Background Sarcopenia is prevalent in patients with chronic kidney disease (CKD). The indices of physical function, such as grip power and gait speed, decreased according to the decline in the estimated glomerular filtration rate (eGFR). Methods We examined the relationships between cystatin C-based GFR (eGFRcys), creatinine-based GFR (eGFRcre), their ratio (eGFRcys/eGFRcre) and sarcopenia in community-dwelling older adults in Japan. This cross-sectional study included 302 men aged 73.9 ± 6.2 years and 647 women aged 72.9 ± 5.8 years from a rural area in Hyogo Prefecture, Japan. eGFRcys and eGFRcre were simultaneously measured, and sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) 2019 criteria was evaluated. Results eGFRcys and the eGFRcys/eGFRcre ratio were significantly correlated with grip power and gait speed (p < 0.001). The eGFRcys/eGFRcre ratio was also correlated with skeletal muscle mass index (SMI) (p < 0.01). Univariate logistic regression analysis showed eGFRcys and eGFRcys/eGFRcre ratio but not eGFRcre were associated with sarcopenia (p < 0.01). The presence of low eGFRcys (CKDcys) and low eGFRcys/eGFRcre ratio (< 1.0) but not that of low eGFRcre (CKDcre) were associated with sarcopenia (p < 0.01). In the multivariate logistic regression analysis, when the eGFRcys/eGFRcre ratio was added as a covariate to the basic model, it was significantly associated with sarcopenia in women (p < 0.05). Moreover, low eGFRcys/eGFRcre ratio (< 1.0) was associated with a higher risk of sarcopenia in men (p < 0.01). Conclusion In conclusion, CKDcys but not CKDcre is associated with sarcopenia. A lower eGFRcys/eGFRcre ratio may be a practical screening marker of sarcopenia in community-dwelling older adults.

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Background and Objectives: Conservative treatment is the gold standard for acute osteoporotic vertebral fractures (AOVFs). However, the treatment strategy for multiple AOVFs remains unknown. We conducted a prospective study using magnetic resonance imaging (MRI) to investigate how rapidly subsequent osteoporotic vertebral fractures (OVFs) occur as domino OVFs within 3 months. This study aimed to assess the incidence and impact of domino OVFs on quality of life (QOL) following conservative treatment for initial AOVFs. Materials and Methods: A prospective multicenter cohort study was conducted at eight hospitals. The included patients were those with AOVFs occurring within 3 weeks, aged >60 years, and diagnosed using MRI. All patients were treated conservatively and underwent MRI after 3 months. Subsequent domino OVFs were defined as newly occurring OVFs within 3 months. Patient characteristics, types of conservative treatment, and patient-reported outcomes, including a visual analogue scale (VAS), the Oswestry disability index (ODI), and the Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ), were evaluated and compared between the domino OVF and non-domino OVF groups. Results: A total of 227 patients were analyzed. The mean age was 80.1 ± 7.3 years and 78% were female. Subsequent domino OVFs were observed in 31 (13.6%) patients within 3 months. An increasing number of prevalent OVFs were significantly associated with domino OVFs (p = 0.01). No significant differences in bone mineral density, type of brace, and anti-osteoporosis medications were found between the two groups. The JOABPEQ (excluding social function), ODI, and VAS were significantly improved after 3 months. Patients with domino OVFs at 3 months had poorer JOABPEQ social life function, ODI, and VAS than those with non-domino OVFs. Conclusions: In this study, the incidence of domino OVFs was 13.6% within 3 months. Domino OVFs had a negative impact on QOL at 3 months and were associated with prevalent OVFs.

