Skip to main content
SpringerLink
Log in

Sarcopenia and Osteoporosis: What Orthopaedic Surgeons Should Know

  • Chapter
  • First Online:
European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 14))

  • 941 Accesses

Abstract

Sarcopenia, the age-associated loss of skeletal muscle and function, is an integral part of the physical component of the “frailty syndrome”. There is evidence that sarcopenia can reach levels where mobility, balance and functionality overall are hampered. So, the diagnosis of sarcopenia should be part of the standard diagnostic and therapeutic repertoire of Geriatric Medicine and Orthogeriatrics. From a pathophysiological point of view, both sarcopenia and frailty share many components, very importantly the one of a low-inflammatory state. The propensity to lack adequate responses to internal and external stresses in frailty, highlights that other domains are involved in this multi-dimensional syndrome.

As with muscle mass, bone mass is declining irrespective of gender or life-span. Both Geriatric Medicine and Orthogeriatrics in addition very often deal with patients suffering from fragility fractures due to osteoporosis. In essence, sarcopenia as well as osteoporosis often develop in parallel and the Orthopaedic surgeon seeing elderly persons with fragility fractures is also confronted with sarcopenia and the clinical signs of frailty. In this mainly multi-morbid population, a close interplay between the Orthopaedic surgeons and Geriatricians therefore helps in the management of this fast-increasing population.

© EFORT 2014

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5 Suppl):990S–1.

    CAS  PubMed  Google Scholar 

  2. Baumgartner R, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–63.

    Article  CAS  PubMed  Google Scholar 

  3. Muscaritoli M, Anker SD, Argiles J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010;29:154–9.

    Article  CAS  PubMed  Google Scholar 

  4. Cruz-Jentoft A, Baeyens JP, Bauer J, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010;39:412–23.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Cederholm TE, Bauer JM, Boirie Y, et al. Towards a definition of sarcopenia. Clin Geriatr Med. 2011;27:341–53.

    Article  PubMed  Google Scholar 

  6. Fielding R, Vellas B, Evans W, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. J Am Med Dir Assoc. 2011;12:249–56.

    Article  PubMed  Google Scholar 

  7. Doherty TJ. Invited review: aging and sarcopenia. J Appl Physiol. 2003;95:1717–27.

    CAS  PubMed  Google Scholar 

  8. Iannuzi-Sucich M, Prestwood KM, Kenny AM. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy older men and women. J Gerontol A Biol Sci Med Sci. 2002;57:M772–7.

    Article  Google Scholar 

  9. Frontera WR, Hughes VA, Fielding R, et al. Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol. 2000;88:1321–6.

    CAS  PubMed  Google Scholar 

  10. Ferrucci L, Guralnik JM, Buchner D, et al. Departures of linearity tin the relationship between measures of muscular strength and physical performance of the lower extremities: the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci. 2007;52:M275–85.

    Google Scholar 

  11. Baumgartner RN, Waters LW. Sarcopenia and sarcopenic-obesity. In: Pathy MS, Sinclair AJ, Morley JE, editors. Principles and practice of geriatric medicine. Chichester: Wiley; 2006. p. 909–33.

    Google Scholar 

  12. Goodpaster B, Won Park S, Harris TB, et al. 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. 2006;61A:1059–64.

    Article  Google Scholar 

  13. Zamboni M, Mazzali G, Fantin F, et al. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis. 2008;18:388–95.

    Article  CAS  PubMed  Google Scholar 

  14. Bergman H, Ferrucci L, Guralnik J, et al. Frailty: an emerging research and clinical paradigm – issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62:731–7.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Berrut G, Andrieu S, Arauio de Carvalho J, et al. Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrcs), WHO (World Health Organization), and SFGG (Société Francaise de Gériatrie et de Gérontologie) Workshop – Athens, 20–21 January, 2012 Tool (GFST). J Nutr Health Aging. 2013;17:688–93.

    Google Scholar 

  16. Strandberg T, Pitkälä K. Frailty in elderly people. Lancet. 2007;369:1328–9.

    Article  PubMed  Google Scholar 

  17. Leng SX, Xue QL, Tian J, et al. Inflammation and frailty in older women. J Am Geriatr Soc. 2007;55:864–71.

    Article  PubMed  Google Scholar 

  18. Hubbard RE, O’Mahony MS, Calver BL, Woodhouse KW. Nutrition, inflammation, and leptin levels in aging and frailty. J Am Geriatr Soc. 2007;56(2):279–84.

    Article  PubMed  Google Scholar 

  19. Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162:2333–41.

    Article  PubMed  Google Scholar 

  20. Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci. 2006;61A:589–93.

    Article  CAS  Google Scholar 

  21. Michelon E, Blaum C, Semba RD, et al. Vitamin and carotenoid status in older women: associations with the frailty syndrome. J Gerontol A Biol Sci Med Sci. 2006;61A:600–7.

