Abstract
The aim of this study was to compare bone structure parameters and likelihood of falls across European Working Group on Sarcopenia in Older People (EWGSOP2) sarcopenia categories. 3334 Swedish 70-year olds had appendicular lean mass (normalized to height; ALMHt), lumbar spine and total hip areal BMD (aBMD) estimated by dual-energy X-ray absorptiometry. Volumetric BMD (vBMD) and structure at the distal and proximal tibia and radius were estimated by peripheral quantitative computed tomography. Hand grip strength and timed up-and-go were assessed, and sarcopenia was defined according to EWGSOP2 criteria. Incident falls were self-reported 6 and 12 months after baseline. Only 0.8% and 1.0% of participants had probable and confirmed sarcopenia, respectively. Almost one-third of participants with confirmed sarcopenia reported incident falls, compared with 20% for probable sarcopenia and 14% without sarcopenia (P = 0.025). Participants with confirmed sarcopenia had poorer bone parameters (all P < 0.05) except endosteal circumference at the proximal radius and tibia, while those with probable sarcopenia had lower cortical area at the proximal radius (B = − 5.9; 95% CI − 11.7, − 0.1 mm2) and periosteal and endosteal circumferences at the proximal tibia (− 3.3; − 6.4, − 0.3 and − 3.8; − 7.5, − 0.1 mm2, respectively), compared with those without sarcopenia. Compared with probable sarcopenia, confirmed sarcopenic participants had significantly lower lumbar spine and total hip aBMD, distal radius and tibia total vBMD, and proximal radius and tibia cortical vBMD, area and thickness (all P < 0.05). Swedish 70-year olds with confirmed sarcopenia demonstrate poorer BMD and bone architecture than those with probable and no sarcopenia, and have increased likelihood of incident falls.
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References
Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
Edwards MH, Gregson CL, Patel HP, Jameson KA, Harvey NC, Sayer AA, Dennison EM, Cooper C (2013) Muscle size, strength and physical performance and their associations with bone structure in the Hertfordshire Cohort Study. J Bone Miner Res 28:2295–2304
Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31
He H, Liu Y, Tian Q, Papasian C, Hu T, Deng H-W (2016) Relationship of sarcopenia and body composition with osteoporosis. Osteoporos Int 27:473–482
Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G (2012) Sarcopenia as a risk factor for falls in elderly individuals: Results from the ilSIRENTE study. Clin Nutr 31:652–658
Wong AKO (2016) A comparison of peripheral imaging technologies for bone and muscle quantification: a mixed methods clinical review. Curr Osteoporos Rep 14:359–373
Hirschfeld HP, Kinsella R, Duque G (2017) Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 28:2781–2790
Bruyere O, Cavalier E, Reginster JY (2017) Vitamin D and osteosarcopenia: an update from epidemiological studies. Curr Opin Clin Nutr Metab Care 20:498–503
Johansson J, Nordström A, Gustafson Y, Westling G, Nordström P (2017) Increased postural sway during quiet stance as a risk factor for prospective falls in community-dwelling elderly individuals. Age Ageing 46(6):964–970
Hind K, Oldroyd B, Truscott JG (2010) In vivo precision of the GE Lunar iDXA densitometer for the measurement of total-body, lumbar spine, and femoral bone mineral density in adults. J Clin Densitom 13:413–417
Szabo KA, Webber CE, Gordon C, Adachi JD, Tozer R, Papaioannou A (2011) Reproducibility of peripheral quantitative computed tomography measurements at the radius and tibia in healthy pre- and postmenopausal women. Can Assoc Radiol J 62:183–189
Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423
Johansson J, Nordström A, Nordström P Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women. Bone 81:72–79
Freedson PS, Melanson E, Sirard J (1998) Calibration of the computer science and applications, Inc. accelerometer. Med Sci Sports Exerc 30:777–781
