The Joint Occurrence of Osteoporosis and Sarcopenia (Osteosarcopenia): Definitions and Characteristics

Sepúlveda-Loyola, Walter; Phu, Steven; Hassan, Ebrahim Bani; Brennan-Olsen, Sharon; Zanker, Jesse; Vogrin, Sara; Conzade, Romy; Kirk, Ben; Saedi, Ahmed Al; Probst, Vanessa S.; Duque, Gustavo

doi:10.1016/j.jamda.2019.09.005

Cited by 77 publications

(51 citation statements)

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“…When compared to non‐osteosarcopenic individuals, the risk of falls (ORs: 2.83–3.63; P < 0.05) and fractures (ORs: 3.86–4.38; P < 0.05) when using multiple sarcopenia definitions is significantly higher in osteosarcopenic older adults attending a falls and fractures clinic …”

Section: Epidemiologymentioning

confidence: 98%

“…Each year of schooling was also associated with a 3% lower prevalence of osteosarcopenia in men (0.97, 95% CI 0.95–0.99) . In other study among 148 geriatric inpatients, osteosarcopenic individuals were at greater risk of malnourishment (mini‐nutritional assessment scores: 8.50 ± 2.52 points, P < 0.001) compared with osteoporosis or sarcopenia alone, and among 253 older Australians, osteosarcopenia is associated with poorer balance and functional capacity [odds ratios (ORs) ranging from 2.56 to 7.19; P < 0.05] vs. osteopenia and osteoporosis alone . Others have noted that muscle strength and functional performance measures are also lower in those with osteosarcopenia vs. osteoporosis or sarcopenia alone …”

Section: Epidemiologymentioning

confidence: 99%

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Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

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Background Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia, is an emerging geriatric giant, which poses a serious global health burden. Methods and results The prevalence of osteosarcopenia ranges in community‐dwelling older adults [5–37% (≥65 years)] with the highest rates observed in those with fractures (low‐trauma fracture: ~46%; hip fracture: 17.1–96.3%). Among 2353 community‐dwelling adults, risk factors associated with osteosarcopenia include older age [men: 14.3% (60–64 years) to 59.4% (≥75 years); women: 20.3% (60–64 years) to 48.3% (≥75 years), P < 0.05], physical inactivity [inverse relationship: 0.64, 95% confidence interval (CI) 0.46–0.88 (sexes combined)], low body mass index (inverse relationship: men: 0.84, 95% CI 0.81–0.88; women: 0.77, 95% CI 0.74–0.80), and higher fat mass (men: 1.46, 95% CI 1.11–1.92; women: 2.25, 95% CI 1.71–2.95). Among 148 geriatric inpatients, osteosarcopenic individuals demonstrate poorer nutritional status (mini‐nutritional assessment scores: 8.50 ± 2.52 points, P < 0.001) vs. osteoporosis or sarcopenia alone, while among 253 older Australians, osteosarcopenia is associated with impaired balance and functional capacity [odds ratios (ORs): 2.56–7.19; P < 0.05] vs. non‐osteosarcopenia. Osteosarcopenia also associates with falls (ORs: 2.83–3.63; P < 0.05), fractures (ORs: 3.86–4.38; P < 0.05), and earlier death [hazard ratio (1‐year follow‐up): 1.84, 95% CI; 0.69–4.92, P = 0.023] vs. non‐osteosarcopenia. Conclusions This syndrome is expected to grow in age‐related and disease‐related states, a likely consequence of immunosenescence coinciding with increased sedentarism, obesity, and fat infiltration of muscle and bone. Evidence suggests the pathophysiology of osteosarcopenia includes genetic polymorphisms, reduced mechanical loading, and impaired endocrine functioning, as well as altered crosstalk between muscle, bone, and fat cells. Clinicians should screen for osteosarcopenia via imaging methods (i.e. dual‐energy X‐ray absorptiometry) to quantify muscle and bone mass, in addition to assessing muscle strength (i.e. grip strength) and functional capacity (i.e. gait speed). A comprehensive geriatric assessment, including medical history and risk factors, must also be undertaken. Treatment of this syndrome should include osteoporotic drugs [bone anabolics/antiresorptives (i.e. teriparatide, denosumab, bisphosphates)] where indicated, and progressive resistance and balance exercises (at least 2‐3 times/week). To maximize musculoskeletal health, nutritional recommendations [protein (1.2–1.5 g/kg/day), vitamin D (800–1000 IU/day), calcium (1300 mg/day), and creatine (3–5 g/day)] must also be met. It is anticipated that diagnosis and treatment for osteosarcopenia will become part of routine healthcare in the future. However, further work is required to identify biomarkers, which, in turn, may increase diagnosis, risk stratification, and targeted treatments to improve health outcomes.

