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Gandham A, Gregori G, Johansson L, Larsson BAM, Johansson H, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Axelsson K, Lorentzon M. Sarcopenia definitions and their association with injurious falls in older Swedish women from the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone fractures (SUPERB) study. Osteoporos Int 2024:10.1007/s00198-024-07196-0. [PMID: 39105786 DOI: 10.1007/s00198-024-07196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Associations between different sarcopenia definitions and the risk of injurious falls were investigated in 75-80-year-old women in the Swedish SUPERB cohort. Only sarcopenia according to the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was associated with incident injurious falls with and without fractures in older women. PURPOSE To investigate the association between three commonly used sarcopenia definitions and the risk of injurious falls in a population of older Swedish women. METHODS A total of 2,883 75-80-year-old women with complete data on relevant sarcopenia definitions from the Swedish SUPERB cohort were studied. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC: low handgrip strength and gait speed), revised European Working Group on Sarcopenia in Older People (EWGSOP2: low appendicular lean mass index (ALMI, dual-energy X-ray absorptiometry (DXA)-derived), appendicular lean mass (kg)/height (m2), hand grip strength (kg), or low chair stand time (s)), and Asian Working Group for Sarcopenia (AWGS: low ALMI and hand grip strength (kg) or low gait speed (m/s)). Questionnaires captured the occurrence of falls in the past 12 months. Incident injurious falls were identified using national registers. Cox regression (hazard ratios (HR) and 95% confidence intervals (CI)) analyses were performed without adjustment and after adjustment for age, body mass index, previous falls, and the Charlson comorbidity index. RESULTS During a median (IQR) follow-up time of 7.06 (6.2-7.9) years, there were 491 injurious falls without fracture and 962 injurious falls when also including falls resulting in a fracture. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased risk of injurious falls. Individuals with sarcopenia defined by SDOC had a higher risk of injurious falls with and without fracture (HR 2.11; 95% CI, 1.63-2.73 and HR, 2.16; 95% CI, 1.55-3.02, respectively). CONCLUSION Sarcopenia definitions confined to muscle function and strength such as SDOC, rather than including DXA-determined ALMI (EWGSOP2 and AWGS), are associated with incident injurious falls with and without fractures in older women.
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Affiliation(s)
- Anoohya Gandham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia.
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Giulia Gregori
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Berit A M Larsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Sisjön Health Centre, Sisjön, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Axelsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- n Västra Götaland, Geriatric Medicine, Institute of, Regio, Medicine, Sahlgrenska University Hospital, Building K, 6Th Floor, 431 80, Mölndal, Sweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia.
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Region Västra Götaland, Geriatric Medicine, Institute of Medicine, Sahlgrenska University Hospital, Building K, 6Th Floor, 431 80, Mölndal, Sweden.
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Gandham A, Gregori G, Johansson L, Johansson H, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Axelsson K, Lorentzon M. Sarcopenia definitions and their association with fracture risk in older Swedish women. J Bone Miner Res 2024; 39:453-461. [PMID: 38477811 PMCID: PMC11262149 DOI: 10.1093/jbmr/zjae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
The purpose of this study was to investigate the prevalence of three sarcopenia definitions and their associations with fracture risk in older Swedish women when adjusted for fracture risk assessment (FRAX)-based risk factors; 2,883 women with a mean age of 77.8 years were included. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC; low handgrip strength [kg] and gait speed (m/s)), revised European Working Group on Sarcopenia in Older People (EWGSOP2; low appendicular lean mass index, appendicular lean mass [ALM]/height; kg/m2], and hand grip strength [kg]), and Asian Working Group for Sarcopenia (AWGS; low ALM (kg), and hand grip strength [kg]) definitions. Femoral neck T-score was obtained from dual-energy X-ray absorptiometry. All fractures, confirmed by X-ray or medical record review, were subsequently categorized as major osteoporotic fractures (MOFs) and hip fractures. Deaths were verified through regional registers. The total follow-up time was 6.4 ± 1.3 (mean ± SD) yr. Cox regression (hazard ratios [HR] and 95% CIs) analyses were performed with adjustment for age, FRAX variables, and femoral neck T-score. Sarcopenia prevalence was 4.5% (n = 129) according to SDOC, 12.5% (n = 360) for EWGSOP2, and 10.3% (n = 296) defined by AWGS. Individuals with sarcopenia defined by SDOC had a higher mortality risk than individuals without sarcopenia (HR: 3.41; 95% CI: 2.51, 4.62) after adjusting for age and FRAX variables. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased fracture risk after adjusting for age and FRAX variables. Individuals with sarcopenia defined by SDOC had a higher risk for any fractures (HR: 1.48; 95% CI: 1.10, 1.99) and MOF (HR: 1.42; 95% CI: 1.03, 1.98) compared with individuals without sarcopenia after adjusting for clinical risk factors used in FRAX. In conclusion, sarcopenia defined by SDOC, incorporating muscle function/strength, was the only sarcopenia definition associated with fracture risk in older women.
