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Rahimipour Anaraki S, Mohammadian A, Saghafian Larijani S, Niksolat M, Rashedi V, Gholizadeh Mesgarha M. Frailty syndrome in women with osteoporosis, should physicians consider screening? A cross-sectional study. Bone Rep 2023; 19:101722. [PMID: 37929043 PMCID: PMC10624968 DOI: 10.1016/j.bonr.2023.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
Despite its high prevalence and profound impact, frailty syndrome often goes undiagnosed. The study revealed a significant correlation between osteoporosis and frailty syndrome, with predictive accuracy exceeding 75 %. Given these findings and the existing recommendation for osteoporosis screening in older women, we underscore the importance of concurrently screening osteoporotic women for frailty. Introduction Frailty syndrome, a prevalent and significant geriatric condition, impacts healthcare costs and quality of life. Previous reviews have associated frailty syndrome with osteoporosis, but original research on this link is limited and has produced conflicting results. This study aims to investigate the relationship between frailty syndrome, osteoporosis, bone mineral densitometry T-score, and other influencing factors. Methods In this cross-sectional study, post-menopausal women underwent screening for osteoporosis and frailty syndrome using bone mineral densitometry and the Fried phenotype. Exclusion criteria included a history of diseases related to bone loss or medications affecting bone metabolism. Bivariate and multivariable tests were used to examine the correlation between frailty syndrome and various covariates, including the diagnosis of osteoporosis. Results A total of 272 women aged 60 to 89 years (mean age 68.57 ± 6.22) were evaluated. Osteoporosis was prevalent in 44.9 % of participants, and frailty syndrome was identified in 36.4 %. The regression model identified age, menopausal age, and the diagnosis of osteoporosis as variables significantly and independently associated with frailty syndrome. A T-score lower than -2.5 in the femur neck or lumbar spine exhibited a sensitivity of 86.6 % and specificity of 76.5 % in predicting frailty syndrome. Conclusion Older adults with osteoporosis face an increased risk of frailty syndrome. Therefore, we recommend that primary care providers screen osteoporotic women for frailty syndrome and, when appropriate, refer this group to geriatric specialists for further evaluation.
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Affiliation(s)
| | - Ali Mohammadian
- Faculty of Medicine, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | | | - Maryam Niksolat
- Firoozabadi Clinical and Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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El Miedany Y, El Gaafary M, Gadallah N, Mahran S, Hassan W, Fathi N, Abu-Zaid MH, Tabra SAA, Shalaby RH, Elwakil W. Targeted optimum care approach for osteoporotic fragility fractures: tailored strategy based on risk stratification to reduce incidents of falls-an initiative by the Egyptian Academy of bone health based on the FLS national register. Arch Osteoporos 2023; 18:139. [PMID: 37985519 DOI: 10.1007/s11657-023-01347-2] [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: 08/26/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
Since falling is the third cause of chronic disability, a better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention, and management programs for these individuals, particularly those at risk of sustaining a fragility fracture. OBJECTIVE (1) To assess the incidence of falls among osteoporotic patients with fragility fractures. (2) To evaluate the potential for stratifying the people at risk of falling in bone health setting aiming to provide targeted optimum care for them. METHODS This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work and managed under Fracture Liaison Service. All the patients were assessed for their Fracture risk (FRAX), falls risk (FRAS), and sarcopenia risk (SARC-F) as well as functional disability (HAQ). Blood tests for bone profile as well as DXA scan were offered to all the patients. RESULTS Four hundred five patients (121 males, 284 females) were included in this work. Mean age was 70.1 (SD = 9.2) years. The incidence of falls was 64.9%. The prevalence of falls was high (64.8%) in the patients presenting with major osteoporosis fractures and in those with hip fractures (61.8%). The prevalence of fragility fractures was positively correlated with HAQ score and the SARC-F score (p = 0.01 and 0.021 respectively). Falls risk score was positively correlated with FRAX score of major osteoporotic fractures, HAQ score, and SARC-F score (p = 0.01, 0.013, and 0.003 respectively). Seventy percent of the osteopenia patients who sustained fragility fracture had high falls risk and/or SARC-F score. CONCLUSION This study highlighted the importance of falls risk stratification in osteoporotic patients presenting with fragility fractures. Identification of the patients at increased risk of falls should be a component of the standard practice.
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Affiliation(s)
| | - Maha El Gaafary
- Community and Public Health, Ain Shams University, Cairo, Egypt
| | - Naglaa Gadallah
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Safaa Mahran
- Physical Medicine, Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | - Waleed Hassan
- Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - Nihal Fathi
- Physical Medicine, Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | | | | | - Radwa H Shalaby
- Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
| | - Walaa Elwakil
- Rheumatology, Rehabilitation and Physical Medicine, Alexandria University, Alexandria, Egypt.