    Article  CAS  Google Scholar 

  22. Rockwood K, Song X, MacKnight C, Bergman H, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62:738–43.

    Article  PubMed  Google Scholar 

  24. Drey M, Wehr H, Wehr G, et al. The frailty syndrome in general practitioner care: a pilot study. Z Gerontol Geriatr. 2011;44:48–54.

    Article  CAS  PubMed  Google Scholar 

  25. Purser JL, Kuchibhatla MN, Fillenbaum GG, et al. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc. 2006;54:1674–81.

    Article  PubMed  Google Scholar 

  26. Ahmed NN, Sherman SJ, Vanwyck D. Frailty in Parkinson’s disease and its clinical implications. Parkinsonism Relat Disord. 2007;14(4):334–7.

    Article  PubMed  Google Scholar 

  27. Ertel KA, Glymour MM, Glass TA, et al. Frailty modifies effectiveness of psychosocial intervention in recovery from stroke. Clin Rehabil. 2007;21:511–22.

    Article  CAS  PubMed  Google Scholar 

  28. Buchman AS, Boyle PA, Wilson RS, et al. Frailty is associated with incident Alzheimer’s disease and cognitive decline in the elderly. Psychosom Med. 2007;69:483–9.

    Article  PubMed  Google Scholar 

  29. Folsom AR, Boland LL, Cushman M, et al. Frailty and risk of venous thromboembolism in older adults. J Gerontol A Biol Sci Med Sci. 2007;62:79–82.

    Article  PubMed  Google Scholar 

  30. Cooper C, Dere W, Evans W, et al. Frailty and sarcopenia: definitions and outcome parameters. Osteoporos Int. 2012;23:1839–48.

    Article  CAS  PubMed  Google Scholar 

  31. Maggio M, Cattabiani C, Lauretani F, et al. The concept of multiple hormonal dysregulation. Acta Biomed. 2010;81 Suppl 1:19–29.

    PubMed  Google Scholar 

  32. Cappola AR, Xue QL, Fried LP. Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the Women’s Health and Aging studies. J Gerontol A Biol Sci Med Sci. 2009;64:243–8.

    Article  PubMed  Google Scholar 

  33. Perrini S, Laviola L, Carreira MC, et al. The GH/IGF1 axis and signalling pathways in the muscle and bone: mechanisms underlying age-related skeletal muscle wasting and osteoporosis. J Endocrinol. 2010;205:201–10.

    Article  CAS  PubMed  Google Scholar 

  34. von Haehling S, Morley JE, Anker SD. An overview of sacropenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010;1:129–33.

    Article  Google Scholar 

  35. Morley JE. Anorexia, weight loss, and frailty. J Am Med Dir Assoc. 2010;11:225–8.

    Article  PubMed  Google Scholar 

  36. Salvioli S, Capri M, Valensin S, et al. Inflamm-aging, cytokines and aging: state of the art, new hypotheses on the role of mitochondria and new perspectives from systemic biology. Curr Pharm Des. 2006;12:3161–71.

    Article  CAS  PubMed  Google Scholar 

  37. Biagi E, Nylund L, Candela M, et al. Through ageing, and beyond: gut microbiota and inflammatory status in seniors and centenarians. PLoS One. 2010;5(5):310667.

    Article  Google Scholar 

  38. Pahor M, Manini T, Cesari M. Sarcopenia: clnical evaluation, biological markers and other evaluation tools. J Nutr Health Aging. 2009;13:724–8.

    Article  CAS  PubMed  Google Scholar 

  39. Chen LK, Chen YM, Lin MH, et al. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev. 2010;9 Suppl 1:S18–22.

    Article  PubMed  Google Scholar 

  40. Kuo CK, Lin LY, Yu YH, et al. Inverse association between insulin resistance and gait speed in nondiabetic older men: results from the U.S. National Health and Nutrition Examination survey (NHANES) 1999–2002. BMC Geriatr. 2009;9:49.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Goulet ED, Hassaine A, Dionne IJ, et al. Frailty in the elderly is associated with insulin resistance of glucose metabolism in the postabsorptive state only in the presence of increased abdominal fat. Exp Gerontol. 2009;44:740–4.

    Article  CAS  PubMed  Google Scholar 

  42. Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, et al. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int. 2010;21:1121–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Bischoff-Ferari HA, Dawson-Hughes B, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692.

    Article  Google Scholar 

  44. Pramyothin P, Techasurungkul S, Lin J, et al. Vitamin D status and falls, frailty, and fractures among postmenopausal Japanese women living in Hawaii. Osteoporos Int. 2009;20:1955–62.

    Article  CAS  PubMed  Google Scholar 

  45. Ensrud KE, Blackwell TL, Cauley JA, et al. Osteoporotic fractures in Men Study Group. J Am Geriatr Soc. 2011;59:101–6.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Ensrud KE, Ewing SK, Fredman L, et al.; Study of Osteoporotic Fractures Research Group. Circulating 25-hydroxyvitamin D levels and frailty status in older women. J Clin Endocrinol Metab. 2010;95:5266–73.