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Affiliation(s)
- Anoohya Gandham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3168, Australia
| | - Giulia Gregori
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
- Region Västra Götaland, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal 43180, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO166YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO166YD, United Kingdom
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, S10 2RX, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO166YD, United Kingdom
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
| | - Kristian Axelsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
- Region Västra Götaland, Närhälsan Norrmalm, Health Centre, Skövde 54940, Sweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal 43180, Sweden
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Paulin TK, Malmgren L, McGuigan FE, Akesson KE. Osteosarcopenia: Prevalence and 10-Year Fracture and Mortality Risk - A Longitudinal, Population-Based Study of 75-Year-Old Women. Calcif Tissue Int 2024; 114:315-325. [PMID: 38300303 PMCID: PMC10957698 DOI: 10.1007/s00223-023-01181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/28/2023] [Indexed: 02/02/2024]
Abstract
Osteosarcopenia is the coexistence of low bone mass and sarcopenia. In older women, its prevalence is not well described, and it is unknown if sarcopenia is additive to low bone mass for fracture and mortality risk. The study investigated prevalence of osteosarcopenia and if osteosarcopenia is associated with higher fracture and mortality risk than low bone mass alone in older community-dwelling women. The longitudinal, population-based OPRA Cohort (n = 1044), all aged 75 at inclusion, followed for 10 years. Using WHO and EWGSOP2 definitions for low bone mass (T-score < -1.0 femoral neck) and sarcopenia (knee strength; appendicular lean muscle mass) women were categorized (1) Normal, (2) Low bone mass (LBM), and 3) Osteosarcopenia (probable; confirmed). Risk of hip, major osteoporotic fracture, and mortality were estimated. Osteosarcopeniaconfirmed prevalence increased from age 75 to 80 and 85 from 3.0% (29/970) to 4.9% (32/656) to 9.2% (33/358) but prevalence is potentially 2-4 times higher (11.8%, 13.4%, 20.3%) based on osteosarcopeniaprobable. Having osteosarcopeniaprobable significantly increased 10-year risk of hip fracture (HRadj 2.67 [1.34-5.32]), major osteoporotic fracture (HRadj 2.04 [1.27-3.27]), and mortality (HRadj 1.91 [1.21-3.04]). In contrast, LBM increased osteoporotic fracture risk (HRadj 2.08 [1.46-2.97], but not hip fracture (HRadj 1.62 [0.92-2.85]) or mortality (HRadj 0.94 [0.64-1.38]). Median time-to-hip fracture was 7.6 years (normal), 6.0 years (LBM), and 5.7 years (osteosarcopeniaprobable). Prevalence of confirmed osteosarcopenia is almost 10% at age 85. Probable osteosarcopenia significantly increased risk of hip and major osteoporotic fractures and mortality more so than low bone mass alone.
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Affiliation(s)
- Tine Kolenda Paulin
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden.
- Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.
| | - Linnea Malmgren
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Geriatrics, Skåne University Hospital, Malmö, Sweden
| | - Fiona E McGuigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
| | - Kristina E Akesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
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Vendrami C, Shevroja E, Gonzalez Rodriguez E, Gatineau G, Elmers J, Reginster J, Harvey NC, Lamy O, Hans D. Muscle parameters in fragility fracture risk prediction in older adults: A scoping review. J Cachexia Sarcopenia Muscle 2024; 15:477-500. [PMID: 38284511 PMCID: PMC10995267 DOI: 10.1002/jcsm.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/28/2023] [Indexed: 01/30/2024] Open
Abstract
Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA-ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of 'fragility fractures', 'muscle health assessment' and 'risk'. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community-dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty-seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person-years (MPY). The median (interquartile range) sample size was 1642 (921-5756), age 69.2 (63.5-73.6) years, follow-up 10.0 (4.4-12.0) years and number of incident fragility fractures 166 (88-277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in-depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3-creatine dilution test, lean mass indexes and artificial intelligence methods.
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Affiliation(s)
- Colin Vendrami
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
- Internal Medicine Unit, Department of Internal MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Enisa Shevroja
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Guillaume Gatineau
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jolanda Elmers
- University Library of Medicine, Faculty of Biology and MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jean‐Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculo‐Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Olivier Lamy
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
- Internal Medicine Unit, Department of Internal MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Didier Hans
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
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Senanayake D, Seneviratne S, Imani M, Harijanto C, Sales M, Lee P, Duque G, Ackland DC. Classification of Fracture Risk in Fallers Using Dual-Energy X-Ray Absorptiometry (DXA) Images and Deep Learning-Based Feature Extraction. JBMR Plus 2023; 7:e10828. [PMID: 38130762 PMCID: PMC10731096 DOI: 10.1002/jbm4.10828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) scans are one of the most frequently used imaging techniques for calculating bone mineral density, yet calculating fracture risk using DXA image features is rarely performed. The objective of this study was to combine deep neural networks, together with DXA images and patient clinical information, to evaluate fracture risk in a cohort of adults with at least one known fall and age-matched healthy controls. DXA images of the entire body as, well as isolated images of the hip, forearm, and spine (1488 total), were obtained from 478 fallers and 48 non-faller controls. A modeling pipeline was developed for fracture risk prediction using the DXA images and clinical data. First, self-supervised pretraining of feature extractors was performed using a small vision transformer (ViT-S) and a convolutional neural network model (VGG-16 and Resnet-50). After pretraining, the feature extractors were then paired with a multilayer perceptron model, which was used for fracture risk classification. Classification was achieved with an average area under the receiver-operating characteristic curve (AUROC) score of 74.3%. This study demonstrates ViT-S as a promising neural network technique for fracture risk classification using DXA scans. The findings have future application as a fracture risk screening tool for older adults at risk of falls. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Damith Senanayake
- Department of Biomedical EngineeringUniversity of MelbourneParkvilleVICAustralia
- Department of Mechanical EngineeringUniversity of MelbourneParkvilleVICAustralia
| | - Sachith Seneviratne
- Department of Mechanical EngineeringUniversity of MelbourneParkvilleVICAustralia