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Yamaura T, Arizumi F, Maruo K, Kishima K, Yoshie N, Kusukawa T, Imamura F, Tachibana T. The Impact of Controlling Nutritional Status (CONUT) score on functional prognosis in hospitalized elderly patients with acute osteoporotic vertebral fractures. BMC Geriatr 2022; 22:1002. [PMID: 36577983 PMCID: PMC9795616 DOI: 10.1186/s12877-022-03708-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nutritional status, which is associated with osteoporosis and muscle weakness is considered an important factor in the management of acute osteoporotic vertebral fracture (AOVF). However, few reports have investigated the nutritional status of hospitalized patients with AOVF and the impact of malnutrition on their functional prognosis. This study aimed to evaluate the nutritional status of hospitalized elderly patients with AOVF using the Controlling Nutritional Status (CONUT) score and to determine the usefulness of the CONUT score in predicting their functional prognosis. METHODS The CONUT score on admission was retrospectively calculated for 134 hospitalized elderly patients (mean age 83 ± 7.6 years, 66% female) with AOVF who received conservative treatment between 2017 and 2020. Functional outcome was assessed by comparing ambulatory ability before the onset of AOVF and upon discharge. Patients were divided into two groups: CONUT-high ( ≥ 4) and CONUT-low ( ≤ 3), according to receiver operating characteristic (ROC) analysis to predict decline in ambulatory ability upon discharge. Logistic regression analysis was performed to obtain odds ratios (OR) and 95% confidence intervals (CI) of the relationships between the nutritional status and ambulatory ability. The discriminative power of the CONUT score was then compared with other nutritional assessment tools such as the Geriatric Nutritional Risk Index (GNRI) and prognostic nutritional index (PNI) by ROC analysis. RESULTS 81% of hospitalized patients with an AOVF were malnourished at the time of admission. The CONUT-high group had a significantly higher rate of decline in ambulatory ability (P < 0.001) than the CONUT-low group. Logistic regression analysis revealed the CONUT score ( ≥ 4) as an independent risk factor for a decline in ambulatory ability (OR 3.44, 95% CI 1.61-7.37, P = 0.0014). ROC analysis showed that the area under the curve (AUC) for the CONUT score (AUC = 0.724) was significantly greater than that for the GNRI (AUC = 0.624, P = 0.021) and PNI (AUC = 0.636, P = 0.0008). CONCLUSIONS This study showed that 81% of hospitalized elderly patients with AOVFs were malnourished and that the CONUT score was a useful predictive factor of functional prognosis.
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Affiliation(s)
- Tetsuto Yamaura
- Department of Orthopaedic Surgery, JCHO Osaka Minato Central Hospital, Osaka, Japan ,grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Fumihiro Arizumi
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Keishi Maruo
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Kazuya Kishima
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Norichika Yoshie
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Tomoyuki Kusukawa
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
| | - Fumiaki Imamura
- Department of Orthopaedic Surgery, JCHO Osaka Minato Central Hospital, Osaka, Japan
| | - Toshiya Tachibana
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, 1-1 mukogawa-cho, Nishinomiya, Hyogo Japan
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Medical optimization of osteoporosis for adult spinal deformity surgery: a state-of-the-art evidence-based review of current pharmacotherapy. Spine Deform 2022; 11:579-596. [PMID: 36454531 DOI: 10.1007/s43390-022-00621-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Osteoporosis is a common, but challenging phenomenon to overcome in adult spinal deformity (ASD) surgery. Several pharmacological agents are at the surgeon's disposal to optimize the osteoporotic patient prior to undergoing extensive reconstruction. Familiarity with these medications will allow the surgeon to make informed decisions on selecting the most appropriate adjuncts for each individual patient. METHODS A comprehensive literature review was conducted in PubMed from September 2021 to April 2022. Studies were selected that contained combinations of various terms including osteoporosis, specific medications, spine surgery, fusion, cage subsidence, screw loosening, pull-out, junctional kyphosis/failure. RESULTS Bisphosphonates, denosumab, selective estrogen receptor modulators, teriparatide, abaloparatide and romosozumab are all pharmacological agents currently available for adjunctive use. While these medications have been shown to have beneficial effects on improving bone mineral density in the osteoporotic patient, varying evidence is available on their specific effects in the context of extensive spine surgery. There is still a lack of human studies with use of the newer agents. CONCLUSION Bisphosphonates are first-line agents due to their low cost and robust evidence behind their utility. However, in the absence of contraindications, optimizing bone quality with anabolic medications should be strongly considered in preparation for spinal deformity surgeries due to their beneficial and favorable effects on fusion and hardware compared to the anti-resorptive medications.
