-energy x-ray absorptiometry, and completed hand grip strength and gait speed tests. Osteopenia/osteoporosis was defined as a T-score at any site ≤-1.0 SD. Sarcopenia was defined using the European Working Group on Sarcopenia algorithm. Participants were contacted every 4 months for 6 ± 2 years to ascertain incident fractures (confirmed by radiographic reports) and for 2 years for incident falls. RESULTS Prevalence of osteosarcopenia was 8%, while 34% of participants had osteopenia/osteoporosis alone and 7% had sarcopenia alone. Men with osteosarcopenia had significantly increased fall (incidence rate ratio: 1.41; 95% confidence interval [CI]: 1.02 to 1.95) and fracture risk (hazard ratio: 1.87; 95% CI: 1.07 to 3.26) compared with men with neither osteopenia/osteoporosis nor sarcopenia. There was no statistical interaction between osteopenia/osteoporosis and sarcopenia, and falls and fracture risk were not different for osteosarcopenia compared with either condition alone (all p > .05). CONCLUSIONS Community-dwelling older men with combined osteopenia/osteoporosis and sarcopenia do not have increased falls and fracture risk compared with those with either condition. Further research is required to clarify whether the term "osteosarcopenia" has any meaning above and beyond either term alone and therefore potential clinical utility for falls and fracture prediction.
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Affiliation(s)
- David Scott
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Australian Institute for Musculoskeletal Science, Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - Markus Seibel
- Bone Research Program, ANZAC Research Institute, University of Sydney, New South Wales, Australia.,Department of Endocrinology and Metabolism, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Australia.,The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David G Le Couteur
- ANZAC Research Institute, University of Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, New South Wales, Australia.,Department of Andrology, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales, Australia.,School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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35
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Hernández-Álvarez D, Mena-Montes B, Toledo-Pérez R, Pedraza-Vázquez G, López-Cervantes SP, Morales-Salazar A, Hernández-Cruz E, Lazzarini-Lechuga R, Vázquez-Cárdenas RR, Vilchis-DeLaRosa S, Posadas-Rodríguez P, Santín-Márquez R, Rosas-Carrasco O, Ibañez-Contreras A, Alarcón-Aguilar A, López-Díazguerrero NE, Luna-López A, Königsberg M. Long-Term Moderate Exercise Combined with Metformin Treatment Induces an Hormetic Response That Prevents Strength and Muscle Mass Loss in Old Female Wistar Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:3428543. [PMID: 31814870 PMCID: PMC6877950 DOI: 10.1155/2019/3428543] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022]
Abstract
Sarcopenia is a syndrome characterized by a progressive and generalized skeletal muscle mass and strength loss, as well as a poor physical performance, which as strongly been associated with aging. Sedentary lifestyle in the elderly contributes to this condition; however, physical activity improves health, reducing morbidity and mortality. Recent studies have shown that metformin (MTF) can also prevent muscle damage promoting muscular performance. To date, there is great controversy if MTF treatment combined with exercise training improves or nullifies the benefits provided by physical activity. This study is aimed at evaluating the effect of long-term moderate exercise combined with MTF treatment on body composition, strength, redox state, and survival rate during the life of female Wistar rats. In this study, rats performed moderate exercise during 20 of their 24 months of life and were treated with MTF for one year or for 6 months, i.e., from 12 to 24 months old and 18 to 24 months old. The body composition (percentage of fat, bone, and lean mass) was determined using a dual-energy X-ray absorption scanner (DXA), and grip strength was determined using a dynamometer. Likewise, medial and tibial nerve somatosensory evoked potentials were evaluated and the redox state was measured by HPLC, calculating the GSH/GSSG ratio in the gastrocnemius muscle. Our results suggest- that the MTF administration, both in the sedentary and the exercise groups, might activate a mechanism that is directly related to the induction of the hormetic response through the redox state modulation. MTF treatment does not eliminate the beneficial effects of exercise throughout life, and although MTF does not increase muscle mass, it increases longevity.