Background and Objectives: In this retrospective cohort study, we investigate associations between the Hounsfield units (HU) value of upper instrumented vertebra (UIV) and proximal junctional kyphosis (PJK) after adult spinal deformity (ASD) surgery. Materials and Methods: The cohort consisted of 60 patients (mean age 71.7 years) who underwent long instrumented fusion surgery (≥6 vertebrae) for ASD with at least 1 year of follow-up. The preoperative bone mineral density (BMD) measured on DXA scans, the HU values at UIV and UIV+1, and the radiographic parameters were compared between the PJK and non-PJK groups. The severity of UIV fracture was assessed using a semiquantitative (SQ) grade. Results: PJK occurred in 43% of patients. No significant differences in patient age, sex, BMD, and preoperative radiographic parameters were observed between the PJK and non-PJK groups. The HU values of the UIV (103.4 vs. 149.0, p < 0.001) and UIV+1 (102.0 vs. 145.7, p < 0.001) were significantly lower in the PJK group. The cutoff values of HU at UIV and UIV+1 were 122.8 and 114.9, respectively. Lower HU values at UIV (Grade 1: 134.2, Grade 2: 109.6, Grade 3: 81.1, p < 0.001) and UIV+1 (Grade 1: 131.5, Grade 2: 107.1, Grade 3: 82.1, p < 0.001) were associated with severe SQ grade. Conclusions: Lower HU values at UIV and UIV+1 had a negative impact on signal incidence of PJK and were correlated with the severity of UIV fractures. Preoperative treatment of osteoporosis seems necessary for preoperative UIV HU values less than 120.

Background Nutritional status, which is associated with osteoporosis and muscle weakness is considered an important factor in the management of acute osteoporotic vertebral fracture (AOVF). However, few reports have investigated the nutritional status of hospitalized patients with AOVF and the impact of malnutrition on their functional prognosis. This study aimed to evaluate the nutritional status of hospitalized elderly patients with AOVF using the Controlling Nutritional Status (CONUT) score and to determine the usefulness of the CONUT score in predicting their functional prognosis. Methods The CONUT score on admission was retrospectively calculated for 134 hospitalized elderly patients (mean age 83 ± 7.6 years, 66% female) with AOVF who received conservative treatment between 2017 and 2020. Functional outcome was assessed by comparing ambulatory ability before the onset of AOVF and upon discharge. Patients were divided into two groups: CONUT-high ( ≥ 4) and CONUT-low ( ≤ 3), according to receiver operating characteristic (ROC) analysis to predict decline in ambulatory ability upon discharge. Logistic regression analysis was performed to obtain odds ratios (OR) and 95% confidence intervals (CI) of the relationships between the nutritional status and ambulatory ability. The discriminative power of the CONUT score was then compared with other nutritional assessment tools such as the Geriatric Nutritional Risk Index (GNRI) and prognostic nutritional index (PNI) by ROC analysis. Results 81% of hospitalized patients with an AOVF were malnourished at the time of admission. The CONUT-high group had a significantly higher rate of decline in ambulatory ability (P < 0.001) than the CONUT-low group. Logistic regression analysis revealed the CONUT score ( ≥ 4) as an independent risk factor for a decline in ambulatory ability (OR 3.44, 95% CI 1.61–7.37, P = 0.0014). ROC analysis showed that the area under the curve (AUC) for the CONUT score (AUC = 0.724) was significantly greater than that for the GNRI (AUC = 0.624, P = 0.021) and PNI (AUC = 0.636, P = 0.0008). Conclusions This study showed that 81% of hospitalized elderly patients with AOVFs were malnourished and that the CONUT score was a useful predictive factor of functional prognosis.

Background Sarcopenia is prevalent in patients with chronic kidney disease (CKD). Sarcopenia is prevalent in patients with chronic kidney disease (CKD). The indices of physical function, such as grip power and gait speed, decreased according to the decline in estimated glomerular filtration rate (eGFR).Methods We examined the relationships between cystatin C-based GFR (eGFRcys), and creatininebased GFR (eGFRcre), and their ratio (eGFRcys/eGFRcre) and low skeletal muscle mass index (SMI) in community-dwelling older adults in Japan. This cross-sectional study included 286 men aged 73.3±6.2 years and 606 women aged 72.9±5.8 years from a rural area in Hyogo Prefecture, Japan. eGFRcys and eGFRcre were simultaneously measured, whereas low SMI based on the AWGS criteria was evaluated.Results eGFRcys and the eGFRcys/eGFRcre were significantly correlated with grip power and gait speed. The eGFRcys/eGFRcre was also correlated with SMI. In the multivariate logistic regression analysis, when the eGFRcys/eGFRcre was added as a covariate to the basic model, it was significantly associated with low SMI, both in all subjects. Moreover, CKDcys with a low eGFRcys/eGFRcre ratio (<1.0) was associated with a higher risk of low SMI than CKDcys alone. ConclusionIn conclusion, CKDcys but not CKDcre is an independent risk factor of low SMI. In patients with CKDcys, lower eGFRcys/eGFRcre may be a practical screening marker of low SMI in communitydwelling older adults.

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