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Sui SX, Holloway-Kew KL, Hyde NK, Williams LJ, Tembo MC, West E, Pasco JA. How Well Do Low Population-Specific Values for Muscle Parameters Associate with Indices of Poor Physical Health? Cross-Sectional Data from the Geelong Osteoporosis Study. J Clin Med 2022; 11:jcm11102906. [PMID: 35629032 PMCID: PMC9143052 DOI: 10.3390/jcm11102906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to examine associations between skeletal muscle deficits and indices of poor health. Cut-points for skeletal muscle deficits were derived using data from the Geelong Osteoporosis Study and definitions from the revised European Consensus on Definition and Diagnosis and the Foundation for the National Institutes of Health. Participants (n = 665; 323 women) aged 60–96 year had handgrip strength measured by dynamometry and appendicular lean mass by whole-body dual-energy X-ray absorptiometry. Physical performance was assessed using the Timed Up and Go test. Sex-specific cut-points were equivalent to two standard deviations below the mean young reference range from the Geelong Osteoporosis Study. Indices of poor health included fractures, falls, and hospitalisations. Low trauma fractures since age 50 year (excluding skull, face, digits) were self-reported and confirmed using radiological reports. Falls (≥1 in the past 12 months) and hospitalisations (past month) were self-reported. Logistic regression models (age- and sex-adjusted) were used to examine associations. Receiver Operating Characteristic curves were applied to determine optimal cut-points for handgrip strength, Timed Up and Go, appendicular lean mass/height2, and appendicular lean mass/body mass index that discriminated poor health outcomes. There were 48 participants (6.9%) with hospitalisations, 94 (13.4%) with fractures, and 177 (25.3%) with at least one fall (≥1). For all cut-points, low handgrip strength was consistently associated with falls. There was little evidence to support an association between low appendicular lean mass, using any cut-point, and indices of poor health. Optimal cut-offs for predicting falls (≥1) were: handgrip strength 17.5 kg for women and 33.5 kg for men; Timed Up and Go 8.6 s for women and 9.9 s for men; appendicular lean mass/height2 6.2 kg/m2 for women and 7.46 kg/m2 for men; and appendicular lean mass/body mass index 0.6 m2 for women and 0.9 m2 for men. In conclusion, muscle strength and function performed better than lean mass to indicate poor health. These findings add to the growing evidence base to inform decisions regarding the selection of skeletal muscle parameters and their optimal cut-points for identifying sarcopenia.
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Affiliation(s)
- Sophia X. Sui
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
- Correspondence: ; Tel.: +61-3-4215-3306; Fax: +61-3-4215-3491
| | - Kara L. Holloway-Kew
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Natalie K. Hyde
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Lana J. Williams
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Monica C. Tembo
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Emma West
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Julie A. Pasco
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
- Department of Medicine–Western Campus, The University of Melbourne, St Albans, VIC 3010, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
- Barwon Health, University Hospital Geelong, Geelong, VIC 3220, Australia
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Wu PY, Chen SC, Lin YC, Chen PC, Chung WS, Huang YC, Wu PH, Tsai YC, Huang JC, Chiu YW, Chang JM. Role of Fracture Risk Assessment Tool and Bone Turnover Markers in Predicting All-Cause and Cardiovascular Mortality in Hemodialysis Patients. Front Med (Lausanne) 2022; 9:891363. [PMID: 35463031 PMCID: PMC9021425 DOI: 10.3389/fmed.2022.891363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Fracture Risk Assessment Tool (FRAX) and bone turnover markers (BTMs) predict fractures in the general population. However, the role of FRAX and BTMs in predicting mortality remains uncertain in hemodialysis (HD) patients. Methods One hundred and sixty-four HD patients stratified by low or high risk of 10-year fracture probability using FRAX. High risk of fracture was defined as 10-year probability of hip fracture ≥3% or major osteoporotic fracture ≥20%. The association of high risk of fracture and BTMs with all-cause mortality and cardiovascular (CV) mortality were evaluated using multivariate-adjusted Cox regression analysis. Results Eighty-five (51.8%) patients were classified as high risk of fracture based on FRAX among 164 HD patients. During a mean follow-up period of 3.5 ± 1.0 years, there were 39 all-cause deaths and 23 CV deaths. In multivariate-adjusted Cox regression, high risk of fracture based on FRAX was independently associated with all-cause mortality [hazard ratio (HR): 2.493, 95% confidence interval (CI): 1.026–6.056, p = 0.044) but not with CV mortality (HR: 2.129, 95% CI: 0.677–6.700, p = 0.196). There were no associations between BTMs and mortality risk. Furthermore, lower geriatric nutritional risk index (GNRI) was significantly associated with increased CV mortality (HR: 0.888, 95% CI: 0.802–0.983, p = 0.022) after adjusting by confounding variables. Conclusion High risk of fracture using FRAX was an independent predictor of all-cause mortality in patients undergoing HD. FRAX, rather than BTMs, has an important role of prognostic significance in HD patients.