- Melbourne School of DesignUniversity of MelbourneParkvilleVICAustralia
| | - Mahdi Imani
- Australian Institute for Musculoskeletal Science (AIMSS), Geroscience & Osteosarcopenia Research ProgramUniversity of Melbourne and Western HealthSt AlbansVICAustralia
- Department of Medicine‐Western HealthMelbourne Medical SchoolSt AlbansVICAustralia
| | - Christel Harijanto
- Department of Medicine‐Western HealthMelbourne Medical SchoolSt AlbansVICAustralia
| | - Myrla Sales
- Australian Institute for Musculoskeletal Science (AIMSS), Geroscience & Osteosarcopenia Research ProgramUniversity of Melbourne and Western HealthSt AlbansVICAustralia
- Department of Medicine‐Western HealthMelbourne Medical SchoolSt AlbansVICAustralia
| | - Peter Lee
- Department of Biomedical EngineeringUniversity of MelbourneParkvilleVICAustralia
| | - Gustavo Duque
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health CentreMontrealQCCanada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of MedicineMcGill UniversityMontrealQCCanada
| | - David C. Ackland
- Department of Biomedical EngineeringUniversity of MelbourneParkvilleVICAustralia
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Le Rossignol S, Fraser E, Grant A, Doma K, Wilkinson M, Morse L, McEwen P, Hazratwala K, Connor J. Patients with knee osteoarthritis have altered gait and gaze patterns compared to age-matched controls: A pilot study. PLoS One 2023; 18:e0283451. [PMID: 38011143 PMCID: PMC10681189 DOI: 10.1371/journal.pone.0283451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/07/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Although knee Osteoarthritis (KOA) sufferers are at an increased risk of falls, possibly due to impaired gait function, the associated gaze behaviour in patients with KOA are largely unknown. Thus, we compared gait and gaze behaviours characteristics between KOA patients and asymptomatic age-matched controls. RESULTS For Timed Up and Go (TUG) and stair climb tasks, the KOA group demonstrated longer periods of gaze fixations with less frequency of fixations compared to the control group. Conversely, for the Timed up and Go Agility (TUGA) test shorter fixation and frequency patterns were observed. The KOA group presented a shorter final stride length prior to the initiation of the first step in the Stair climb assessment. In addition, for the 30m walk and dual task assessments, the average step length was significantly shorter in the KOA group compared to controls. CONCLUSION Overall, we found altered gait and gaze behaviours are evident in KOA patients which could relate to their increased falls risk.
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Affiliation(s)
- Scott Le Rossignol
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Ewen Fraser
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kenji Doma
- School of Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Peter McEwen
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Jonathan Connor
- School of Exercise Science, James Cook University, Townsville, Queensland, Australia
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Kirk B, Harrison SL, Zanker J, Burghardt AJ, Orwoll E, Duque G, Cawthon PM. Interactions Between HR-pQCT Bone Density and D 3 Cr Muscle Mass (or HR-pQCT Bone Structure and HR-pQCT Muscle Density) in Predicting Fractures: The Osteoporotic Fractures in Men Study. J Bone Miner Res 2023; 38:1245-1257. [PMID: 37351915 PMCID: PMC10528106 DOI: 10.1002/jbmr.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 06/24/2023]
Abstract
We examined if an interaction exists between bone and muscle in predicting fractures in older men. Prospective data from the Osteoporotic Fractures in Men study was used to build Cox proportional hazards models. Predictors included HR-pQCT total volumetric BMD (Tt.BMD), trabecular BMD (Tb.BMD), cortical BMD (Ct.BMD) and cortical area (Ct.Ar) at distal radius/tibia, HR-pQCT muscle volume and density (diaphyseal tibia), D3 -creatine dilution (D3 Cr) muscle mass, and grip strength and leg force, analyzed as continuous variables and as quartiles. Incident fractures were self-reported every 4 months via questionnaires and centrally adjudicated by physician review of radiology reports. Potential confounders (demographics, comorbidities, lifestyle factors, etc.) were considered. A total of 1353 men (mean age 84.2 ± 4.0 years, 92.7% white) were followed for 6.03 ± 2.11 years. In the unadjusted (continuous) model, there were no interactions (p > 0.05) between any muscle variable (D3 Cr muscle mass, muscle volume, muscle density, grip strength or leg force) and Tt.BMD at distal radius/tibia for fractures (all: n = 182-302; nonvertebral: n = 149-254; vertebral: n = 27-45). No consistent interactions were observed when interchanging Tt.BMD for Tb.BMD/Ct.BMD or for Ct.Ar (bone structure) at the distal radius/tibia in the unadjusted (continuous) models. Compared with men in quartiles (Q) 2-4 of D3 Cr muscle mass and Q2-4 of distal tibia Tt.BMD, men in Q1 of both had increased risk for all fractures (hazard ratio (HR) = 2.00; 95% confidence interval [CI] 1.24-3.23, p = 0.005) and nonvertebral fractures (HR = 2.10; 95% CI 1.25-3.52, p < 0.001) in the multivariable-adjusted model. Confidence intervals overlapped (p > 0.05) when visually inspecting other quartile groups in the multivariable-adjusted model. In this prospective cohort study of older men, there was no consistent interactions between bone and muscle variables on fracture risk. Larger sample sizes and longer follow-up may be needed to clarify if there is an interaction between bone and muscle on fracture risk in men. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | | | - Jesse Zanker
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Andrew J. Burghardt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Gustavo Duque
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, McGill University, Montreal, QC, Canada
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Gielen E, Dupont J, Dejaeger M, Laurent MR. Sarcopenia, osteoporosis and frailty. Metabolism 2023; 145:155638. [PMID: 37348597 DOI: 10.1016/j.metabol.2023.155638] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/21/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
Muscles and bones are intricately connected tissues displaying marked co-variation during development, growth, aging, and in many diseases. While the diagnosis and treatment of osteoporosis are well established in clinical practice, sarcopenia has only been classified internationally as a disease in 2016. Both conditions are associated with an increased risk of adverse health outcomes such as fractures, dysmobility and mortality. Rather than focusing on one dimension of bone or muscle mass or weakness, the concept of musculoskeletal frailty captures the overall loss of physiological reserves in the locomotor system with age. The term osteosarcopenia in particular refers to the double jeopardy of osteoporosis and sarcopenia. Muscle-bone interactions at the biomechanical, cellular, paracrine, endocrine, neuronal or nutritional level may contribute to the pathophysiology of osteosarcopenia. The paradigm wherein muscle force controls bone strength is increasingly facing competition from a model centering on the exchange of myokines, osteokines and adipokines. The most promising results have been obtained in preclinical models where common drug targets have been identified to treat these conditions simultaneously. In this narrative review, we critically summarize the current understanding of the definitions, epidemiology, pathophysiology, and treatment of osteosarcopenia as part of an integrative approach to musculoskeletal frailty.
