Advertisement

Calcified Tissue International

, Volume 105, Issue 4, pp 392–402 | Cite as

Diagnostic Value of Mid-Thigh and Mid-Calf Bone, Muscle, and Fat Mass in Osteosarcopenia: A Pilot Study

  • Ebrahim Bani Hassan
  • Steven Phu
  • Sara Vogrin
  • Génesis Escobedo Terrones
  • Xaviera Pérez
  • Isabel Rodriguez-Sanchez
  • Gustavo DuqueEmail author
Original Research

Abstract

Osteosarcopenia is defined as the concomitant occurrence of osteoporosis and sarcopenia. Current lack of consensus on sarcopenia definitions, combined with the low sensitivity and specificity of screening methodologies, has resulted in varying prevalences of sarcopenia, and consequently osteosarcopenia diagnosis. Previous research indicates that mid-thigh is a potential surrogate region for the assessment of bone, muscle, and fat mass in a single, efficient and low-radiation dual x-ray absorptiometry (DXA) scan. We hypothesized that muscle and bone mass measurements in the mid-thigh region can be used to evaluate bone and muscle health and function. A retrospective study was conducted on community-dwelling older subjects (> 65 y.o., n = 260) who were at risk of falls and fractures. Mid-thigh and mid-calf bone, lean muscle, and fat masses, as well as their association with muscle function, falls, and fractures were compared against conventional measures (hip/spine bone, appendicular lean, and gynoid/android fat masses). Mid-thigh bone, lean, and fat masses showed strong correlation with conventional measures. Mid-thigh lean mass showed similar associations with grip strength, gait speed, and timed up and go (TUG) test as appendicular lean mass. Appendicular, mid-thigh and mid-calf lean masses corrected for body mass index (BMI) showed stronger associations than when corrected for height2. None of the indices were associated with fractures; but fat mass was invariably associated with falls. Those with falls and fractures history had lower bone and muscle mass at mid-thigh. Mid-thigh is a potential new surrogate to study bone, muscle, and fat mass in older people, with comparable ability in predicting muscle performance and falls.

Keywords

Osteosarcopenia Osteoporosis Sarcopenia Falls Fractures Appendicular lean mass 

Notes

Acknowledgements

This study was supported by the Australian Institute for Musculoskeletal Science (AIMSS) as the host institute. The authors would like to thank Mrs Solange Bernardo (the fracture liaison nurse) for coordinating the patient attendance and assistance in data collection. We are also grateful to Mrs Paula Casas for kindly reviewing the manuscript. Ebrahim Bani Hassan was supported by the Australian Medical Research Future Fund (MRFF) under MACH-RART Scheme.

Compliance with Ethical Standards

Conflict of interest

Ebrahim Bani Hassan, Steven Phu, Sara Vogrin, Génesis Escobedo Terrones, Xaviera Pérez, Isabel Rodriguez-Sanchez, and Gustavo Duque declare that they have no competing interest.

Human and Animal Rights and Informed Consent

This study was approved by the local Human Ethics Research Committee (DB2017.13 and QA2018.80_46205). Participant consent was waived due to use of de-identified data collected as part of standard care and to the low risk nature of the study.