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Affiliation(s)
- David Hernández-Álvarez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Posgrado en Ciencias Biológicas, Universidad Autónoma Metropolitana, Ciudad de México 09340, Mexico
| | - Beatriz Mena-Montes
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Instituto Nacional de Geriatría, SSA, Ciudad de México 10200, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Rafael Toledo-Pérez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Gibrán Pedraza-Vázquez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Stefanie Paola López-Cervantes
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Alfredo Morales-Salazar
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Edith Hernández-Cruz
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Roberto Lazzarini-Lechuga
- Departamento de Biología de la Reproducción, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Roman Royer Vázquez-Cárdenas
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Silvia Vilchis-DeLaRosa
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Pedro Posadas-Rodríguez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | - Roberto Santín-Márquez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | | | | | - Adriana Alarcón-Aguilar
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
| | | | | | - Mina Königsberg
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México 09340, Mexico
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Anand A, Shetty AP, Renjith KR, K S SVA, Kanna RM, Rajasekaran S. Does Sarcopenia Increase the Risk for Fresh Vertebral Fragility Fractures?: A Case-Control Study. Asian Spine J 2019; 14:17-24. [PMID: 31575110 PMCID: PMC7010510 DOI: 10.31616/asj.2019.0049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Case-control study. PURPOSE Sarcopenia is an age associated condition characterized by decrease in muscle mass, strength, and physical performance. We aimed to investigate whether sarcopenia increased the risk of vertebral fragility fractures among the elderly. OVERVIEW OF LITERATURE Initial reports on sarcopenia suggest its contribution to the development of vertebral fragility fractures. However, recent studies showed contradictory findings. METHODS Fifty-one consecutive patients with vertebral fragility fractures and matched controls without fractures were evaluated for sarcopenia, T-score, body mass index, and presence of preexisting vertebral fractures. Sarcopenia was diagnosed as total psoas cross-sectional area (TPA) 2 standard deviations below normative value from normal young adults and decreased handgrip strength (26 kg for men and 18 kg for women). Univariate and multivariate analyses were performed using the fresh fracture occurrence as the dependent variable. RESULTS Sarcopenia was confirmed in 29.4% and 7.8% of cases and controls (p=0.005), respectively; 56.8% and 13.7% of cases and controls had previous vertebral fractures. Sarcopenia prevalence was greater among those with previous fractures (38% vs. 7.6%; odds ratio, 7.76; p<0.001). TPA was lower among the cases (1,278 mm2 vs. 1,569 mm2 , p=0.001) and those with previous fractures (1,168 mm2 vs. 1,563 mm2 , p<0.001). Handgrip strength was greater among those without previous fractures (19.6 kg vs. 16.3 kg, p=0.05). In multivariate analysis, sarcopenia was not identified as a significant predictor of fresh fractures whereas previous fractures and lower T-score were found to be significant. CONCLUSIONS Sarcopenia is not an independent risk factor for fresh vertebral fragility fractures in the elderly.
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Affiliation(s)
- Ashish Anand
- Department of Orthopaedics, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - K R Renjith
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Sri Vijay Anand K S
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
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Bauer JM, Cruz-Jentoft AJ, Fielding RA, Kanis JA, Reginster JY, Bruyère O, Cesari M, Chapurlat R, Al-Daghri N, Dennison E, Kaufman JM, Landi F, Laslop A, Locquet M, Maggi S, McCloskey E, Perna S, Rizzoli R, Rolland Y, Rondanelli M, Szulc P, Vellas B, Vlaskovska M, Cooper C. Is There Enough Evidence for Osteosarcopenic Obesity as a Distinct Entity? A Critical Literature Review. Calcif Tissue Int 2019; 105:109-124. [PMID: 31098729 DOI: 10.1007/s00223-019-00561-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/02/2019] [Indexed: 12/16/2022]
Abstract
The co-existence of impaired bone health (osteopenia/osteoporosis), reduced muscle mass and strength (sarcopenia), and increased adiposity (obesity) in middle-aged and older people has been identified in recent studies, leading to a proposal for the existence of "osteosarcopenic obesity" as a distinct entity. Evidence for the pathophysiological overlap of these conditions is mounting, although a causal relationship is yet to be established. Each component condition occurs frequently with increasing age, and with shared risk factors in many instances, thus, an overlap of these three conditions is not surprising. However, whether the concurrent existence of sarcopenia, osteoporosis and obesity leads to an increased risk of adverse musculoskeletal outcomes and mortality above and beyond the risks associated with the sum of the component parts remains to be proven and is a question of research interest. In this article, we review evidence for the existence of osteosarcopenic obesity including the current operational definition of osteosarcopenic obesity, prevalence, pathophysiology, outcomes and exploratory approaches to the management of components. We conclude that, there is insufficient evidence to support a discrete clinical entity of osteosarcopenic obesity at this time. To expand knowledge and understanding in this area, there is a need for consensus on a definition of osteosarcopenic obesity which will allow for identification, further epidemiological studies and comparisons between studies. Additionally, studies should assess whether the clinical outcomes associated with osteosarcopenic obesity are worse than the mere addition of those linked with its components. This will help to determine whether defining a person as having this triad will eventually result in a more effective treatment than addressing each of the three conditions separately.
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Affiliation(s)
- Jürgen M Bauer
- Center for Geriatric Medicine, University of Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Heidelberg, Germany.
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - John A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Roland Chapurlat
- INSERM, UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon Cedex 03, France
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopaedics, Orthogeriatric Unit, Teaching Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Andrea Laslop
- Scientific Office, Federal Office for Safety in Health Care, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Médéa Locquet
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | | | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Mellanby Centre for Bone Research and Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038, Zallaq, Bahrain
| | - René Rizzoli
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Yves Rolland
- CHU Toulouse, Médecine Gériatrie Gérontopôle, Cité de la Santé, 20 Rue du Pont Saint Pierre, Inserm 1027, 31059, Toulouse, France
| | - Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Pavia, Italy
| | - Pawel Szulc
- INSERM, UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Bruno Vellas
- CHU Toulouse, Médecine Gériatrie Gérontopôle, Cité de la Santé, 20 Rue du Pont Saint Pierre, Inserm 1027, 31059, Toulouse, France
| | - Mila Vlaskovska
- Medical Faculty, Department of Pharmacology, Medical University Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria
| | - Cyrus Cooper
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
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Scott D, Johansson J, McMillan LB, Ebeling PR, Nordstrom P, Nordstrom A. Associations of Sarcopenia and Its Components with Bone Structure and Incident Falls in Swedish Older Adults. Calcif Tissue Int 2019; 105:26-36. [PMID: 30899995 DOI: 10.1007/s00223-019-00540-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare bone structure parameters and likelihood of falls across European Working Group on Sarcopenia in Older People (EWGSOP2) sarcopenia categories. 3334 Swedish 70-year olds had appendicular lean mass (normalized to height; ALMHt), lumbar spine and total hip areal BMD (aBMD) estimated by dual-energy X-ray absorptiometry. Volumetric BMD (vBMD) and structure at the distal and proximal tibia and radius were estimated by peripheral quantitative computed tomography. Hand grip strength and timed up-and-go were assessed, and sarcopenia was defined according to EWGSOP2 criteria. Incident falls were self-reported 6 and 12 months after baseline. Only 0.8% and 1.0% of participants had probable and confirmed sarcopenia, respectively. Almost one-third of participants with confirmed sarcopenia reported incident falls, compared with 20% for probable sarcopenia and 14% without sarcopenia (P = 0.025). Participants with confirmed sarcopenia had poorer bone parameters (all P < 0.05) except endosteal circumference at the proximal radius and tibia, while those with probable sarcopenia had lower cortical area at the proximal radius (B = - 5.9; 95% CI - 11.7, - 0.1 mm2) and periosteal and endosteal circumferences at the proximal tibia (- 3.3; - 6.4, - 0.3 and - 3.8; - 7.5, - 0.1 mm2, respectively), compared with those without sarcopenia. Compared with probable sarcopenia, confirmed sarcopenic participants had significantly lower lumbar spine and total hip aBMD, distal radius and tibia total vBMD, and proximal radius and tibia cortical vBMD, area and thickness (all P < 0.05). Swedish 70-year olds with confirmed sarcopenia demonstrate poorer BMD and bone architecture than those with probable and no sarcopenia, and have increased likelihood of incident falls.
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Affiliation(s)
- David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, VIC, Australia.
| | - Jonas Johansson
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Lachlan B McMillan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Peter Nordstrom
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordstrom
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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40
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Uemura K, Yamada M, Okamoto H. Association of bioimpedance phase angle and prospective falls in older adults. Geriatr Gerontol Int 2019; 19:503-507. [DOI: 10.1111/ggi.13651] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/26/2018] [Accepted: 02/07/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Kazuki Uemura
- Center for Liberal Arts and Sciences, Faculty of EngineeringToyama Prefectural University Imizu Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human SciencesUniversity of Tsukuba Tokyo Japan
| | - Hiroshi Okamoto
- Center for Liberal Arts and Sciences, Faculty of EngineeringToyama Prefectural University Imizu Japan
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Harvey NC, Kanis JA, Liu E, Johansson H, Lorentzon M, McCloskey E. Appendicular lean mass and fracture risk assessment: implications for FRAX® and sarcopenia. Osteoporos Int 2019; 30:537-539. [PMID: 30815717 PMCID: PMC6430419 DOI: 10.1007/s00198-019-04904-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/14/2019] [Indexed: 11/25/2022]
Abstract
The vast majority of current sarcopenia definitions use DXA-derived appendicular lean mass (DXA ALM) as an approximation of muscle mass. However, there is increasing evidence that ALM is poorly predictive of incident fractures. In this editorial, we describe findings from several cohorts suggesting that DXA ALM gives only limited information on the risk of incident fracture, and that in the US MrOS, WHI and Health ABC cohorts, accounting for femoral neck bone mineral density may entirely remove ALM-fracture associations. These observations raise important questions about the role of DXA ALM both in sarcopenia definitions and as a potential input variable for FRAX. We conclude that DXA ALM is unlikely to be a useful addition to the FRAX tool, but that other means of estimating muscle mass, such as those derived from creatine dilution or peripheral quantitative CT, might offer more value for fracture risk assessment.
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Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - E Liu
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - H Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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42
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Wong RMY, Wong H, Zhang N, Chow SKH, Chau WW, Wang J, Chim YN, Leung KS, Cheung WH. The relationship between sarcopenia and fragility fracture-a systematic review. Osteoporos Int 2019; 30:541-553. [PMID: 30610245 DOI: 10.1007/s00198-018-04828-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022]
Abstract
Sarcopenia is a common geriatric syndrome characterized by progressive decrease of muscle mass and function leading to an increased risk of physical disability, poor quality of life, and mortality. Increasing evidence shows that sarcopenia is related with fragility fractures. This systematic review aimed to summarize the following: (1) the prevalence of sarcopenia in patients with fragility fracture and (2) the associated risk factors for fragility fracture in patients with sarcopenia. Literature search was conducted in PubMed and Cochrane databases. Studies with the prevalence of sarcopenia in elderly patients with fragility fracture and associated risk factors in patients with sarcopenia were included. A total of 15 papers were included, with 10 reporting sarcopenia prevalence, and 5 on fracture risk in patients with sarcopenia. The prevalence of sarcopenia after fracture ranged from 12.4 to 95% in males and 18.3 to 64% in females. The prevalence of sarcopenia in elderly patients with fragility fracture was high, especially in men. Two studies showed that sarcopenia was a risk factor for fragility fracture when associated with low bone mineral density (BMD) but only in men. Caution should be taken for male patients with sarcopenia and low BMD, which is related to significantly increased risk of fractures. There is a pressing need for further research on sarcopenia and its risk on fragility fracture to better understand the relationship, pathophysiology, and mechanisms, which may shed light on potential interventions to improve clinical outcomes.
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Affiliation(s)
- R M Y Wong
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - H Wong
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - N Zhang
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - S K H Chow
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
- The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, People's Republic of China
| | - W W Chau
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - J Wang
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Y N Chim
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - K S Leung
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - W H Cheung
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China.
- The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, People's Republic of China.
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Follis S, Bea JW, Cauley JA, Shadyab AH, Cook A, Chen Z. Reply to Effects of Hormone Replacement Therapy on Sarcopenia: Is It Real? J Am Geriatr Soc 2019; 67:1298-1299. [PMID: 30697691 DOI: 10.1111/jgs.15805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Shawna Follis
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona
| | - Jennifer W Bea
- The University of Arizona Cancer Center, Tucson, Arizona.,Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Aladdin H Shadyab
- Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, California
| | - Alan Cook
- Trauma Research Program, Chandler Regional Medical Center, Chandler, Arizona
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona
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Abstract
Fractures resulting from osteoporosis become increasingly common in women after age 55 years and men after age 65 years, resulting in substantial bone-associated morbidities, and increased mortality and health-care costs. Research advances have led to a more accurate assessment of fracture risk and have increased the range of therapeutic options available to prevent fractures. Fracture risk algorithms that combine clinical risk factors and bone mineral density are now widely used in clinical practice to target high-risk individuals for treatment. The discovery of key pathways regulating bone resorption and formation has identified new approaches to treatment with distinctive mechanisms of action. Osteoporosis is a chronic condition and long-term, sometimes lifelong, management is required. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. In people at a very high or imminent risk of fracture, therapy with teriparatide or abaloparatide should be considered; however, since treatment duration with these drugs is restricted to 18-24 months, treatment should be continued with an antiresorptive drug. Individuals at high risk of fractures do not receive adequate treatment and strategies to address this treatment gap-eg, widespread implementation of Fracture Liaison Services and improvement of adherence to therapy-are important challenges for the future.
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Affiliation(s)
| | - Michael R McClung
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA; Mary MacKillop Institute for Health, Australian Catholic University, Melbourne, VIC, Australia
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Suzuki T, Palus S, Springer J. Skeletal muscle wasting in chronic heart failure. ESC Heart Fail 2018; 5:1099-1107. [PMID: 30548178 PMCID: PMC6300810 DOI: 10.1002/ehf2.12387] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Abstract
Patients suffering from chronic heart failure (CHF) show an increased prevalence (~20% in elderly CHF patients) of loss of muscle mass and muscle function (i.e. sarcopenia) compared with healthy elderly people. Sarcopenia, which can also occur in obese patients, is considered a strong predictor of frailty, disability, and mortality in older persons and is present in 5–13% of elderly persons aged 60–70 years and up to 50% of all octogenarians. In a CHF study, sarcopenia was associated with lower strength, reduced peak oxygen consumption (peak VO2, 1173 ± 433 vs. 1622 ± 456 mL/min), and lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001). Unfortunately, there are only very limited therapy options. Currently, the main intervention remains resistance exercise. Specialized nutritional support may aid the effects of resistance training. Testosterone has significant positive effects on muscle mass and function, and low endogenous testosterone has been described as an independent risk factor in CHF in a study with 618 men (hazard ratio 0.929, P = 0.042). However, the use of testosterone is controversial because of possible side effects. Selective androgen receptor modulators have been developed to overcome these side effects but are not yet available on the market. Further investigational drugs include growth hormone, insulin‐like growth factor 1, and several compounds that target the myostatin pathway. The continuing development of new treatment strategies and compounds for sarcopenia, muscle wasting regardless of CHF, and cardiac cachexia makes this a stimulating research area.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Sandra Palus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Jochen Springer
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
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Follis S, Cook A, Bea JW, Going SB, Laddu D, Cauley JA, Shadyab AH, Stefanick ML, Chen Z. Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women. J Am Geriatr Soc 2018; 66:2314-2320. [PMID: 30375641 PMCID: PMC6289680 DOI: 10.1111/jgs.15613] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/11/2018] [Accepted: 08/18/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To investigate associations between sarcopenia, obesity, and sarcopenic obesity and incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women. DESIGN Prospective cohort study. SETTING Three Women's Health Initiative (WHI) clinical centers (Tucson-Phoenix, AZ; Pittsburgh, PA; Birmingham, AL). PARTICIPANTS Postmenopausal women aged 50 to 79 enrolled in the WHI who underwent bone and body composition scans using dual-energy x-ray absorptiometry at baseline (N = 11,020). MEASUREMENTS Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage greater than 42%. Sarcopenic obesity was defined as co-occurrence of sarcopenia and obesity. The fall outcome was defined as falling 2 or more times in any year during 7 years of follow-up. The risk of falls associated with sarcopenic obesity were analyzed using log binomial regression models stratified according to age and race/ethnicity. RESULTS Sarcopenic obesity was associated with greater risk of falls in women aged 50 to 64 (relative risk (RR) = 1.35, 95% confidence interval (CI)=1.17-1.56) and 65 to 79 (RR = 1.21, 95% CI=1.05-1.39). Sarcopenic obesity related fall risk was higher in Hispanic women (RR = 2.40, 95% CI=1.56-3.67) than non-Hispanic white women (RR = 1.24, 95% CI=1.11-1.39). CONCLUSION In a multiethnic cohort of postmenopausal women, sarcopenic obesity-related fall risk was high in women younger than 65 and those age 65 and older. Sarcopenic obesity posed the highest risk for falls in Hispanic women. The findings support identification of causal factors and health disparities in sarcopenic obesity to customize fall prevention strategies and ameliorate this significant public health burden. J Am Geriatr Soc 66:2314-2320, 2018.