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Affiliation(s)
- Evelien Gielen
- Gerontology and Geriatrics Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium; Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jolan Dupont
- Gerontology and Geriatrics Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Marian Dejaeger
- Gerontology and Geriatrics Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium; Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Michaël R Laurent
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; Geriatrics Department, Imelda Hospital, Bonheiden, Belgium.
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Alajlouni DA, Bliuc D, Tran TS, Blank RD, Center JR. Muscle strength and physical performance contribute to and improve fracture risk prediction in older people: A narrative review. Bone 2023; 172:116755. [PMID: 37028582 DOI: 10.1016/j.bone.2023.116755] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/20/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
Osteoporotic fractures present a major health problem with an increasing prevalence in older people. Fractures are associated with premature mortality, reduced quality of life, subsequent fracture, and increased costs. Hence, it is crucial to identify those at higher risk of fracture. Fracture risk assessment tools incorporated clinical risk factors to improve fracture predictive power over BMD alone. However, fracture risk prediction using these algorithms remains suboptimal, warranting further improvement. Muscle strength and physical performance measurements have been associated with fracture risk. In contrast, the contribution of sarcopenia, the composite condition of low muscle mass, muscle strength and/or physical performance, to fracture risk is unclear. It is uncertain whether this is due to the problematic definition of sarcopenia per se or limitations of the diagnostic tools and cut-off points of the muscle mass component. The recent position statement from the Sarcopenia Definition and Outcomes Consortium confirmed the inclusion of muscle strength and performance in the definition of sarcopenia but not DXA-assessed lean mass. Therefore, clinicians should focus on functional assessment (muscle strength and performance) rather than muscle mass, at least as assessed by DXA, as predictors of fractures. Muscle strength and performance are modifiable risk factors. Resistance exercise improves muscle parameters in the elderly, potentially leading to reduced risk of falls and fractures in the general population and in those who sustained a fracture. Therapists may consider exercise intervention to improve muscle parameters and potentially reduce the risk of fractures. The aim of this review was to explore 1) the contribution of muscle parameters (i.e., muscle mass, strength, and physical performance) to fracture risk in older adults, and 2) the added predictive accuracy of these parameters beyond the existing fracture assessment tools. These topics provide the rationale for investigating strength and physical performance interventions to reduce fracture risk. Most of the included publications showed that muscle mass is not a good predictor of fracture risk, while poor muscle strength and performance are associated with an increased risk of fracture, particularly in men, independent of age, BMD, and other risk factors for fractures. Muscle strength and performance can potentially improve the predictive accuracy in men beyond that obtained by the fracture risk assessment tools, Garvan FRC and FRAX.
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Affiliation(s)
- Dima A Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
| | - Dana Bliuc
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
| | - Thach S Tran
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia; School of Biomedical Engineering, University of Technology, Sydney, New South Wales, Australia.