References

  1. 1.
    Binkley N, Buehring B (2009) Beyond FRAX: it’s time to consider “Sarco-Osteopenia”. J Clin Densitom 12:413–416CrossRefGoogle Scholar
  2. 2.
    AlSaedi A, BaniHassan E, Duque G (2019) The diagnostic role of fat in osteosarcopenia. J Lab Precis Med 1:1–10.  https://doi.org/10.21037/jlpm.2019.02.01 Google Scholar
  3. 3.
    Bani Hassan E, Duque G (2017) Osteosarcopenia: a new geriatric syndrome. Aust Fam Physician 46:849–853Google Scholar
  4. 4.
    Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Muir SW, Montero-Odasso M, Gunawardene P, Demontiero O, Duque G (2014) Phenotype of osteosarcopenia in older individuals with a history of falling. J Am Med Dir Assoc 16:290–295CrossRefGoogle Scholar
  5. 5.
    Tong J, Li W, Vidal C, Yeo LS, Fatkin D, Duque G (2011) Lamin A/C deficiency is associated with fat infiltration of muscle and bone. Mech Ageing Dev 132:552–559CrossRefGoogle Scholar
  6. 6.
    Paintin J, Cooper C, Dennison E (2018) Osteosarcopenia. Br J Hosp Med 79:253–258CrossRefGoogle Scholar
  7. 7.
    Yoshimura N, Muraki S, Oka H, Iidaka T, Kodama R, Kawaguchi H, Nakamura K, Tanaka S, Akune T (2017) Is osteoporosis a predictor for future sarcopenia or vice versa? Four-year observations between the second and third ROAD study surveys. Osteoporos Int 28:189–199CrossRefGoogle Scholar
  8. 8.
    Girgis CM, Mokbel N, Digirolamo DJ (2014) Therapies for musculoskeletal disease: can we treat two birds with one stone? Curr Osteoporosis Rep 12:142–153CrossRefGoogle Scholar
  9. 9.
    Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Gunawardene P, Demontiero O, Duque G (2015) Comprehensive nutritional status in sarco-osteoporotic older fallers. J Nutr Health Aging 19:474–480CrossRefGoogle Scholar
  10. 10.
    Demontiero O, Boersma D, Suriyaarachchi P, Duque G (2014) Clinical outcomes of impaired muscle and bone interactions. Clin Rev Bone Miner Metab 12:86–92CrossRefGoogle Scholar
  11. 11.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova 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 39:412–423CrossRefGoogle Scholar
  12. 12.
    Hirschfeld HP, Kinsella R, Duque G (2017) Osteosarcopenia: where bone, muscle, and fat collide. Osteoporosis Int 28:2781–2790CrossRefGoogle Scholar
  13. 13.
    Reijnierse EM, Trappenburg MC, Leter MJ, Blauw GJ, Sipila S, Sillanpaa E, Narici MV, Hogrel JY, Butler-Browne G, McPhee JS, Gapeyeva H, Paasuke M, de van der Schueren MA, Meskers CG, Maier AB (2015) The impact of different diagnostic criteria on the prevalence of sarcopenia in healthy elderly participants and geriatric outpatients. Gerontology 61:491–496CrossRefGoogle Scholar
  14. 14.
    Dupuy C, Lauwers-Cances V, Guyonnet S, Gentil C, Abellan Van Kan G, Beauchet O, Schott A-M, Vellas B, Rolland Y (2015) Searching for a relevant definition of sarcopenia: results from the cross-sectional EPIDOS study. J Cachexia Sarcopenia Muscle 6:144–154CrossRefGoogle Scholar
  15. 15.
    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 Dir Assoc 20:382–383CrossRefGoogle Scholar
  16. 16.
    Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330:1769–1775CrossRefGoogle Scholar
  17. 17.
    Bassey EJ, Fiatarone MA, O’Neill EF, Kelly M, Evans WJ, Lipsitz LA (1992) Leg extensor power and functional performance in very old men and women. Clin Sci (London) 82:321–327CrossRefGoogle Scholar
  18. 18.
    Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E, Harris TB (2002) Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc 50:897–904CrossRefGoogle Scholar
  19. 19.
    Jung Lee S, Janssen I, Heymsfield SB, Ross R (2004) Relation between whole-body and regional measures of human skeletal muscle. Am J Clin Nutr 80:1215–1221CrossRefGoogle Scholar
  20. 20.
    Hansen RD, Williamson DA, Finnegan TP, Lloyd BD, Grady JN, Diamond TH, Smith EU, Stavrinos TM, Thompson MW, Gwinn TH, Allen BJ, Smerdely PI, Diwan AD, Singh NA, Fiaatarone-Singh MA (2007) Estimation of thigh muscle cross-sectional area by dual-energy X-ray absorptiometry in frail elderly patients. Am J Clin Nutr 86:952–958CrossRefGoogle Scholar
  21. 21.
    Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older P, The Extended Group for E (2018) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:afy169Google Scholar
  22. 22.
