Psoas cross-sectional area as a predictor of mortality and a diagnostic tool for sarcopenia in hip fracture patients

  • Seong-Eun Byun
  • Sujin Kim
  • Kyu-Hwang Kim
  • Yong-Chan HaEmail author
Original Article


This study aimed to determine: (1) the association between psoas cross-sectional area (PCA) and mortality in hip fracture patients, and (2) the usefulness of PCA as a diagnostic tool for sarcopenia. A total of 373 female and 121 male hip fracture patients aged 50 years or more who had surgical repair of their hip fracture between 2011 and 2017 were analyzed. PCA was measured at L4–L5 disc level using CT. PCA of gender-specific 20th percentile determined from this study cohort was used as a cutoff value. The effect of decreased PCA on mortality was analyzed. The association between PCA and appendicular lean mass (ALM) or/and grip strength was analyzed. In survival time of both genders, a significant difference was found between patients with the lowest quintile and upper 4 quintiles (p < 0.001 for females, p = 0.040 for males). The lowest quintile of PCA was associated with mortality, with hazard ratio (HR) of 2.33 (95% CI 1.44–3.47, p < 0.001) in females and 2.01 (95% CI 1.01–3.98, p = 0.046) in males. After adjustment of age, American Society of Anesthesiologists classification, body mass index, dementia, and a grip strength, the lowest quintile of PCA was significantly associated with mortality only in females, with HR of 1.76 (95% CI 1.05–2.70, p = 0.017). A moderate association between PCA and ALM was found in both genders (r = 0.358 for females, r = 0.455 for males). In conclusion, measurement of PCA has potential as a prognostic predictor and diagnostic tool for sarcopenia.


Psoas muscle Sarcopenia Diagnostic tool Prognostic predictor Hip fracture 



This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest.