| | - Robert D Blank
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
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10
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Gates M, Pillay J, Nuspl M, Wingert A, Vandermeer B, Hartling L. Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools. Syst Rev 2023; 12:51. [PMID: 36945065 PMCID: PMC10029308 DOI: 10.1186/s13643-023-02181-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND To inform recommendations by the Canadian Task Force on Preventive Health Care, we reviewed evidence on the benefits, harms, and acceptability of screening and treatment, and on the accuracy of risk prediction tools for the primary prevention of fragility fractures among adults aged 40 years and older in primary care. METHODS For screening effectiveness, accuracy of risk prediction tools, and treatment benefits, our search methods involved integrating studies published up to 2016 from an existing systematic review. Then, to locate more recent studies and any evidence relating to acceptability and treatment harms, we searched online databases (2016 to April 4, 2022 [screening] or to June 1, 2021 [predictive accuracy]; 1995 to June 1, 2021, for acceptability; 2016 to March 2, 2020, for treatment benefits; 2015 to June 24, 2020, for treatment harms), trial registries and gray literature, and hand-searched reviews, guidelines, and the included studies. Two reviewers selected studies, extracted results, and appraised risk of bias, with disagreements resolved by consensus or a third reviewer. The overview of reviews on treatment harms relied on one reviewer, with verification of data by another reviewer to correct errors and omissions. When appropriate, study results were pooled using random effects meta-analysis; otherwise, findings were described narratively. Evidence certainty was rated according to the GRADE approach. RESULTS We included 4 randomized controlled trials (RCTs) and 1 controlled clinical trial (CCT) for the benefits and harms of screening, 1 RCT for comparative benefits and harms of different screening strategies, 32 validation cohort studies for the calibration of risk prediction tools (26 of these reporting on the Fracture Risk Assessment Tool without [i.e., clinical FRAX], or with the inclusion of bone mineral density (BMD) results [i.e., FRAX + BMD]), 27 RCTs for the benefits of treatment, 10 systematic reviews for the harms of treatment, and 12 studies for the acceptability of screening or initiating treatment. In females aged 65 years and older who are willing to independently complete a mailed fracture risk questionnaire (referred to as "selected population"), 2-step screening using a risk assessment tool with or without measurement of BMD probably (moderate certainty) reduces the risk of hip fractures (3 RCTs and 1 CCT, n = 43,736, absolute risk reduction [ARD] = 6.2 fewer in 1000, 95% CI 9.0-2.8 fewer, number needed to screen [NNS] = 161) and clinical fragility fractures (3 RCTs, n = 42,009, ARD = 5.9 fewer in 1000, 95% CI 10.9-0.8 fewer, NNS = 169). It probably does not reduce all-cause mortality (2 RCTs and 1 CCT, n = 26,511, ARD = no difference in 1000, 95% CI 7.1 fewer to 5.3 more) and may (low certainty) not affect health-related quality of life. Benefits for fracture outcomes were not replicated in an offer-to-screen population where the rate of response to mailed screening questionnaires was low. For females aged 68-80 years, population screening may not reduce the risk of hip fractures (1 RCT, n = 34,229, ARD = 0.3 fewer in 1000, 95% CI 4.2 fewer to 3.9 more) or clinical fragility fractures (1 RCT, n = 34,229, ARD = 1.0 fewer in 1000, 95% CI 8.0 fewer to 6.0 more) over 5 years of follow-up. The evidence for serious adverse events among all patients and for all outcomes among males and younger females (<65 years) is very uncertain. We defined overdiagnosis as the identification of high risk in individuals who, if not screened, would never have known that they were at risk and would never have experienced a fragility fracture. This was not directly reported in any of the trials. Estimates using data available in the trials suggest that among "selected" females offered screening, 12% of those meeting age-specific treatment thresholds based on clinical FRAX 10-year hip fracture risk, and 19% of those meeting thresholds based on clinical FRAX 10-year major osteoporotic fracture risk, may be overdiagnosed as being at high risk of fracture. Of those identified as being at high clinical FRAX 10-year hip fracture risk and who were referred for BMD assessment, 24% may be overdiagnosed. One RCT (n = 9268) provided evidence comparing 1-step to 2-step screening among postmenopausal females, but the evidence from this trial was very uncertain. For the calibration of risk prediction tools, evidence from three Canadian studies (n = 67,611) without serious risk of bias concerns indicates that clinical FRAX-Canada may be well calibrated for the 10-year prediction of hip fractures (observed-to-expected fracture ratio [O:E] = 1.13, 95% CI 0.74-1.72, I2 = 89.2%), and is probably well calibrated for the 10-year prediction of clinical fragility fractures (O:E = 1.10, 95% CI 1.01-1.20, I2 = 50.4%), both leading to some underestimation of the observed risk. Data from these same studies (n = 61,156) showed that FRAX-Canada with BMD may perform poorly to estimate 10-year hip fracture risk (O:E = 1.31, 95% CI 0.91-2.13, I2 = 92.7%), but is probably well calibrated for the 10-year prediction of clinical fragility fractures, with some underestimation of the observed risk (O:E 1.16, 95% CI 1.12-1.20, I2 = 0%). The Canadian Association of Radiologists and Osteoporosis Canada Risk Assessment (CAROC) tool may be well calibrated to predict a category of risk for 10-year clinical fractures (low, moderate, or high risk; 1 study, n = 34,060). The evidence for most other tools was limited, or in the case of FRAX tools calibrated for countries other than Canada, very uncertain due to serious risk of bias concerns and large inconsistency in findings across studies. Postmenopausal females in a primary prevention population defined as <50% prevalence of prior fragility fracture (median 16.9%, range 0 to 48% when reported in the trials) and at risk of fragility fracture, treatment with bisphosphonates as a class (median 2 years, range 1-6 years) probably reduces the risk of clinical fragility fractures (19 RCTs, n = 22,482, ARD = 11.1 fewer in 1000, 95% CI 15.0-6.6 fewer, [number needed to treat for an additional beneficial outcome] NNT = 90), and may reduce the risk of hip fractures (14 RCTs, n = 21,038, ARD = 2.9 fewer in 1000, 95% CI 4.6-0.9 fewer, NNT = 345) and clinical vertebral fractures (11 RCTs, n = 8921, ARD = 10.0 fewer in 1000, 95% CI 14.0-3.9 fewer, NNT = 100); it may not reduce all-cause mortality. There is low certainty evidence of little-to-no reduction in hip fractures with any individual bisphosphonate, but all provided evidence of decreased risk of clinical fragility fractures (moderate certainty for alendronate [NNT=68] and zoledronic acid [NNT=50], low certainty for risedronate [NNT=128]) among postmenopausal females. Evidence for an impact on risk of clinical vertebral fractures is very uncertain for alendronate and risedronate; zoledronic acid may reduce the risk of this