Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis

Abstract

Osteosarcopenia is associated with increased risk of adverse outcomes such as falls and fractures. Its association with frailty is less well-described, particularly in independent community-dwelling older adults. Although nutrition plays a crucial role in maintaining bone and muscle health, the complex relationship between osteosarcopenia and nutrition in the pathogenesis of frailty remains to be elucidated. In this cross-sectional analysis of 230 independent, community-dwelling individuals (mean age 67.2 ± 7.4 years), we examined the associations between osteosarcopenia with nutritional status and frailty, and the mediating role of nutrition in the association between osteosarcopenia and frailty. Osteosarcopenia was defined as fulfilling both the Asian Working Group for Sarcopenia 2019 consensus definition (low relative appendicular skeletal muscle mass adjusted for height, in the presence of either of either low handgrip strength or slow gait speed) and T-score ≤ −2.5 SD on bone mineral densitometry. We assessed frailty using the modified Fried criteria and nutrition using the Mini-Nutritional Assessment. We performed multiple linear regression, followed by pathway analysis to ascertain whether nutrition mediates the relationship between osteosarcopenia and frailty. Our study population comprised: 27 (11.7%) osteosarcopenic, 35 (15.2%) sarcopenic, 36 (15.7%) osteoporotic and 132 (57.4%) normal (neither osteosarcopenic, sarcopenic nor osteoporotic). Osteosarcopenia (β = 1.1, 95% CI 0.86–1.4) and sarcopenia (β = 1.1, 95% CI 0.90–1.4) were significantly associated with frailty, but not osteoporosis. Nutrition mediated the association between osteosarcopenia and frailty (indirect effect estimate 0.09, bootstrap 95% CI 0.01–0.22). In conclusion, osteosarcopenia is associated with frailty and poorer nutritional status, with nutrition mediating the association between osteosarcopenia and frailty. Our findings support early nutritional assessment and intervention in osteosarcopenia to mitigate the risk of frailty.

Risk Factors of Frailty in Patients with Distal Radius Fractures

“…Nutrition plays a critical role in the pathophysiology of frailty and the maintenance of bone 47 and muscle health. 45 , 48 One study suggested that malnutrition could play a role as a mediator of osteosarcopenia and sarcopenia in the development of frailty. 45 Furthermore, sufficient protein and vitamin D uptake in the elderly has been recommended for the prevention of muscle and bone loss as well as the maintenance of sufficient leg and grip strength.…”

“… 45 , 48 One study suggested that malnutrition could play a role as a mediator of osteosarcopenia and sarcopenia in the development of frailty. 45 Furthermore, sufficient protein and vitamin D uptake in the elderly has been recommended for the prevention of muscle and bone loss as well as the maintenance of sufficient leg and grip strength. 49 Associations between nutritional uptake, especially protein and the occurrence of post-operative surgical complications in patients with hip fractures 50 , 51 and the importance of nutritional status for the improvement of activities of daily living and the incidence of subsequent fracture in DRF patients 52 have been proposed.…”

Frailty in Adults With HIV: Identification, Assessment, and Management

“…Nutrition is an integral part of frailty management. 30 For individuals with sarcopenia or weight loss, providing oral nutritional supplements to undernourished adults can result in weight gain and restoration of function. Multiple factors play a role in weight loss, including medications, depression, malnourishment, and poor dentition.…”

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