Osteosarcopenia: where bone, muscle, and fat collide

Abstract

As the world's population ages, the prevalence of chronic diseases increases. Sarcopenia and osteoporosis are two conditions that are associated with aging, with similar risk factors that include genetics, endocrine function, and mechanical factors. Additionally, bone and muscle closely interact with each other not only anatomically, but also chemically and metabolically. Fat infiltration, a phenomenon observed in age-related bone and muscle loss, is highly prevalent and more severe in sarcopenic and osteoporotic subjects. Clinically, when individuals suffer a combination of both disorders, negative outcomes such as falls, fractures, loss of function, frailty, and mortality increase, thus generating significant personal and socio-economic costs. Therefore, it is suggested that when bone mineral density loss is synchronic with decreased muscle mass, strength, and function, it should be interpreted as a single diagnosis of osteosarcopenia, which may be preventable and treatable. Simple interventions such as resistance training, adequate protein and calcium dietary intake, associated with maintenance of appropriate levels of vitamin D, have a dual positive effect on bone and muscle, reducing falls, fractures, and, consequently, disability. It is essential that fracture prevention approaches-including postfracture management-involve assessment and treatment of both osteoporosis and sarcopenia. This is of particular importance as in older persons the combination of osteopenia/osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. This review summarizes osteosarcopenia epidemiology, pathophysiology, diagnosis, outcomes, and management strategies.

Bone Marrow and Muscle Fat Infiltration Are Correlated among Postmenopausal Women With Osteoporosis: The AMBERS Cohort Study

“…Maugeri and colleagues suggest that the release of inflammatory cytokines including IL‐6 and TNF‐alpha from both marrow and body fat could contribute to this lipotoxicity causing osteo‐ and sarcopenia . This notion has also been supported by Ng and Duque and recently reviewed by Hirschfeld …”

The association between decreased hand grip strength and hip fracture in older people: A systematic review

“…Sarcopenia, osteoporosis, and osteosarcopenia can be considered part of frailty (Hirschfeld et al, 2017). Frailty is associated with chronological age (Bassey and Harries, 1993), but Syddall et al (2003) demonstrated an even stronger association between frailty and (decreased) age and gender stratified HGS.…”

“…Two of those ageing related conditions are osteoporosis and sarcopenia. They have similar risk factors and often occur simultaneously, then referred to as osteosarcopenia (Hirschfeld et al, 2017). Osteoporosis is an undisputed major risk factor for sustaining a hip fracture.…”

“…Investigating other aspects of hip fracture prevention seems therefore critical when striving for an inclusive evidence based approach. This review focused on the relationship between hip fracture and hand grip strength (HGS), with the latter being an indicator for overall muscle strength (Hirschfeld et al, 2017;Rantanen et al, 2003) and an important measure for frailty (Syddall et al, 2003), sarcopenia (Chen et al, 2014;Cruz-Jentoft et al, 2010) and osteoporosis (Cheung et al, 2012; Kritz-Silverstein and Barrett-Connor, 1994). …”

Current Status of Sarcopenia in Korea: A Focus on Korean Geripausal Women

“…These are associated with similar risk factors including genetics, endocrine function, and mechanical factors. 35) Individuals with a combination of both disorders, called 'sarco-osteoporosis,' are at the greatest risk of falls and fractures. 36,37) …”