Fracture Risk in Older Adults With Sarcopenia, Low Bone Mass
Fracture Risk in Older Adults With Sarcopenia, Low Bone Mass
Objectives: To test the hypothesis that men and women with low bone mineral density (BMD) and sarcopenia have a higher risk of fracture than those with only one or neither conditions.
Design: The Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures in women are prospective observational studies with a mean follow up of 9 (2000–2012) and 8 years (1997–2009), respectively.
Setting: U.S. clinical centers.
Participants: Men (n = 5,544; mean age 73.7) and women (n = 1,114; mean age 77.6) aged 65 and older, able to walk without assistance, and without bilateral hip replacement.
Measurements: Sarcopenia was defined as low appendicular lean mass plus slowness or weakness and low BMD according to the World Health Organization definition of a T-score less than –1.0. Participants were classified as having normal BMD and no sarcopenia (3,367 men, 308 women), sarcopenia only (79 men, 48 women), low BMD only (1,986 men, 626 women), and low BMD and sarcopenia (112 men, 132 women).
Results: Men with low BMD and sarcopenia (hazard ratio (HR)=3.79, 95% confidence interval (CI)=2.65–5.41) and men with low BMD only (HR=1.67, 95% CI=1.45–1.93) but not men with sarcopenia only (HR=1.14, 95% CI=0.62–2.09) had greater risk of fracture than men with normal BMD and no sarcopenia. Women with low BMD and sarcopenia (HR=2.27, 95% CI=1.37–3.76) and women with low BMD alone (HR=2.62, 95% CI=1.74–3.95), but not women with only sarcopenia, had greater risk of fracture than women with normal BMD and no sarcopenia.
Conclusion: Men with low BMD and sarcopenia are at especially high risk of fracture. Sarcopenia alone did not increase fracture risk in either group.
Age-related deterioration in bone and muscle, manifested as low bone mineral density (BMD) and sarcopenia, may contribute to fractures. Individuals with low BMD have a greater risk of fracture.
Falls and functional impairments, which are known to be associated with fractures, have been previously linked to sarcopenia and myosteatosis, which results in low muscle strength and function, has been associated with fractures. Hence, sarcopenia may increase risk of fractures.
Sarcopenia was initially defined as the loss of muscle mass, but more-recent definitions of sarcopenia add components of muscle strength and physical performance, because the loss of muscle mass is not sufficient to characterize the sarcopenic syndrome. Inclusion of these additional measures in the operational definition of sarcopenia may improve the prediction of clinical outcomes, such as fractures.
In 2009, the term "sarco-osteopenia" was coined to emphasize that weak bones and weak muscles may contribute to fractures in elderly adults. To the knowledge of the authors of the current study, the combined effect of sarcopenia, defined as low muscle mass and strength, and low BMD on fracture risk has not been studied.
The purpose of the current study was to compare the incidence of nonvertebral fractures in men and women according to low BMD and sarcopenia. It was hypothesized that individuals with sarcopenia and low BMD would have greater risk of fracture than those with one or neither condition.
Abstract and Introduction
Abstract
Objectives: To test the hypothesis that men and women with low bone mineral density (BMD) and sarcopenia have a higher risk of fracture than those with only one or neither conditions.
Design: The Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures in women are prospective observational studies with a mean follow up of 9 (2000–2012) and 8 years (1997–2009), respectively.
Setting: U.S. clinical centers.
Participants: Men (n = 5,544; mean age 73.7) and women (n = 1,114; mean age 77.6) aged 65 and older, able to walk without assistance, and without bilateral hip replacement.
Measurements: Sarcopenia was defined as low appendicular lean mass plus slowness or weakness and low BMD according to the World Health Organization definition of a T-score less than –1.0. Participants were classified as having normal BMD and no sarcopenia (3,367 men, 308 women), sarcopenia only (79 men, 48 women), low BMD only (1,986 men, 626 women), and low BMD and sarcopenia (112 men, 132 women).
Results: Men with low BMD and sarcopenia (hazard ratio (HR)=3.79, 95% confidence interval (CI)=2.65–5.41) and men with low BMD only (HR=1.67, 95% CI=1.45–1.93) but not men with sarcopenia only (HR=1.14, 95% CI=0.62–2.09) had greater risk of fracture than men with normal BMD and no sarcopenia. Women with low BMD and sarcopenia (HR=2.27, 95% CI=1.37–3.76) and women with low BMD alone (HR=2.62, 95% CI=1.74–3.95), but not women with only sarcopenia, had greater risk of fracture than women with normal BMD and no sarcopenia.
Conclusion: Men with low BMD and sarcopenia are at especially high risk of fracture. Sarcopenia alone did not increase fracture risk in either group.
Introduction
Age-related deterioration in bone and muscle, manifested as low bone mineral density (BMD) and sarcopenia, may contribute to fractures. Individuals with low BMD have a greater risk of fracture.
Falls and functional impairments, which are known to be associated with fractures, have been previously linked to sarcopenia and myosteatosis, which results in low muscle strength and function, has been associated with fractures. Hence, sarcopenia may increase risk of fractures.
Sarcopenia was initially defined as the loss of muscle mass, but more-recent definitions of sarcopenia add components of muscle strength and physical performance, because the loss of muscle mass is not sufficient to characterize the sarcopenic syndrome. Inclusion of these additional measures in the operational definition of sarcopenia may improve the prediction of clinical outcomes, such as fractures.
In 2009, the term "sarco-osteopenia" was coined to emphasize that weak bones and weak muscles may contribute to fractures in elderly adults. To the knowledge of the authors of the current study, the combined effect of sarcopenia, defined as low muscle mass and strength, and low BMD on fracture risk has not been studied.
The purpose of the current study was to compare the incidence of nonvertebral fractures in men and women according to low BMD and sarcopenia. It was hypothesized that individuals with sarcopenia and low BMD would have greater risk of fracture than those with one or neither condition.
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