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Osteoporosis International

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01-11-2021 | Sarcopenia | Original Article

The analysis of osteosarcopenia as a risk factor for fractures, mortality, and falls

Authors: Z. Teng, Y. Zhu, Y. Teng, Q. Long, Q. Hao, X. Yu, L. Yang, Y. Lv, J. Liu, Y. Zeng, S. Lu

Published in: Osteoporosis International | Issue 11/2021

Abstract

Summary

Osteosarcopenia is defined as the concomitant occurrence of sarcopenia and osteoporosis/osteopenia. This study aimed to clarify whether osteosarcopenia implies a greater risk of fractures, mortality, and falls and to draw attention to osteosarcopenia.

Introduction

Osteosarcopenia, which is characterized by the co-existence of osteoporosis/osteopenia and sarcopenia, is one of the most challenging geriatric syndromes. However, the association between osteosarcopenia and the risk of falls, fractures, disability, and mortality is controversial.

Methods

We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from their inception to March 18, 2021, for cohort studies on the relationship between osteosarcopenia and fractures, falls, and mortality. Two reviewers independently extracted data and assessed study quality. A pooled analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) using fixed or random-effects models.

Results

Eight cohort studies including 19,836 participants showed that osteosarcopenia significantly increased the risk of fracture (OR 2.46, 95% CI 1.83–3.30, P_{heterogeneity} = 0.006, I² = 63.0%), three cohort studies involving 2601 participants indicated that osteosarcopenia significantly increased the risk of mortality (OR 1.66, 95% CI 1.23–2.26, P_{heterogeneity} = 0.214, I² = 35.2%), and three cohort studies involving 3144 participants indicated that osteosarcopenia significantly increased the risk of falls (OR 1.62, 95% CI 1.28–2.04, P_{heterogeneity} = 0.219, I² = 34.1%). No publication bias existed among the studies regarding the association between osteosarcopenia and fractures. The findings were robust according to the subgroup and sensitivity analyses.

Conclusions

This pooled analysis demonstrated that osteosarcopenia significantly increased the risk of fractures, falls, and mortality, thus highlighting its relevance in daily life. Therefore, we suggest that elderly persons should be aware of the risks associated with osteosarcopenia.

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Sepúlveda-Loyola W, Phu S, Bani Hassan E, Brennan-Olsen SL, Zanker J, Vogrin S, Conzade R, Kirk B, Al Saedi A, Probst V, Duque G (2020) The joint occurrence of osteoporosis and sarcopenia (osteosarcopenia): definitions and characteristics. J Am Med Dir Assoc 21(2):220–225. https://doi.org/10.1016/j.jamda.2019.09.005CrossRefPubMed

Hassan EB, Duque G (2017) Osteosarcopenia: a new geriatric syndrome. Aust Fam Physician 46(11):849–853PubMed

Cedeno-Veloz B, López-Dóriga Bonnardeauxa P, Duque G (2019) Osteosarcopenia: a narrative review. Rev Esp Geriatr Gerontol 54(2):103–108. https://doi.org/10.1016/j.regg.2018.09.010CrossRefPubMed

Lee DW, Choi EY (2016) Sarcopenia as an independent risk factor for decreased BMD in COPD patients: Korean national health and nutrition examination surveys IV and V (2008-2011). PLoS One 11(10):e0164303. https://doi.org/10.1371/journal.pone.0164303CrossRefPubMedPubMedCentral

Lima RM, de Oliveira RJ, Raposo R, Neri SGR, Gadelha AB (2019) Stages of sarcopenia, bone mineral density, and the prevalence of osteoporosis in older women. Arch Osteoporos 14(1):38. https://doi.org/10.1007/s11657-019-0591-4CrossRefPubMed

Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. Lancet 393(10191):2636–2646. https://doi.org/10.1016/S0140-6736(19)31138-9CrossRefPubMed

Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393(10169):364–376. https://doi.org/10.1016/S0140-6736(18)32112-3CrossRefPubMed

Nielsen BR, Abdulla J, Andersen HE, Schwarz P, Suetta C (2018) Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis. Eur Geriatr Med 9(4):419–434. https://doi.org/10.1007/s41999-018-0079-6CrossRefPubMed

Zanker J, Duque G (2020) Osteosarcopenia: the path beyond controversy. Curr Osteoporos Rep 18(2):81–84. https://doi.org/10.1007/s11914-020-00567-6CrossRefPubMed

10.

Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Hirani V (2019) Does combined osteopenia/osteoporosis and sarcopenia confer greater risk of falls and fracture than either condition alone in older men? The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 74(6):827–834. https://doi.org/10.1093/gerona/gly162CrossRefPubMed

11.

Bauer JM, Cruz-Jentoft AJ, Fielding RA, Kanis JA, Reginster JY, Bruyère O, Cesari M, Chapurlat R, Al-Daghri N, Dennison E, Kaufman JM, Landi F, Laslop A, Locquet M, Maggi S, McCloskey E, Perna S, Rizzoli R, Rolland Y, Rondanelli M, Szulc P, Vellas B, Vlaskovska M, Cooper C (2019) Is there enough evidence for osteosarcopenic obesity as a distinct entity? A critical literature review. Calcif Tissue Int 105(2):109–124. https://doi.org/10.1007/s00223-019-00561-wCrossRefPubMed

12.

Kirk B, Zanker J, Duque G (2020) Osteosarcopenia: epidemiology, diagnosis, and treatment-facts and numbers. J Cachexia Sarcopenia Muscle 11:609–618. https://doi.org/10.1002/jcsm.12567CrossRefPubMedPubMedCentral

13.

Saeki C, Takano K, Oikawa T, Aoki Y, Kanai T, Takakura K, Nakano M, Torisu Y, Sasaki N, Abo M, Matsuura T, Tsubota A, Saruta M (2019) Comparative assessment of sarcopenia using the JSH, AWGS, and EWGSOP2 criteria and the relationship between sarcopenia, osteoporosis, and osteosarcopenia in patients with liver cirrhosis. BMC Musculoskelet Disord 20(1):615. https://doi.org/10.1186/s12891-019-2983-4CrossRefPubMedPubMedCentral

14.

Yu R, Leung J, Woo J (2014) Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study. J Am Med Dir Assoc 15(8):551–558. https://doi.org/10.1016/j.jamda.2014.02.005CrossRefPubMed

15.

Albala C, Lera L, Sanchez H, Angel B, Marquez C, Insunza F, Moya MO (2015) Osteoporosis, sarcopenia and fractures in Chilean older people. Osteoporos Int 26(1):S332–S380. https://doi.org/10.1007/s00198-015-3068-3CrossRef

16.

Chalhoub D, Cawthon PM, Ensrud KE, Stefanick ML, Kado DM, Boudreau R, Greenspan S, Newman AB, Zmuda J, Orwoll ES, Cauley JA (2015) Risk of nonspine fractures in older adults with sarcopenia, low bone mass, or both. J Am Geriatr Soc 63(9):1733–1740. https://doi.org/10.1111/jgs.13605CrossRefPubMedPubMedCentral

17.

Duque G, Suriyaarachchi P, Bani-Hassan E, Gomez F, Curcio CL (2017) Sarco-osteopenia vs. sarco-osteoporosis: towards a unified definition of osteosarcopenia. Osteoporos Int 28:S343–S344. https://doi.org/10.1007/s00198-017-3950-2CrossRef

18.

Harris R, Chang Y, Beavers K, Laddu-Patel D, Bea J, Johnson K, LeBoff M, Womack C, Wallace R, Li W, Crandall C, Cauley J (2017) Risk of fracture in women with sarcopenia, low bone mass, or both. J Am Geriatr Soc 65(12):2673–2678. https://doi.org/10.1111/jgs.15050CrossRefPubMedPubMedCentral

19.

Balogun S, Winzenberg T, Wills K, Scott D, Callisaya M, Cicuttini F, Jones G, Aitken D (2019) Prospective associations of osteosarcopenia and osteodynapenia with incident fracture and mortality over 10 years in community-dwelling older adults. Arch Gerontol Geriatr 82:67–73. https://doi.org/10.1016/j.archger.2019.01.015CrossRefPubMed

20.

Yoo JI, Kim H, Ha YC, Kwon HB, Koo KH (2018) Osteosarcopenia in patients with hip fracture is related with high mortality. J Korean Med Sci 33(4):e27. https://doi.org/10.3346/jkms.2018.33.e27CrossRefPubMed

21.

Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative STROBE (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 4(10):e297. https://doi.org/10.1371/journal.pmed.0040297CrossRefPubMedPubMedCentral

22.

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012CrossRefPubMed

23.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRefPubMedPubMedCentral

24.

Woolf B (1955) On estimating the relation between blood group and disease. Ann Hum Genet 19(4):251–253CrossRefPubMed

25.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188. https://doi.org/10.1016/0197-2456(86)90046-2CrossRefPubMed

26.

Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JS, Lee WJ, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CW, Wu CH, Wu SN, Zhang T, Zeng P, Akishita M, Arai H (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15(2):95–101. https://doi.org/10.1016/j.jamda.2013.11.025CrossRefPubMed

27.

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423. https://doi.org/10.1093/ageing/afq034CrossRefPubMedPubMedCentral

28.

Chow YYT, Scott D, Ebeling PR, Dore D, Jones G (2014) “Sarco-osteoporosis” is a predictor of fracture risk in community-dwelling older adults over 4.5 years. Endocr Rev 35

29.

Kaplan SJ, Pham TN, Arbabi S, Gross JA, Damodarasamy M, Bentov I, Taitsman LA, Mitchell SH, Reed MJ (2017) Association of radiologic indicators of frailty with 1-year mortality in older trauma patients: opportunistic screening for sarcopenia and osteopenia. JAMA Surg 152(2):e164604. https://doi.org/10.1001/jamasurg.2016.4604CrossRefPubMed

30.

Biljana M, Jelena M, Branislav J, Milorad R (1999) Bias in meta-analysis and funnel plot asymmetry. Stud Health Technol Inform 68:323–328PubMed

31.

Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRefPubMed

32.

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629CrossRef

33.

Hars M, Biver E, Chevalley T, Herrmann F, Rizzoli R, Ferrari S, Trombetti A (2016) Low lean mass predicts incident fractures independently from FRAX: a prospective cohort study of recent retirees. J Bone Miner Res 31(11):2048–2056. https://doi.org/10.1002/jbmr.2878CrossRefPubMed

34.

Trajanoska K, Schoufour JD, Darweesh SKL, Benz E, Medina-Gomez C, Alferink LJM, Lahousse L, Brusselle G, Stricker B, Darwish Murad S, Zillikens MC, Uitterlinden AG, Ikram MA, Franco OH, Rivadeneira F (2018) Sarcopenia and its clinical correlates in the general population: the Rotterdam Study. J Bone Miner Res 33(7):1209–1218. https://doi.org/10.1002/jbmr.3416CrossRefPubMed

35.

Salech F, Marquez C, Lera L, Angel B, Saguez R, Albala C (2020) Osteosarcopenia predicts falls, fractures, and mortality in Chilean community-dwelling older adults. J Am Med Dir Assoc 22:853–858. https://doi.org/10.1016/j.jamda.2020.07.032CrossRefPubMed

36.

Paintin J, Cooper C, Dennison E (2018) Osteosarcopenia. Br J Hosp Med (Lond) 79(5):253-258. https://doi.org/10.12968/hmed.2018.79.5.253

37.

Beaudart C (2017) Sarcopenia in community dwelling subjects: the Sarcophage study. Osteoporos Int 28(1):S124–S125. https://doi.org/10.1007/s00198-017-3943-1CrossRef

38.

Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R (2004) The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 52(1):80–85. https://doi.org/10.1111/j.1532-5415.2004.52014.xCrossRefPubMed

Title: The analysis of osteosarcopenia as a risk factor for fractures, mortality, and falls
Authors: Z. Teng
Y. Zhu
Y. Teng
Q. Long
Q. Hao
X. Yu
L. Yang
Y. Lv
J. Liu
Y. Zeng
S. Lu
Publication date: 01-11-2021
Publisher: Springer London
Keywords: Sarcopenia
Osteoporosis
Osteoporosis
Published in: Osteoporosis International / Issue 11/2021
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-021-05963-x

At a glance: The STEP trials

Springer Medicine

The analysis of osteosarcopenia as a risk factor for fractures, mortality, and falls

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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