Defining sarcopenia in terms of skeletal health
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Among several sarcopenic indices, height-adjusted appendicular lean mass (ALM) in men and BMI-adjusted ALM in women are associated with fragility fracture. Handgrip strength is the risk factor for fragility fracture.
Various sarcopenia definitions and cutoff points result in mixed skeletal health results. Here, we aimed to determine a suitable definition and elucidate the cutoff values of sarcopenic indices for identifying fracture risk in a community-dwelling Korean cohort.
In an Ansung cohort study (2009–2010), we included 1201 men aged > 50 years and 1627 postmenopausal women with a median age of 64 years. Body composition and bone mineral density were derived on dual-energy X-ray absorptiometry. Grip strength was measured using a hand dynamometer. Fragility fractures included the history of osteoporotic fractures using self-reported questionnaires.
Among appendicular lean mass (ALM)/body mass index (BMI), ALM/height2, and ALM/weight, ALM/height2 for men and ALM/BMI for women significantly predicted fragility fractures. On receiver operating characteristic curve analysis, the cutoff values of ALM/height2 in men and ALM/BMI in women were 7.69 kg/m2, and 0.57, respectively. The optimal grip strength values were 31 kg in men and 19 kg in women. The odds ratios of low ALM/height2 (95% confidence interval) and weak grip strength for fragility fracture were 1.95 (1.03–3.68) and 2.05 (1.01–4.18), respectively, in men after covariate adjustment. The combination of low ALM/height2 and weak grip strength increased fragility fractures 2.16-fold in men. Only the combination of low ALM/BMI and grip strength increased the fracture risk by 1.76-fold in women.
In men, low ALM/height2 or grip strength played a role in fragility fractures. In women, only the combination of low ALM/BMI and grip strength had discriminatory power for fragility fractures.
KeywordsMuscle mass Muscle strength Bone Fracture
This work was supported by the Korean Genome and Epidemiology Study (2001-347-6111-221, 2002-347-6111-221, 2003-347-6111-221, 2004-E71001-00, 2005-E71001-00, 2006-E71005-00, 2007-E71001-00, 2008-E71001-00, 2009-E71002-00, 2010-E71001-00, 2011-E71004-00, and 2012-E71005-00) and the Korea Centers for Disease Control and Prevention (2009-E71007-00 and 2010-E71004-00).
Compliance with ethical standards
This study was approved by an institutional review board of the Ajou University.
Conflict of interest
- 3.Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB, on behalf of the Health ABC Study Investigators (2003) Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 51:1602–1609CrossRefGoogle Scholar
- 8.Moon JH, Kim KM, Kim JH, Moon JH, Choi SH, Lim S, Lim JY, Kim KW, Park KS, and Jang HC. (2016) Predictive values of the new sarcopenia index by the Foundation for the National Institutes of Health Sarcopenia Project for mortality among older Korean adults. PLoS One 11: e0166344Google Scholar
- 9.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People (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
- 11.Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, de Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M (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
- 12.Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JSW, Lee WJ, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CW, Wu CH, Wu SN, Zhang T, Zeng P, Akishita M, Arai H (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15:95–101CrossRefGoogle Scholar
- 13.Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61:1059–1064CrossRefGoogle Scholar
- 16.Cawthon PM, Blackwell TL, Cauley J, Kado DM, Barrett-Connor E, Lee CG, Hoffman AR, Nevitt M, Stefanick ML, Lane NE, Ensrud KE, Cummings SR, Orwoll ES (2015) Evaluation of the usefulness of consensus definitions of sarcopenia in older men: results from the Observational Osteoporotic Fractures in Men Cohort study. J Am Geriatr Soc 63:2247–2259CrossRefGoogle Scholar
- 18.Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Hirani V (2017) Sarcopenic obesity and its temporal associations with changes in bone mineral density, incident falls, and fractures in older men: the concord health and ageing in men project. J Bone Miner Res 32:575–583CrossRefGoogle Scholar
- 24.Chalhoub D, Cawthon PM, Ensrud KE, Stefanick ML, Kado DM, Boudreau R, Greenspan S, Newman AB, Zmuda J, Orwoll ES, Cauley JA, the Osteoporotic Fractures in Men Study Research Group (2015) Risk of nonspine fractures in older adults with sarcopenia, low bone mass, or both. J Am Geriatr Soc 63:1733–1740CrossRefGoogle Scholar
- 25.Kim YS, Lee Y, Chung YS, Lee DJ, Joo NS, Hong D, Song G, Kim HJ, Choi YJ, Kim KM (2012) Prevalence of sarcopenia and sarcopenic obesity in the Korean population based on the Fourth Korean National Health and Nutritional Examination Surveys. J Gerontol A Biol Sci Med Sci 67:1107–1113CrossRefGoogle Scholar