    Lamb SE, Jorstad-Stein EC, Hauer K, Becker C (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe Consensus. J Am Geriatr Soc 53:1618–1622CrossRefGoogle Scholar
  23. 23.
    Bollwein J, Volkert D, Diekmann R, Kaiser MJ, Uter W, Vidal K, Sieber CC, Bauer JM (2013) Nutritional status according to the Mini Nutritional Assessment (MNA®) and frailty in community dwelling older persons: a close relationship. J Nutr Health Aging 17:351–356CrossRefGoogle Scholar
  24. 24.
    Yesavage JA (1988) Geriatric depression scale. Psychopharmacol Bull 24:709–711Google Scholar
  25. 25.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49CrossRefGoogle Scholar
  26. 26.
    Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Fragala MS, Kenny AM, Kiel DP, Kritchevsky SB, Shardell MD, Dam T-TL, Vassileva MT (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol Ser A 69:547–558CrossRefGoogle Scholar
  27. 27.
    Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, Simonsick EM, Harris TB (2005) Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A 60:324–333CrossRefGoogle Scholar
  28. 28.
    Goodpaster BH, Chomentowski P, Ward BK, Rossi A, Glynn NW, Delmonico MJ, Kritchevsky SB, Pahor M, Newman AB (2008) Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial. J Appl Physiol 105:1498–1503CrossRefGoogle Scholar
  29. 29.
    Khan IM, Perrard XY, Brunner G, Lui H, Sparks LM, Smith SR, Wang X, Shi ZZ, Lewis DE, Wu H, Ballantyne CM (2015) Intermuscular and perimuscular fat expansion in obesity correlates with skeletal muscle T cell and macrophage infiltration and insulin resistance. Int J Obes 39:1607CrossRefGoogle Scholar
  30. 30.
    Schrauwen P (2007) High-fat diet, muscular lipotoxicity and insulin resistance. Proc Nutr Soc 66:33–41CrossRefGoogle Scholar
  31. 31.
    Perera S, Mody SH, Woodman RC, Studenski SA (2006) Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 54:743–749CrossRefGoogle Scholar
  32. 32.
    Kim JK, Park MG, Shin SJ (2014) What is the minimum clinically important difference in grip strength? Clin Orthop Relat Res 472:2536–2541CrossRefGoogle Scholar
  33. 33.
    Alghadir A, Anwer S, Brismée J-M (2015) The reliability and minimal detectable change of timed up and go test in individuals with grade 1–3 knee osteoarthritis. BMC Musculoskelet Disord 16:174CrossRefGoogle Scholar
  34. 34.
    Lindemann U, Mohr C, Machann J, Blatzonis K, Rapp K, Becker C (2016) Association between thigh muscle volume and leg muscle power in older women. PLoS ONE 11:e0157885CrossRefGoogle Scholar
  35. 35.
    Chen B-B, Shih TTF, Hsu C-Y, Yu C-W, Wei S-Y, Chen C-Y, Wu C-H, Chen C-Y (2011) Thigh muscle volume predicted by anthropometric measurements and correlated with physical function in the older adults. J Nutr Health Aging 15:433–438CrossRefGoogle Scholar
  36. 36.
    Takeshima N, Shimada K, Islam MM, Kanehisa H, Ishida Y, Brechue WF (2015) Progressive, site-specific loss of muscle mass in older, frail nursing home residents. J Aging Phys Act 23:452–459CrossRefGoogle Scholar
  37. 37.
    Welch D, Ndanyo LS, Brown S, Agyapong-Badu S, Warner M, Stokes M, Samuel D (2018) Thigh muscle and subcutaneous tissue thickness measured using ultrasound imaging in older females living in extended care: a preliminary study. Aging Clin Exp Res 30:463–469CrossRefGoogle Scholar
  38. 38.
    Malkov S, Cawthon PM, Peters KW, Cauley JA, Murphy RA, Visser M, Wilson JP, Harris T, Satterfield S, Cummings S, Shepherd JA, for the Health ABCS (2015) Hip fractures risk in older men and women associated with DXA-derived measures of thigh subcutaneous fat thickness, cross-sectional muscle area, and muscle density. J Bone Miner Res 30:1414–1421CrossRefGoogle Scholar
  39. 39.
    Blake GM, Naeem M, Boutros M (2006) Comparison of effective dose to children and adults from dual X-ray absorptiometry examinations. Bone 38:935–942CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western HealthSt. AlbansAustralia
  2. 2.Department of Medicine-Western HealthThe University of MelbourneSt. AlbansAustralia
  3. 3.Faculty of MedicineAutonomous University of San Luis PotosíSan Luis PotosíMexico
  4. 4.Geriatrics Unit, Faculty of MedicineUniversidad de ChileSantiagoChile
  5. 5.Department of GeriatricsHospital Universitario La PazMadridSpain

Personalised recommendations