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Section: Epidemiologymentioning

confidence: 98%

Section: Epidemiologymentioning

confidence: 99%

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

Self Cite

236

227

View full text Add to dashboard Cite

show abstract

“…While both conditions appear to be distinct, the coexistence of the two conditions, known as osteosarcopenia, may identify a subpopulation of older individuals at greater risk of adverse health outcomes compared to either condition alone. Osteosarcopenia is associated with a 3- to 4-fold increased odds of falls and fractures in older individuals attending a falls clinic [ 1 ]. Osteosarcopenic individuals who suffered a hip fracture also had 1.8 times greater hazard for mortality compared to non-osteosarcopenic individuals [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…In the current study, we diagnosed participants presenting with severe sarcopenia which is a strength given that our previous findings showed that the severity of sarcopenia was the driving factor that increased falls and fractures. (34) Studies assessing the impact of sarcopenia in modulating balance performance are required to further efforts in developing interventions. The findings of the present study should also be taken in context of the limitations.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of the Short Physical Performance Battery for Sarcopenia

Phu

Kirk

Hassan

et al. 2020

Preprint

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BACKGROUND: Sarcopenia is defined as the age-related loss of muscle mass, strength and physical performance. The original European Working Group on Sarcopenia in Older Persons (EWGSOP1) definition, and its revision (EWGSOP2), provide new cut-points and alternate measures for sarcopenia diagnosis. However, sarcopenia is rarely diagnosed in clinical settings owing to its labour-intensive screening process. Given the Short Physical Performance Battery (SPPB) is a quick, easily administrable and objective measure of muscle strength and physical performance, both of which are key components of sarcopenia, this study examined the diagnostic value of the SPPB for this muscle disease. METHODS: A cross-sectional analysis of 294 community-dwelling older persons (≥65 years) was conducted. Appendicular lean body mass [(ALM) divided by height squared (ALM/h 2 )], muscle strength (handgrip/sit to stand), and physical performance [gait speed, timed up and go (TUG) and SPPB] were assessed using validated procedures, while participants were diagnosed with sarcopenia following the EWGSOP1 and EWGSOP2 criteria. Diagnostic ability of the SPPB independently and combined with ALM/h 2 for sarcopenia was determined using area under the curve (AUC). Potential cut-points were identified, and sensitivity and specificity calculated. RESULTS: Prevalence of sarcopenia ranged from 4 to 16% depending on the definition. The SPPB demonstrated moderate (AUC = 0.644-0.770) value in diagnosing sarcopenia, and a cut-point of ≤8points in SPPB performance resulted in high sensitivity (82-100%) but low specificity (36-41%) for diagnosing those with severe sarcopenia. CONCLUSIONS: The SPPB displayed acceptable value in diagnosing older adults with severe sarcopenia. Moreover, the high sensitivity of the SPPB when using the cut-point of ≤8 suggests it may be a favourable screening tool for sarcopenia in clinical settings where ALM measurements are not available.

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The Joint Occurrence of Osteoporosis and Sarcopenia (Osteosarcopenia): Definitions and Characteristics

Cited by 77 publications

References 36 publications

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

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

The Diagnostic Value of the Short Physical Performance Battery for Sarcopenia

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