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Affiliation(s)
- Shawna Follis
- The University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ
| | - Alan Cook
- Trauma Research Program, Chandler Regional Medical Center, Chandler, AZ
| | - Jennifer W. Bea
- The University of Arizona Cancer Center, Tucson, AZ
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ
| | - Scott B. Going
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, The University of Illinois at Chicago, Chicago, IL 60612
| | - Jane A. Cauley
- University of Pittsburgh, Graduate School of Public Health, Dept of Epidemiology, Pittsburgh PA
| | - Aladdin H. Shadyab
- Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA
| | - Zhao Chen
- The University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ
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Harvey NC, Odén A, Orwoll E, Lapidus J, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cooper C, Cawthon PM, Kanis JA, Ohlsson C, Mellström D, Johansson H, McCloskey E. Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study. J Bone Miner Res 2018; 33:2150-2157. [PMID: 30011086 PMCID: PMC6272117 DOI: 10.1002/jbmr.3556] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/23/2018] [Accepted: 07/07/2018] [Indexed: 11/17/2022]
Abstract
Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height2 ), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta-analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow-up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height2 (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height2 and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height2 and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height2 was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Nicholas C Harvey
- Medical Research Council (MRC) Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southamptonand University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Anders Odén
- Centre for Bone and Arthritis Research (CBAR)Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
| | - Eric Orwoll
- Oregon Health & Science UniversityPortlandORUSA
| | - Jodi Lapidus
- Department of Public Health and Preventive MedicineDivision of BiostatisticsOregon Health and Science UniversityPortlandORUSA
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public HealthThe Chinese University of Hong KongHong KongThe People's Republic of China
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research UnitLund University, Lund, Sweden; and Department of OrthopedicsSkane University HospitalMalmöSweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research UnitLund University, Lund, Sweden; and Department of OrthopedicsSkane University HospitalMalmöSweden
| | - Eva Ribom
- Department of Surgical SciencesUniversity of UppsalaUppsalaSweden
| | - Cyrus Cooper
- Medical Research Council (MRC) Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southamptonand University Hospital Southampton NHS Foundation TrustSouthamptonUK
- National Institute for Health Research (NIHR) Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Peggy M Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California–San FranciscoSan FranciscoCAUSA
| | - John A Kanis
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Institute for Health and AgingCatholic University of AustraliaMelbourneAustralia
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research (CBAR)Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR)Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Johansson
- Centre for Bone and Arthritis Research (CBAR)Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Institute for Health and AgingCatholic University of AustraliaMelbourneAustralia
| | - Eugene McCloskey
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA)Mellanby Centre for Bone ResearchUniversity of SheffieldSheffieldUK
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Su Y, Woo JW, Kwok TCY. The Added Value of SARC-F to Prescreening Using FRAX for Hip Fracture Prevention in Older Community Adults. J Am Med Dir Assoc 2018; 20:83-89. [PMID: 30314676 DOI: 10.1016/j.jamda.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To examine the potential added value of a simple 5-item questionnaire for sarcopenia screening (SARC-F) to the Fracture Risk Assessment Tool (FRAX) for hip fracture risk prediction, in order to identify at-risk older adults for screening with dual-energy x-ray absorptiometry (DXA). DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Two thousand Chinese men and 2000 Chinese women aged 65 years or older were recruited from local communities and were prospectively followed up for about 10 years. MEASURES Areal bone mineral density (BMD) of hip and lumbar spine were measured by DXA at baseline. Ten-year FRAX probability of hip fracture was calculated using the baseline risk factors. Information from the baseline questionnaire was extracted to calculate a modified SARC-F score. The independent predictive values of SARC-F and FRAX questionnaire were evaluated using multivariate survival analysis. The added predictive values of SARC-F to FRAX for pre-DXA screening were examined. RESULTS During the follow-up, 63 (3.2%) men and 69 (3.5%) women had at least 1 incident hip fracture. SARC-F had an independent value of FRAX for hip fracture risk prediction, with an adjusted hazard ratio [95% confidence interval (CI)] of 1.24 (1.02, 1.52) and 1.15 (0.99, 1.13) in men and women, respectively. Compared with using FRAX, using SARC-F in conjunction with FRAX made the sensitivity for prediction rise from 58.7% to 76.2% in men and from 69.6% to 78.3% in women, with a nondecreased area under receiver operating characteristic curve of 0.67. Prescreening using FRAX in conjunction with SARC-F could save more than half of the DXA assessment than with no prescreening. CONCLUSIONS/IMPLICATIONS SARC-F is associated with a modest increase in hip fracture risk, especially in men. Conjoint evaluation for sarcopenia in addition to FRAX screening may help identify older adults at higher risk of hip fracture for more intensive screening and/or preventive interventions.