Menai M, van Hees VT, Elbaz A, Kivimaki M, Singh-Manoux A, Sabia S (2017) Accelerometer assessed moderate-to-vigorous physical activity and successful ageing: results from the Whitehall II study. Sci Rep 7:45772
Tudor-Locke C, Camhi SM, Troiano RP (2012) Peer reviewed: a catalog of rules, variables, and definitions applied to accelerometer data in the National Health and Nutrition Examination Survey, 2003–2006. Prev Chronic Dis 9:e113
Laurent MR, Dubois V, Claessens F, Verschueren SMP, Vanderschueren D, Gielen E, Jardí F (2016) Muscle-bone interactions: from experimental models to the clinic? A critical update. Mol Cell Endocrinol 432:14–36
Edwards MH, Ward KA, Ntani G, Parsons C, Thompson J, Sayer AA, Dennison EM, Cooper C (2015) Lean mass and fat mass have differing associations with bone microarchitecture assessed by high resolution peripheral quantitative computed tomography in men and women from the Hertfordshire Cohort Study. Bone 81:145–151
Chalhoub D, Cawthon PM, Ensrud KE et al (2015) Risk of nonspine fractures in older adults with sarcopenia, low bone mass, or both. J Am Geriatr Soc 63:1733–1740
Harris R, Chang Y, Beavers K et al (2017) Risk of fracture in women with sarcopenia, low bone mass, or both. J Am Geriatr Soc 65(12):2673–2678
Scott D, Seibel M, Cumming R et al (2018) 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. https://doi.org/10.1093/gerona/gly162
Samu S, Juha S, Toni R, Risto H, Sirola J (2013) Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas 75:175–180
Troy KL, Mancuso ME, Butler TA, Johnson JE (2018) Exercise early and often: effects of physical activity and exercise on women’s bone health. Int J Environ Res Public Health 15:878
Kim S, Baker BS, Sharma-Ghimire P, Bemben DA, Bemben MG (2018) Association between bone-specific physical activity scores and pQCT-derived measures of bone strength and geometry in healthy young and middle-aged premenopausal women. Arch Osteoporos 13:83
Phu S, Vogrin S, Zanker J, Bani Hassan E, Al Saedi A, Duque G (2019) Agreement between initial and revised european working group on sarcopenia in older people definitions. J Am Med Directors Assoc 20:382–383.e1
Locquet M, Beaudart C, Petermans J, Reginster J-Y, Bruyère O (2019) EWGSOP2 Versus EWGSOP1: impact on the prevalence of sarcopenia and its major health consequences. J Am Med Directors Assoc 20:384–385
Zanker J, Scott D, Reijnierse EM et al (2019) Establishing an operational definition of sarcopenia in Australia and New Zealand: delphi method based consensus statement. J Nutr Health Aging 23:105–110
Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, O’Loughlin P, Black D (2012) Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. Br Med J 345:e4547
Sanders KM, Lim K, Stuart AL, Macleod A, Scott D, Nicholson GC, Busija L (2017) Diversity in fall characteristics hampers effective prevention: the precipitants, the environment, the fall and the injury. Osteoporos Int 28(10):3005–3015
Acknowledgements
This study was funded by the Swedish Research Council (Grant No. 2011–2976). David Scott is supported by a NHMRC RD Wright Biomedical Career Development Fellowship (GNT1123014). The authors would like to thank Healthy Ageing Initiative research personnel Magnus Lindblom, David Lapveteläinen, and Jim Viklund, who were responsible for data collection.
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David Scott, Jonas Johansson, Lachlan B. McMillan, Peter R. Ebeling, Peter Nordstrom and Anna Nordstrom declare that they have no conflict of interest.
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The study was approved by the Umeå University Research Ethics Committee and complied with the World Medical Association’s Declaration of Helsinki. All participants provided written informed consent.
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Scott, D., Johansson, J., McMillan, L.B. et al. Associations of Sarcopenia and Its Components with Bone Structure and Incident Falls in Swedish Older Adults. Calcif Tissue Int 105, 26–36 (2019). https://doi.org/10.1007/s00223-019-00540-1
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DOI: https://doi.org/10.1007/s00223-019-00540-1