outcome (4 RCTs, n = 2367, ARD = 18.7 fewer in 1000, 95% CI 25.6-6.6 fewer, NNT = 54) for postmenopausal females. Denosumab probably reduces the risk of clinical fragility fractures (6 RCTs, n = 9473, ARD = 9.1 fewer in 1000, 95% CI 12.1-5.6 fewer, NNT = 110) and clinical vertebral fractures (4 RCTs, n = 8639, ARD = 16.0 fewer in 1000, 95% CI 18.6-12.1 fewer, NNT=62), but may make little-to-no difference in the risk of hip fractures among postmenopausal females. Denosumab probably makes little-to-no difference in the risk of all-cause mortality or health-related quality of life among postmenopausal females. Evidence in males is limited to two trials (1 zoledronic acid, 1 denosumab); in this population, zoledronic acid may make little-to-no difference in the risk of hip or clinical fragility fractures, and evidence for all-cause mortality is very uncertain. The evidence for treatment with denosumab in males is very uncertain for all fracture outcomes (hip, clinical fragility, clinical vertebral) and all-cause mortality. There is moderate certainty evidence that treatment causes a small number of patients to experience a non-serious adverse event, notably non-serious gastrointestinal events (e.g., abdominal pain, reflux) with alendronate (50 RCTs, n = 22,549, ARD = 16.3 more in 1000, 95% CI 2.4-31.3 more, [number needed to treat for an additional harmful outcome] NNH = 61) but not with risedronate; influenza-like symptoms with zoledronic acid (5 RCTs, n = 10,695, ARD = 142.5 more in 1000, 95% CI 105.5-188.5 more, NNH = 7); and non-serious gastrointestinal adverse events (3 RCTs, n = 8454, ARD = 64.5 more in 1000, 95% CI 26.4-13.3 more, NNH = 16), dermatologic adverse events (3 RCTs, n = 8454, ARD = 15.6 more in 1000, 95% CI 7.6-27.0 more, NNH = 64), and infections (any severity; 4 RCTs, n = 8691, ARD = 1.8 more in 1000, 95% CI 0.1-4.0 more, NNH = 556) with denosumab. For serious adverse events overall and specific to stroke and myocardial infarction, treatment with bisphosphonates probably makes little-to-no difference; evidence for other specific serious harms was less certain or not available. There was low certainty evidence for an increased risk for the rare occurrence of atypical femoral fractures (0.06 to 0.08 more in 1000) and osteonecrosis of the jaw (0.22 more in 1000) with bisphosphonates (most evidence for alendronate). The evidence for these rare outcomes and for rebound fractures with denosumab was very uncertain. Younger (lower risk) females have high willingness to be screened. A minority of postmenopausal females at increased risk for fracture may accept treatment. Further, there is large heterogeneity in the level of risk at which patients may be accepting of initiating treatment, and treatment effects appear to be overestimated. CONCLUSION An offer of 2-step screening with risk assessment and BMD measurement to selected postmenopausal females with low prevalence of prior fracture probably results in a small reduction in the risk of clinical fragility fracture and hip fracture compared to no screening. These findings were most applicable to the use of clinical FRAX for risk assessment and were not replicated in the offer-to-screen population where the rate of response to mailed screening questionnaires was low. Limited direct evidence on harms of screening were available; using study data to provide estimates, there may be a moderate degree of overdiagnosis of high risk for fracture to consider. The evidence for younger females and males is very limited. The benefits of screening and treatment need to be weighed against the potential for harm; patient views on the acceptability of treatment are highly variable. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO): CRD42019123767.
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Affiliation(s)
- Michelle Gates
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Jennifer Pillay
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Megan Nuspl
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Aireen Wingert
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Ben Vandermeer
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Lisa Hartling
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
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11
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Shieh A, Karlamangla AS, Karvonen-Guttierez C, Greendale GA. Menopause-Related Changes in Body Composition Are Associated With Subsequent Bone Mineral Density and Fractures: Study of Women's Health Across the Nation. J Bone Miner Res 2023; 38:395-402. [PMID: 36542065 PMCID: PMC10023299 DOI: 10.1002/jbmr.4759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
During the menopause transition (MT), lean mass decreases and fat mass increases. We examined the associations of these body composition changes during the MT (2 years before to 2 years after the final menstrual period) with bone mineral density (BMD) at the end of the MT and fracture after the MT. We included 539 participants from the Study of Women's Health Across the Nation who were not taking bone-beneficial or bone-detrimental medications before or during the MT. Using multivariable linear regression, we assessed the independent associations of % lean mass loss and % fat mass gain during the MT (mutually adjusted) with femoral neck (FN) and lumbar spine (LS) BMD at the end of the MT, adjusted for pre-MT BMD, pre-MT lean and fat mass, race/ethnicity, Study of Women's Health Across the Nation (SWAN) study site, age, and cigarette use. We used Cox proportional hazards regression to quantify the relations of % lean loss and % fat gain during the MT with fracture after the MT. The Cox model was adjusted for the covariates above plus post-MT use of bone-detrimental medications, and censored at the first use of bone-beneficial medications; we further controlled for FN or LS BMD at the end of the MT. Adjusted for covariates, each standard deviation (SD) (6.9%) increment in lean mass loss was associated with 0.010 g/cm2 lower FN BMD (p < 0.0001); each SD (19.9%) increment in fat mass gain was related to 0.026 g/cm2 greater FN (p = 0.009) and LS (p = 0.03) BMD. Each SD increment in lean mass loss and fat mass gain was associated with 63% (p = 0.001) and 28% (p = 0.05) greater fracture hazard after the MT; associations were essentially unchanged by BMD adjustment. MT-related lean mass loss and fat mass gain were associated differentially with BMD; both were independently related to more fractures. Mitigating MT-related body composition changes may reduce fracture risk. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Albert Shieh
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Arun S. Karlamangla
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | | | - Gail A. Greendale
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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12
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Kirk B, Zhang S, Vogrin S, Harijanto C, Sales M, Duque G. Comparing the Fracture Profile of Osteosarcopenic Older Adults with Osteopenia/Osteoporosis Alone. Calcif Tissue Int 2023; 112:297-307. [PMID: 36436030 DOI: 10.1007/s00223-022-01044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether osteosarcopenia is associated with a greater likelihood of recurrent fractures, as well as type of fracture, than osteopenia/osteoporosis or sarcopenia alone. METHODS Anthropometry (height/weight; scales and stadiometer), body composition (bone mineral density [BMD] and appendicular lean mass; dual-energy x-ray absorptiometry), grip strength (hydraulic dynamometer), and gait speed (4 m) were measured in an outpatient clinic. WHO definition for osteopenia/osteoporosis (BMD T-score below -1 SDs) while sarcopenia was defined by SDOC or EWGSOP2. Number and location of fractures within the past 5 years were self-reported and verified by medical records (unverified fractures excluded). Univariable and multivariable regressions were used to examine the association between the exposure and outcome while adjusting for confounders. RESULTS 481 community-dwelling older adults (median age: 78, IQR: 72, 83; 75.9% women) were included. Prevalence of osteosarcopenia depended on the definition (SDOC: 179 (37.2%); EWGSOP2: 123 (25.6%)). In multivariable analysis adjusting for age, sex, alcohol, smoking, BMI, lowest BMD T-score, physical activity, and comorbidities, the likelihood of recurrent fractures (≥ 2 vs 0-1) was significantly higher in those with osteosarcopenia versus osteopenia/osteoporosis irrespective of the definition (SDOC: odds ratio [OR]: 1.63, 95% CI: 1.03, 2.59, p = 0.037; EWGSOP2: OR: 1.83, 95% CI: 1.12, 3.01, p = 0.016]. Associations with sarcopenia alone (SDOC: 10; EWGSOP2: 7) were not possible due to the extremely low prevalence of this condition in those with normal BMD. CONCLUSION Our data suggest osteosarcopenia is associated with a greater likelihood of recurrent fractures versus osteopenia/osteoporosis alone. Further studies are needed to evaluate the relationship with sarcopenia alone.
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Simon Zhang
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Christel Harijanto
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Myrla Sales
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia.
- Department of Medicine and Research Institute, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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13
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Harvey NC, Orwoll E, Cauley JA, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cawthon PM, Ensrud K, Liu E, Laskou F, Ward KA, Dennison EM, Cooper C, Kanis JA, Vandenput L, Lorentzon M, Ohlsson C, Mellström D, Johansson H, McCloskey E. Greater pQCT Calf Muscle Density Is Associated with Lower Fracture Risk, Independent of FRAX, Falls and BMD: A Meta-Analysis in the Osteoporotic Fractures in Men (MrOS) Study. JBMR Plus 2022; 6:e10696. [PMID: 36530188 PMCID: PMC9751652 DOI: 10.1002/jbm4.10696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72-1.0 and 0.78; 95% CI, 0.66-0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88-1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59-0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, School of MedicineOregon Health & Science UniversityPortlandORUSA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public HealthThe Chinese University of Hong KongShatinChina
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences MalmoLund University and Department of Orthopedics, Skane University HospitalMalmoSweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences MalmoLund University and Department of Orthopedics, Skane University HospitalMalmoSweden
| | - Eva Ribom
- Department of Surgical SciencesUniversity of UppsalaUppsalaSweden
| | - Peggy M. Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - Kristine Ensrud
- Medicine and Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMNUSA
- Center for Care Delivery and Outcomes ResearchMinneapolis VA Health Care SystemMinneapolisMNUSA
| | - Enwu Liu
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Faidra Laskou
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Kate A. Ward
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - John A. Kanis
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Dan Mellström
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Johansson
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Eugene McCloskey
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal ResearchUniversity of SheffieldSheffieldUK
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The benefits of physical activity on successful bone, spine and joint ageing: Highlights of the recent literature. Joint Bone Spine 2022; 89:105434. [PMID: 35777554 DOI: 10.1016/j.jbspin.2022.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
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de Almeida Marques Bernabé R, de Souza Vieira M, Felício de Souza V, Gomes Fontana L, Albergaria BH, Marques-Rocha JL, Guandalini VR. Muscle strength is associated with fracture risk obtained by fracture risk assessment tool (FRAX) in women with breast cancer. BMC Cancer 2022; 22:1115. [PMID: 36320019 PMCID: PMC9623985 DOI: 10.1186/s12885-022-10203-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background Women with breast cancer are at risk for the development of sarcopenia and occurrence of fractures. The initial and periodic screening of these conditions can prevent the risks of disability, poor quality of life, and death. The present study investigated the association between sarcopenia phenotypes and fracture risk, assessed by the Fracture Risk Assessment Tool (FRAX) in women with breast cancer. Methods Cross-sectional study. It included women aged between 40 and 80 years, diagnosed with Luminal subtype breast cancer, with time of diagnosis ≤ 12 months, who had not started endocrine therapy, did not have metastasis, had not been treated for another malignancy, and had no recurrences. Sociodemographic, habits and lifestyle, clinical, anthropometric, and body composition variables were considered. Muscle strength, skeletal muscle mass, and physical performance were investigated using handgrip strength (HGS), appendicular skeletal muscle mass index (ASMI), and Timed Up and Go test (TUGT), respectively. Fracture risk was assessed using FRAX. Multiple linear regression models were conducted to verify the association between exposure variables and sarcopenia phenotypes. A significance level of p < 0.05 was adopted for all tests using the SPPS 25.0 program. Results Sixty-two women with a mean age of 58.1 ± 10.4 years were evaluated. Of these, 66.1% self-declared to be non-white, 41.9% and 71.0% did not consume alcohol or smoke, respectively, and 61.3% were insufficiently active. A total of 45.2% had clinical stage II carcinoma and 65.5% had the invasive breast carcinoma histological subtype. There was a predominance of adequacy of HGS (88.7%), ASMI (94.5%), and TUGT (96.8%), as well as low risk of hip fractures (85.5%) and major fractures (82.3%). HGS remained associated with FRAX hip fractures (p = 0.007) and FRAX major fractures (p = 0.007) in the adjusted models, while ASMI was associated with body mass (p < 0.001). Conclusions Low muscle strength was the sarcopenia phenotype that remained associated with fracture risk in women with breast cancer, independently of sociodemographic factors, level of physical activity, and clinical factors. In addition to the assessment of probable sarcopenia, this measurement may point out the risk of fractures.
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Affiliation(s)
- Rayne de Almeida Marques Bernabé
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Mariana de Souza Vieira
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Vanusa Felício de Souza
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Luana Gomes Fontana
- grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - Ben-Hur Albergaria
- grid.412371.20000 0001 2167 4168Department of Social Medicine, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 - Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - José Luiz Marques-Rocha
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil ,grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - Valdete Regina Guandalini
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil ,grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
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Carey JJ, Chih-Hsing Wu P, Bergin D. Risk assessment tools for osteoporosis and fractures in 2022. Best Pract Res Clin Rheumatol 2022; 36:101775. [PMID: 36050210 DOI: 10.1016/j.berh.2022.101775] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis is one of the frequently encountered non-communicable diseases in the world today. Several hundred million people have osteoporosis, with many more at risk. The clinical feature is a fragility fracture (FF), which results in major reductions in the quality and quantity of life, coupled with a huge financial burden. In recognition of the growing importance, the World Health Organisation established a working group 30 years ago tasked with providing a comprehensive report to understand and assess the risk of osteoporosis in postmenopausal women. Dual-energy X-ray absorptiometry (DXA) is the most widely endorsed technology for assessing the risk of fracture or diagnosing osteoporosis before a fracture occurs, but others are available. In clinical practice, important distinctions are essential to optimise the use of risk assessments. Traditional tools lack specificity and were designed for populations to identify groups at higher risk using a 'one-size-fits-all' approach. Much has changed, though the purpose of risk assessment tools remains the same. In 2022, many tools are available to aid the identification of those most at risk, either likely to have osteoporosis or suffer the clinical consequence. Modern technology, enhanced imaging, proteomics, machine learning, artificial intelligence, and big data science will greatly advance a more personalised risk assessment into the future. Clinicians today need to understand not only which tool is most effective and efficient for use in their practice, but also which tool to use for which patient and for what purpose. A greater understanding of the process of risk assessment, deciding who should be screened, and how to assess fracture risk and prognosis in older men and women more comprehensively will greatly reduce the burden of osteoporosis for patients, society, and healthcare systems worldwide. In this paper, we review the current status of risk assessment, screening and best practice for osteoporosis, summarise areas of uncertainty, and make some suggestions for future developments, including a more personalised approach for individuals.
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Affiliation(s)
- John J Carey
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland.
| | - Paulo Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Director, Obesity/Osteoporosis Special Clinic, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Diane Bergin
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland; Galway University Hospitals, Ireland
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Harvey NC, Orwoll E, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cauley JA, Cawthon PM, Ensrud K, Liu E, Cruz-Jentoft AJ, Fielding RA, Cooper C, Kanis JA, Lorentzon M, Ohlsson C, Mellström D, Johansson H, McCloskey E. Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX ® , Falls, and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A Meta-Analysis. J Bone Miner Res 2021; 36:1235-1244. [PMID: 33831257 PMCID: PMC7611727 DOI: 10.1002/jbmr.4293] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height2 (ALM/ht2 ) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX® ) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht2 only), Morley, the International Working Group on Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP1 and 2), Asian Working Group on Sarcopenia, Foundation for the National Institutes of Health (FNIH) 1 and 2 (using ALM/body mass index [BMI], incorporating muscle strength and/or physical performance measures plus ALM/ht2 ), and Sarcopenia Definitions and Outcomes Consortium (gait speed and grip strength). Associations were adjusted for age and time since baseline and reported as hazard ratio (HR) for first incident fracture, here major osteoporotic fracture (MOF; clinical vertebral, hip, distal forearm, proximal humerus). Further analyses adjusted additionally for FRAX-MOF probability (n = 7531; calculated ± fnBMD), prior falls (y/n), or fnBMD T-score. Results were synthesized by meta-analysis. In 5660 men in USA, 2764 Sweden and 1987 Hong Kong (mean ages 73.5, 75.4, and 72.4 years, respectively), sarcopenia prevalence ranged from 0.5% to 35%. Sarcopenia status, by all definitions except those of FNIH, was associated with incident MOF (HR = 1.39 to 2.07). Associations were robust to adjustment for prior falls or FRAX probability (without fnBMD); adjustment for fnBMD T-score attenuated associations. EWGSOP2 severe sarcopenia (incorporating chair stand time, gait speed, and grip strength plus ALM) was most predictive, albeit at low prevalence, and appeared only modestly influenced by inclusion of fnBMD. In conclusion, the predictive value for fracture of sarcopenia definitions based on ALM is reduced by adjustment for fnBMD but strengthened by additional inclusion of physical performance measures. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Eric Orwoll
- Oregon Health & Science University, Portland, OR, USA
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Eva Ribom
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristine Ensrud
- Medicine and Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Dan Mellström
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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