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Affiliation(s)
- Yi Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jean W Woo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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49
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Abstract
Sarcopenia is defined as a combination of low muscle mass with low muscle function. The term was first used to designate the loss of muscle mass and performance associated with aging. Now, recognized causes of sarcopenia also include chronic disease, a physically inactive lifestyle, loss of mobility, and malnutrition. Sarcopenia should be differentiated from cachexia, which is characterized not only by low muscle mass but also by weight loss and anorexia. Sarcopenia results from complex and interdependent pathophysiological mechanisms that include aging, physical inactivity, neuromuscular compromise, resistance to postprandial anabolism, insulin resistance, lipotoxicity, endocrine factors, oxidative stress, mitochondrial dysfunction, and inflammation. The prevalence of sarcopenia ranges from 3% to 24% depending on the diagnostic criteria used and increases with age. Among patients with rheumatoid arthritis 20% to 30% have sarcopenia, which correlates with disease severity. Sarcopenia exacts a heavy toll of functional impairment, metabolic disorders, morbidity, mortality, and healthcare costs. Thus, the consequences of sarcopenia include disability, quality of life impairments, falls, osteoporosis, dyslipidemia, an increased cardiovascular risk, metabolic syndrome, and immunosuppression. The adverse effects of sarcopenia are particularly great in patients with a high fat mass, a condition known as sarcopenic obesity. The diagnosis of sarcopenia rests on muscle mass measurements and on functional tests that evaluate either muscle strength or physical performance (walking, balance). No specific biomarkers have been identified to date. The management of sarcopenia requires a multimodal approach combining a sufficient intake of high-quality protein and fatty acids, physical exercise, and antiinflammatory medications. Selective androgen receptor modulators and anti-myostatin antibodies are being evaluated as potential stimulators of muscle anabolism.
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Affiliation(s)
- Anne Tournadre
- Service de rhumatologie, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France; Unité de Nutrition Humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
| | - Gaelle Vial
- Service de rhumatologie, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France; Unité de Nutrition Humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Frédéric Capel
- Unité de Nutrition Humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Martin Soubrier
- Service de rhumatologie, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France; Unité de Nutrition Humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Yves Boirie
- Service de nutrition clinique, hôpital G.-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Unité de Nutrition Humaine, UMR1019 INRA, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
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50
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Springer J, Springer JI, Anker SD. Muscle wasting and sarcopenia in heart failure and beyond: update 2017. ESC Heart Fail 2018; 4:492-498. [PMID: 29154428 PMCID: PMC5695190 DOI: 10.1002/ehf2.12237] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia (loss of muscle mass and muscle function) is a strong predictor of frailty, disability and mortality in older persons and may also occur in obese subjects. The prevalence of sarcopenia is increased in patients suffering from chronic heart failure. However, there are currently few therapy options. The main intervention is resistance exercise, either alone or in combination with nutritional support, which seems to enhance the beneficial effects of training. Also, testosterone has been shown to increased muscle power and function; however, a possible limitation is the side effects of testosterone. Other investigational drugs include selective androgen receptor modulators, growth hormone, IGF‐1, compounds targeting myostatin signaling, which have their own set of side effects. There are abundant prospective targets for improving muscle function in the elderly with or without chronic heart failure, and the continuing development of new treatment strategies and compounds for sarcopenia and cardiac cachexia makes this field an exciting one.
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Affiliation(s)
- Jochen Springer
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Joshua-I Springer
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
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