Recently, the National Osteoporosis Foundation (NOF) changed its name to the Bone Health and Osteoporosis Foundation (BHOF). Several years ago, in 2016 at my urging, this column was renamed from “Update on osteoporosis” to “Update on bone health.” I believe we were on the leading edge of this movement. As expressed in last year’s Update, our patients’ bone health must be emphasized more than it has been in the past.1
Consider that localized breast cancer carries a 5-year survival rate of 99%.2 Most of my patients are keenly aware that periodic competent breast imaging is the key to the earliest possible diagnosis. By contrast, in this country a hip fracture carries a mortality in the first year of 21%!3 Furthermore, approximately one-third of women who fracture their hip do not have osteoporosis.4 While the risk of hip fracture is greatest in women with osteoporosis, it is not absent in those without the condition. Finally, the role of muscle mass, strength, and performance in bone health is a rapidly emerging topic and one that constitutes the core of this year’s Update.
Muscle mass and strength play key role in bone health
de Villiers TJ, Goldstein SR. Update on bone health: the International Menopause Society white paper 2021. Climacteric. 2021;24:498-504. doi:10.1080/13697137.2021.1950967.
Recently, de Villiers and Goldstein offered an overview of osteoporosis.5 What is worthy of reporting here is the role of muscle in bone health.
The bone-muscle relationship
Most clinicians know that osteoporosis and osteopenia are well-defined conditions with known risks associated with fracture. According to a review of PubMed, the first article with the keyword “osteoporosis” was published in 1894; through May 2020, 93,335 articles used that keyword. “Osteoporosis” is derived from the Greek osteon (bone) and poros (little hole). Thus, osteoporosis means “porous bone.”
Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass, strength, and function, and the condition is associated with a risk of adverse outcomes that include physical disabilities, poor quality of life, and death.6,7 “Sarcopenia” has its roots in the Greek words sarx (flesh) and penia (loss), and the term was coined in 1989.8 A PubMed review that included “sarcopenia” as the keyword revealed that the first article was published in 1993, with 12,068 articles published through May 2020.
Notably, muscle accounts for about 60% of the body’s protein. Muscle mass decreases with age, but younger patients with malnutrition, cachexia, or inflammatory diseases are also prone to decreased muscle mass. While osteoporosis has a well-accepted definition based on dual-energy x-ray absorptiometry (DXA) measurements, sarcopenia has no universally accepted definition, consensus diagnostic criteria, or treatment guidelines. In 2016, however, the International Classification of Diseases, Tenth Revision, Clinical Modification (CD-10-CM) finally recognized sarcopenia as a disease entity.
Currently, the most widely accepted definition comes from the European Working Group on Sarcopenia in Older People, which labeled presarcopenia as low muscle mass without impact on muscle strength or performance; sarcopenia as low muscle mass with either low muscle strength or low physical performance; and severe sarcopenia has all 3 criteria being present.9
When osteosarcopenia (osteoporosis or osteopenia combined with sarcopenia) exists, it can result in a threefold increase in risk of falls and a fourfold increase in fracture risk compared with women who have osteopenia or osteoporosis alone.10
WHAT THIS EVIDENCE MEANS FOR PRACTICE
The morbidity and mortality from fragility fractures are well known. Initially, diagnosis of risk seemed to be mainly T-scores on bone mineral density (BMD) testing (normal, osteopenic, osteoporosis). The FRAX fracture risk assessment tool, which includes a number of variables, further refined risk assessment. Increasingly, there is evidence of crosstalk between muscle and bone. Sarcopenia, the loss of skeletal muscle mass, strength, and performance, appears to play an important role as well for fracture risk. Simple tools to evaluate a patient’s muscle status exist. At the very least, resistance and balance exercises should be part of all clinicians’ patient counseling for bone health.
The morbidity and mortality from fragility fractures are well known. Initially, diagnosis of risk seemed to be mainly T-scores on bone mineral density (BMD) testing (normal, osteopenic, osteoporosis). The FRAX fracture risk assessment tool, which includes a number of variables, further refined risk assessment. Increasingly, there is evidence of crosstalk between muscle and bone. Sarcopenia, the loss of skeletal muscle mass, strength, and performance, appears to play an important role as well for fracture risk. Simple tools to evaluate a patient’s muscle status exist. At the very least, resistance and balance exercises should be part of all clinicians’ patient counseling for bone health.
Continue to: Denosumab decreased falls risk, improved sarcopenia measures vs comparator antiresorptives...