Associations of Body Composition Trajectories with Bone Mineral Density, Muscle Function, Falls, and Fractures in Older Men: The Concord Health and Ageing in Men Project

Abstract

Background Weight loss increases fracture risk in older adults. We aimed to determine associations of 2-year body composition trajectories with subsequent falls and fractures in older men. Methods We measured appendicular lean mass (ALM) and total fat mass (FM) by dual-energy X-ray absorptiometry at baseline and Year 2 in 1,326 community-dwelling men aged ≥70 and older. Body composition trajectories were determined from residuals of a linear regression of change in ALM on change in FM (higher values indicate maintenance of ALM over FM), and a categorical variable for change in ALM and FM (did not lose [≥−5% change] versus lost [<−5% change]). Bone mineral density (BMD), hand grip strength, and gait speed were assessed at Years 2 and 5. After Year 2, incident fractures (confirmed by radiographical reports) and falls were recorded for 6.8 years. Results Compared with men who did not lose ALM or FM, men who did not lose ALM but lost FM, and men who lost both ALM and FM, had reduced falls (−24% and −34%, respectively; both p < .05). Men who lost ALM but did not lose FM had increased falls (incidence rate ratio = 1.73; 95% CI 1.37–2.18). ALM/FM change residuals were associated with improved lumbar spine BMD (B = 0.007; 95% CI 0.002–0.012 g/cm2 per SD increase) and gait speed (0.015; 0.001–0.029 m/s), and reduced hip fractures (hazard ratio = 0.68; 95% CI 0.47–0.99). Conclusions Fracture risk may be increased in older men who lose higher ALM relative to FM. Weight loss interventions for obese older men should target maintenance of lean mass.

A Comparison of Bone-Targeted Exercise Strategies to Reduce Fracture Risk in Middle-Aged and Older Men with Osteopenia and Osteoporosis: LIFTMOR-M Semi-Randomized Controlled Trial

“…Findings of a recent population‐based study in community‐dwelling older men indicate maintenance of ALM with an accompanying reduction in FM is associated with reduced incidence of falls . Although the CON group lost LM and gained FM, HiRIT improved body composition with an increase in weight but reduction in fat, suggesting increased LM, and IAC reduced fat.…”

Exploring the Impact of Obesity on Skeletal Muscle Function in Older Age

“…Treating obesity appropriately in older age is of upmost importance in order to prevent any further loss of skeletal muscle associated with aging (219)(220)(221). Treatment of obesity in older age (and sarcopenic-obesity) requires a combination of personalized nutrition and physical activity approaches as, under certain conditions, inappropriate changes to these paradigms may actually accelerate the progression of sarcopenia given the susceptibility to energy restriction and, thus, a potential catabolic state (222). As the pathogenesis of these three conditions (sarcopenia, obesity, and sarcopenic-obesity) is multifaceted, understanding the optimal treatment is highly complex.…”

“…Optimal treatment of sarcopenic-obesity likely incorporates a combination of resistance and aerobic training in the presence of a small dietary calorie deficit with sufficient protein intake, as severe weight reduction strategies may also compromise the ability to preserve muscle function and mass which may subsequently lead to frailty, disability, and increased morbidity and mortality (220,223). It is also noteworthy that bone density may also be impaired with weight-loss programs which may, in-turn, contribute to fracture risk, and subsequent further risk of hospitalization, periods of prolonged inactivity and further muscle loss and functional impairment (87,104,222). Nevertheless, weight loss should be considered safe in older adults, if managed appropriately (222,223).…”

“…It is also noteworthy that bone density may also be impaired with weight-loss programs which may, in-turn, contribute to fracture risk, and subsequent further risk of hospitalization, periods of prolonged inactivity and further muscle loss and functional impairment (87,104,222). Nevertheless, weight loss should be considered safe in older adults, if managed appropriately (222,223). As such, treatment of sarcopenia alone may be easier than treatment of (pre)-sarcopenic obese individuals.…”

Risk factors for decreased bone mineral density in men with type 2 diabetes.

“…Снижение МПК в проксимальном отделе и шейке бедра оказалось ассоциировано с относительно низкими показателями массы тела и массы ЖТ, что согласуется с данными литературы [15]. Ранее показано, что масса ЖТ является важным предиктором снижения МПК у женщин с СД2, находящихся в постменопаузе [16].…”