  1. 1.
    Cederholm T, Cruz-Jentoft AJ, Maggi S (2013) Sarcopenia and fragility fractures. Eur J Phys Rehabil Med 49:111–117Google Scholar
  2. 2.
    Sjöblom S, Suuronen J, Rikkonen T, Honkanen R, Kroger H, Sirola J (2013) Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas 75:175–180CrossRefGoogle Scholar
  3. 3.
    Yoo JI, Ha YC, Kwon HB, Lee YK, Koo KH, Yoo MJ (2016) High Prevalence of Sarcopenia in Korean patients after hip fracture: a case-control study. J Korean Med Sci 31:1479–1484CrossRefGoogle Scholar
  4. 4.
    Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R (2012) Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients. Arch Gerontol Geriatr 55:e48–e52CrossRefGoogle Scholar
  5. 5.
    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:e27CrossRefGoogle Scholar
  6. 6.
    Landi F, Calvani R, Ortolani E, Salini S, Martone AM, Santoro L, Santoliquido A, Sisto A, Picca A, Marzetti E (2017) The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int 28:1569–1576CrossRefGoogle Scholar
  7. 7.
    Cesari M, Fielding RA, Pahor M, Goodpaster B, Hellerstein M, Van Kan GA, Anker SD, Rutkove S, Vrijbloed JW, Isaac M, Rolland Y (2012) Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia. J Cachexia Sarcopenia Muscle 3:181–190CrossRefGoogle Scholar
  8. 8.
    Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635CrossRefGoogle Scholar
  9. 9.
    Morrel GR, Ikizler TA, Chen X, Heilbrun ME, Wei G, Boucher R, Beddhu S (2016) Psoas muscle cross-sectional area as a measure of whole body lean muscle mass in maintenance hemodialysis patients. J Ren Nutr 45:423–440Google Scholar
  10. 10.
    Hervochon R, Bobbio A, Guinet C, Mansuet-Lupo A, Rabbat A, Régnard JF, Roche N, Damotte D, Iannelli A, Alifano M (2017) Body mass index and total psoas area affect outcomes in patients undergoing pneumonectomy for cancer. Ann Thorac Surg 103:287–295CrossRefGoogle Scholar
  11. 11.
    Fitzpatrick J, Chambers ES, Parkinson JR, Frost G, Bell JD, Thomas EL (2017) Psoas major cross-sectional area: a potential marker of cardiorespiratory fitness. Int J Clin Exp Physiol 4:15–20CrossRefGoogle Scholar
  12. 12.
    Peng P, Hyder O, Firoozmand A, Kneuertz P, Schulick RD, Huang D, Makary M, Hirose K, Edil B, Choti MA, Herman J, Cameron JL, Wolfgang CL, Pawlik TM (2012) Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg 16:1478–1486CrossRefGoogle Scholar
  13. 13.
    Sabel MS, Lee J, Cai S, Englesbe MJ, Holcombe S, Wang S (2011) Sarcopenia as a prognostic factor among patients with stage III melanoma. Ann Surg Oncol 18:3579–3585CrossRefGoogle Scholar
  14. 14.
    Jones KI, Doleman B, Scott S, Lund JN, Williams JP (2015) Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Color Dis 17:O20–O26CrossRefGoogle Scholar
  15. 15.
    Englesbe MJ, Patel SP, He K, Lynch RJ, Schaubel DE, Harbaugh C, Holcombe S, Wang S (2010) Sarcopenia and mortality after liver transplantation. J Am Coll Surg 211:271–278CrossRefGoogle Scholar
  16. 16.
    Boutin RD, Bamrungchart S, Bateni CP, Beavers DP, Beavers KM, Meehan JP, Lenchik L (2017) CT of patients with hip fracture: muscle size and attenuation help predict mortality. Am J Roentgenol 208:208–215CrossRefGoogle Scholar
  17. 17.
    Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JS (2014) Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc 15:95–101CrossRefGoogle Scholar
  18. 18.
    Park SH, Goo JM, Jo CH (2004) Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 5:11–18CrossRefGoogle Scholar
  19. 19.
    Greiner M, Pfeiffer D, Smith R (2000) Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 45:23–41CrossRefGoogle Scholar
  20. 20.
    Couch A, Ho K, Darwood R, Hsu J (2018) Lean psoas area does not correlate with clinical outcomes in moderately to severely injured older people. Australas J Ageing 37:E7–E11CrossRefGoogle Scholar
  21. 21.
    Kim G, Kang SH, Kim Y, Baik SK (2017) Prognostic value of sarcopenia in patients with liver cirrhosis: a systematic review and meta-analysis. PLoS ONE 45:1–16Google Scholar
  22. 22.
    Owens W (2001) American Society of Anaesthesiologists physical status classification system is not a risk classification system. Anesthesiology 94:378CrossRefGoogle Scholar
  23. 23.
    Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788–795CrossRefGoogle Scholar
  24. 24.
    Richmond J, Aharonoff G, Zuckerman J, Koval K (2003) Mortality risk after hip fracture. J Orthop Trauma 17:53–56CrossRefGoogle Scholar
  25. 25.
    Yeoh CJC, Fazal MA (2014) ASA grade and elderly patients with femoral neck fracture. Geriatr Orthop Surg Rehabil 5:195–199CrossRefGoogle Scholar
  26. 26.
    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. Age Ageing 39:412–423CrossRefGoogle Scholar
  27. 27.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE et al (2011) Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: Prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc 12:249–256CrossRefGoogle Scholar
  28. 28.
    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 TT, Vassileva MT (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol Ser A Biol Sci Med Sci 69:547–558CrossRefGoogle Scholar
  29. 29.
    Rutten I, Ubachs J, Kruitwagen R, Beets-Tan R, Damink S, Gorp T (2017) Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer. J Cachexia Sarcopenia Muscle 8:630–638CrossRefGoogle Scholar
  30. 30.
    Wakabayashi H, Watanabe N, Oritsu H, Shimizu Y, Anraku M (2016) Pre-operative psoas muscle mass and post-operative gait speed following total hip arthroplasty for osteoarthritis. J Cachexia Sarcopenia Muscle 7:95–96CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Seong-Eun Byun
    • 1
  • Sujin Kim
    • 2
  • Kyu-Hwang Kim
    • 3
  • Yong-Chan Ha
    • 3
    Email author
  1. 1.Department of Orthopaedic Surgery, CHA Bundang Medical CenterCHA UniversitySeongnam-siRepublic of Korea
  2. 2.Department of RadiologyChung-Ang University HospitalSeoulRepublic of Korea
  3. 3.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulRepublic of Korea

Personalised recommendations