Assess for osteopenia/osteoporosis plus sarcopenia to determine those at greatest fracture risk
Sepúlveda-Loyola and colleagues performed a cross-sectional analysis of 253 participants, of which 77% were women, average age 78, who presented for a “falls and fractures” risk assessment. T-scores were measured by DXA. In addition, the investigators measured components of sarcopenia, including physical performance (evaluated by hand grip strength, gait speed, timed up and go test, and 5-time sit to stand test) and dynamic and static balance. Falls in the previous year were self-reported, with 42% of participants having fallen once and 54%, more than once.
Results. Participants with osteosarcopenia had a statistically significant increased rate of falls of approximately threefold and an increased rate of fractures that was approximately fourfold when compared with osteopenia or osteoporosis alone.
Another important finding was that, despite the links between osteoporosis, fracture, and poor clinical outcomes, the investigators did not find differences in fracture rates in the osteopenic compared with the osteoporotic classifications. Their findings corroborated those of other studies that reported discrepancies in fractures and bone mineral density (BMD), with osteopenic older adults experiencing fracture rates similar to and in some cases greater than those diagnosed with osteoporosis.7
Thus, it appears that the use of T-scores that combine osteopenic and osteoporotic criteria into the osteosarcopenic category may be sufficient to capture individuals at the greatest risk of fracture.
Skeletal muscle mass plays a role in vertebral compression fractures
Tokeshi and colleagues conducted retrospective observational study to investigate the relationships between skeletal muscle mass, BMD, and TBS in individuals with osteoporotic vertebral compression fractures.
They evaluated 142 patients with an average age of 75; of these, 30% had radiographically diagnosed vertebral compression fractures (average age, 79) and 70% had no vertebral compression fractures (average age, 70). Body composition was measured using whole-body DXA; appendicular skeletal muscle mass index was determined as the sum of upper and lower extremities’ lean mass (kg/height in m2 ). TBS was measured using the patented algorithm software on DXA scans for the lumbar vertebrae.
Results. The investigators found that the vertebral compression fracture group was statistically significantly older, had lower femur BMD, and had decreased leg muscle mass. The TBS was not identified as a risk factor.
Certain lifestyle factors add to risk of osteosarcopenia
In an editorial, Kirk and colleagues summarized the epidemiology, diagnosis, and treatment of osteosarcopenia. They concluded that this syndrome can be expected to grow in age-related and disease-related states as a consequence of immunosenescence coinciding with an increase in sedentary lifestyle, obesity, and fat infiltration of muscle and bone.
Increasingly, clinicians should screen for osteosarcopenia via imaging methods (DXA) to quantitate bone mass (as is currently done) and, increasingly, quantify muscle mass. In addition, assessment of muscle strength, easily done by testing grip strength, as well as functional capacity (gait speed), will become increasingly important.
Finally, the authors call for a more comprehensive geriatric assessment that includes medical history and risk factors as well as treatment (including osteoporosis drugs, where indicated), and progressive resistance and balance exercises. Nutritional recommendations, in terms of protein, vitamin D, and calcium, also are necessary. They anticipate that diagnosis and treatment of osteosarcopenia will become part of routine health care in the future.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
In the past, our assessment of risk for fragility fracture was based mostly on bone mass measurement by DXA. Scoring systems like the FRAX tool have included other risk factors, such as age, body mass index, previous fracture, family history of hip fracture, smoking, any history of rheumatoid arthritis, use of glucocorticoids, and alcohol consumption. However, sarcopenia is a condition characterized by loss of skeletal muscle mass, strength, and function. While it is a natural part of the aging process, when it is severe and coupled with osteopenia or osteoporosis, it significantly increases the risks of falls as well as fracture. Women’s HCPs should increasingly think about the presence of sarcopenia in their patients, especially those with low bone mass (osteopenia or osteoporosis), particularly when making decisions about initiating pharmaceutical intervention. In addition, recommendations for resistive and balance exercises virtually should be universal.
In the past, our assessment of risk for fragility fracture was based mostly on bone mass measurement by DXA. Scoring systems like the FRAX tool have included other risk factors, such as age, body mass index, previous fracture, family history of hip fracture, smoking, any history of rheumatoid arthritis, use of glucocorticoids, and alcohol consumption. However, sarcopenia is a condition characterized by loss of skeletal muscle mass, strength, and function. While it is a natural part of the aging process, when it is severe and coupled with osteopenia or osteoporosis, it significantly increases the risks of falls as well as fracture. Women’s HCPs should increasingly think about the presence of sarcopenia in their patients, especially those with low bone mass (osteopenia or osteoporosis), particularly when making decisions about initiating pharmaceutical intervention. In addition, recommendations for resistive and balance exercises virtually should be universal.
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