Osteosarcopenic Obesity: Current Knowledge, Revised Identification Criteria and Treatment Principles

Abstract

Osteosarcopenic obesity (OSO) syndrome describes the simultaneous deterioration of bone, muscle and excess fat, resulting in reduced functionality and systemic metabolic dysregulation. The key component contributing to this may be ectopic fat in the viscera, bone and muscle. OSO research to date is summarized, and the revised criteria for its identification for research purposes are reviewed and proposed, including new criteria to assess visceral fat in males and females. Finally, nutritional and physical activity recommendations are consolidated into a treatment algorithm, which can be validated in future studies and which may also be applied to preventative management.

Chronic Stress Contributes to Osteosarcopenic Adiposity via Inflammation and Immune Modulation: The Case for More Precise Nutritional Investigation

“…Literature searches were performed using combination of key-words and the use of Boolean AND, to include chronic stress with inflammation, immune system, chronic diseases, adiposity/obesity and nutrition. The most recent review and update on the osteosarcopenic obesity diagnostic criteria, characteristics and treatment principles was published in 2019 by Kelly et al [22]. Therefore, the references from that paper were explored and the phrase "osteosarcopenic obesity" was used in the search to capture any relevant articles published in the meantime.…”

“…Subsequently, it has been recognized and studied throughout the world in different populations, including Koreans [42][43][44][45], Chinese [46][47][48], Mexicans [49], Brazilians [50,51], Italians [52], and most strikingly, it was even identified in Greek young (18-20 years) obese men and women [53]. Other studies have linked OSO with various other ill consequences, including cancer and kidney disease; see review [22].…”

“…As it was addressed in the recent 5-year update on OSO, the current working definition of OSO is that it is a condition encompassing the simultaneous deterioration of bone (osteopenia/osteoporosis) and muscle (sarcopenia/dynapenia) with the increased presence of fat (adipose tissue), as either overt overweight/obesity or redistributed fat (in visceral regions), as well as infiltrated fat into bone and muscle [22]. For a more widespread interpretation, body composition includes bone, muscle (or lean tissue as its proxy) and adipose tissues.…”

Phenotypes of Sarcopenic Obesity: Exploring the Effects on Peri-Muscular Fat, the Obesity Paradox, Hormone-Related Responses and the Clinical Implications

“…As defined recently by Kelly et al [31], fat mass and fat mass index are included to measure obesity, while waist circumference (WC), visceral fat, visceral/subcutaneous fat ratio, intramuscular adipose tissue by BIA and the android to gynoid fat ratio are used to determine the extent of abdominal/visceral fat. In addition, BIA cutoffs were included as it has been previously used to identify osteosarcopenic obesity, a variant phenotype of obesity, mainly observed in older adults [32].…”

“…Although the preference is to use DXA, BIA and, whenever possible, computed tomography for magnetic resonance imaging to measure ectopic fat mass and to identify osteosarcopenic obesity, a recent systematic review has suggested that the proxy measures of ectopic fat can be easily used in the field or the clinical settings [31]. Finally, the authors have utilized broadly established cutoffs or those of European origin; however, I further encourage adjustments to the criteria for various ethnic groups.…”