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Affiliation(s)
- Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Doctoral Degree Program of Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chen
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Shiuan Chung
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Radiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Chin Huang
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tembo MC, Mohebbi M, Holloway-Kew KL, Gaston J, Sui SX, Brennan-Olsen SL, Williams LJ, Kotowicz MA, Pasco JA. The contribution of musculoskeletal factors to physical frailty: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:921. [PMID: 34724934 PMCID: PMC8561908 DOI: 10.1186/s12891-021-04795-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Musculoskeletal conditions and physical frailty have overlapping constructs. We aimed to quantify individual contributions of musculoskeletal factors to frailty. Methods Participants included 347 men and 360 women aged ≥60 yr (median ages; 70.8 (66.1–78.6) and 71.0 (65.2–77.5), respectively) from the Geelong Osteoporosis Study. Frailty was defined as ≥3, pre-frail 1–2, and robust 0, of the following; unintentional weight loss, weakness, low physical activity, exhaustion, and slowness. Measures were made of femoral neck BMD, appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) by DXA (Lunar), SOS, BUA and SI at the calcaneus (Lunar Achilles Insight) and handgrip strength by dynamometers. Binary and ordinal logistic regression models and AUROC curves were used to quantify the contribution of musculoskeletal parameters to frailty. Potential confounders included anthropometry, smoking, alcohol, prior fracture, FMI, SES and comorbidities. Results Overall, 54(15.6%) men and 62(17.2%) women were frail. In adjusted-binary logistic models, SI, ALMI and HGS were associated with frailty in men (OR = 0.73, 95%CI 0.53–1.01; OR=0.48, 0.34–0.68; and OR = 0.11, 0.06–0.22; respectively). Muscle measures (ALMI and HGS) contributed more to this association than did bone (SI) (AUROCs 0.77, 0.85 vs 0.71, respectively). In women, only HGS was associated with frailty in adjusted models (OR = 0.30 95%CI 0.20–0.45, AUROC = 0.83). In adjusted ordinal models, similar results were observed in men; for women, HGS and ALMI were associated with frailty (ordered OR = 0.30 95%CI 0.20–0.45; OR = 0.56, 0.40–0.80, respectively). Conclusion Muscle deficits appeared to contribute more than bone deficits to frailty. This may have implications for identifying potential musculoskeletal targets for preventing or managing the progression of frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04795-4.
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Affiliation(s)
- Monica C Tembo
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - James Gaston
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - Sophia X Sui
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - Sharon L Brennan-Olsen
- School of Health and Social Development, Deakin University, Waterfront Geelong Campus, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Waterfront Geelong Campus, Geelong, VIC, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, VIC, Australia
| | - Lana J Williams
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia.,Barwon Health, Geelong, VIC, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia.,Barwon Health, Geelong, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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8
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Bouvard B, Annweiler C, Legrand E. Osteoporosis in older adults. Joint Bone Spine 2021; 88:105135. [PMID: 33486108 DOI: 10.1016/j.jbspin.2021.105135] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022]
Abstract
The incidence of fragility fractures increases progressively with advance in age after 50 years, and the phenomenon of population ageing will lead to an increased proportion of the world population having osteoporosis and fractures. The consequences of fractures are more serious in older adults: all low-trauma fractures were associated with increased mortality risk and the risk of a second major osteoporotic fracture after a first one also increased with advance in age. Along with the decrease in bone mineral density, falls play an essential role in the occurrence of fragility fractures in older adults, and the assessment of the risk of falling is part of the fracture risk assessment. Despite advances in the diagnosis of osteoporosis, the assessment of fracture risk, and a wide range of effective anti-osteoporosis medications, with parenteral route which can improve observance, many data indicate that the therapeutic care gap is particularly wide in the elderly in whom the importance and impact of a treatment are high and even more in those living in institutions.
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Affiliation(s)
- Béatrice Bouvard
- Service de Rhumatologie, CHU Angers, 4, rue Larrey, 49933 Angers, France; Groupe d'étude sur le remodelage osseux et les biomatériaux, CHU Angers, 4, rue Larrey, 49933 Angers, France; Faculté de Santé, Université d'Angers, Angers, France.
| | - Cédric Annweiler
- Faculté de Santé, Université d'Angers, Angers, France; Département de gériatrie et Centre mémoire ressources recherche, Centre de recherche sur l'autonomie et la longévité, Centre Hospitalier Universitaire, UPRES EA 4638, Université d'Angers, UNAM, Angers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON, Canada
| | - Erick Legrand
- Service de Rhumatologie, CHU Angers, 4, rue Larrey, 49933 Angers, France; Groupe d'étude sur le remodelage osseux et les biomatériaux, CHU Angers, 4, rue Larrey, 49933 Angers, France; Faculté de Santé, Université d'Angers, Angers, France
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