    Google Scholar 

  47. Shardell M, Hicks GE, Miller RR, et al. Association of low vitamin D levels with the frailty syndrome in men and women. J Gerontol A Biol Sci Med Sci. 2009;64:69–75.

    Article  PubMed  Google Scholar 

  48. Wilhelm-Leen ER, Hall YN, Deboer IH, et al. Vitamin D deficiency and frailty in older Americans. J Intern Med. 2010;268:171–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Boxer RS, Dauser DA, Walsh SJ, et al. The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc. 2008;56:454–61.

    Article  PubMed  Google Scholar 

  50. Diekmann R, Winning K, Bauer JM, et al. Vitamin D status and physical function in nursing home residents: a 1-year observational study. Z Gerontol Geriatr. 2013;46:403–9.

    Article  CAS  PubMed  Google Scholar 

  51. Xue QL, Walston JD, Fried LP, et al. Prediction of risk of falling, physical disability, and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171:1119–21.

    Article  PubMed  Google Scholar 

  52. Cesari M, Pahor M, Lauretani F, et al. Skeletal muscle and mortality from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci. 2009;64:377–84.

    Article  PubMed  Google Scholar 

  53. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305:50–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Morley JE, Argiles JM, Evans WJ, et al. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc. 2010;11:391–6.

    Article  PubMed  Google Scholar 

  55. Hergenroeder AL, Wert DM, Hile ES, et al. Association of body mass index with self-report and performance-based measures of balance and mobility. Phys Ther. 2011;91:1223–34.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Kaiser M, Bauer JM, Ramsch C, et al. MNA-International Group: validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13:782–8.

    Article  CAS  PubMed  Google Scholar 

  57. Bauer JM, Sieber CC. Sarcopenia and frailty – a clinician’s controversial point of view. Exp Gerontol. 2008;43:674–8.

    Article  CAS  PubMed  Google Scholar 

  58. Drey M, Grösch C, Neuwirth C, et al. The Motor Unit Number Index (MUNIX) in sarcopenic patients. Exp Gerontol. 2013;48:381–4.

    Article  CAS  PubMed  Google Scholar 

  59. Drey M, Sieber CC, Bauer JM, et al. C-terminal Agrin Fragment as a potential marker for sarcopenia caused by degeneration of the neuromuscular junction. Exp Gerontol. 2013;48:76–80.

    Article  CAS  PubMed  Google Scholar 

  60. Cesari M, Fielding RA, Pahor M, et al. Biomarkers of sarcopenia in clinical trials – recommendations from the International Working Group on Sarcopenia. J Cachexia Sarcopenia Muscle. 2012;3:181–90.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Evans WJ, Morley JE, Argiles J, et al. Cachexia: a new definition. Clin Nutr. 2008;27:793–9.

    Article  CAS  PubMed  Google Scholar 

  62. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.

    Article  PubMed  Google Scholar 

  63. Fiatarone MA, O’Neill EF, Rayn ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769–75.

    Article  CAS  PubMed  Google Scholar 

  64. Freiberger E, Sieber C. Mobility in old age: aspects of training in independently living older people. Dtsch Med Wochenschr. 2013;138:2007–10.

    Article  CAS  PubMed  Google Scholar 

  65. Tech A, Drey M, Freiberger E, et al. Residual effects of muscle strength and muscle power training and detraining on physical function in community-dwelling prefrail older adults: a randomized controlled trial. BMC Geriatr. 2012;12:68. doi:10.1186/1471-2138-12-58.

    Article  Google Scholar 

  66. Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14:542–59.

    Article  PubMed  Google Scholar 

  67. Bollwein J, Diekmann R, Kaiser MJ, et al. Distribution bunt not amount of protein intake is associated with frailty: a cross-sectional investigation in the region of Nürnberg. Nutr J. 2013;12:109.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Meynial-Denis D, Guerin O, Schneider SM, et al. New strategies to fight against sarcopenia at old age. J Aging Res. 2012;2012:676041. doi:10.1155/2012/676042.

    Article  Google Scholar 

  69. Semba RD, Ferrucci L, Sun K, et al. Oxidative stress and severe walking disability among older women. Am J Med. 2007;120:1084–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Bollwein J, Diekmann R, Kasier JM, et al. Dietary quality is related to frailty in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2013;68:483–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander University Erlangen-Nuremberg, Kobergerger Strasse 62, Nuremberg, D-90408, Germany

    Cornel C. Sieber MD

  2. Hospital “Barmherzige Brüder Regensburg”, Regensburg, Germany

    Cornel C. Sieber MD

Authors
  1. Cornel C. Sieber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cornel C. Sieber MD .

Editor information

Editors and Affiliations

  1. Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, United Kingdom

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2014 EFORT

About this chapter

Cite this chapter

Sieber, C.C. (2014). Sarcopenia and Osteoporosis: What Orthopaedic Surgeons Should Know. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 14. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54030-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54030-1_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54029-5

  • Online ISBN: 978-3-642-54030-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation