Original Editor - Saliu Balogun

Top Contributors - Saliu Balogun  

Introduction[edit | edit source]

Osteosarcopenia, sometimes called sarco-osteopenia, is a geriatric syndrome that refers to the presence of both low bone mass (osteopenia/osteoporosis) and low muscle mass/function (sarcopenia) within the same individual[1][2]. Sarcopenia and osteopenia are independent risk factors for several conditions, including fractures[3][4] and falls[3]. Hence, the presence of these conditions within the same person (i.e., osteosarcopenia) further exacerbates the risk of poorer health outcomes. For example, compared to those with sarcopenia or osteopenia alone, individuals with osteosarcopenia have an elevated risk of impaired physical performance, falls[5], fracture[5], poor mobility[6], impaired quality of life[6] and mortality[5].

Prevalence[edit | edit source]

Unlike osteopenia/osteoporosis, several clinical definitions of sarcopenia have been proposed (see sarcopenia for details). Hence, the prevalence of osteosarcopenia varies depending on the definitions of sarcopenia considered. Generally, the prevalence of osteosarcopenia is estimated to range from 5 to 37% among community-dwelling older people[6]. With the global population ageing, the proportion of individuals with osteosarcopenia is projected to increase, irrespective of the definition of sarcopenia considered.

Pathophysiology: Bone muscle interaction[edit | edit source]

Bone and muscle are anatomically and functionally interconnected[7]. The bone-muscle interaction was traditionally provided by the mechanostat theory, which suggests that bone strength is responsive to the mechanical load exerted by the skeletal muscle[8]. Hence, bone modelling and remodelling are biomechanically influenced by the muscle[9]. However, more recent evidence suggests that the relationship between bones and muscles is beyond biomechanical forces and that there are biochemical and molecular pathways through which bone and muscles communicate and influence each other’s function[10][9]. The video provides a further discussion on the pathophysiology of osteosarcopenia.


Risk factors[edit | edit source]

Osteosarcopenia has shared risk factors with other chronic diseases, including physical inactivity and high adiposity[6]. High adiposity increases fat infiltration within and around the skeletal muscle, compromising muscle and bone quality. Osteosarcopenia increases with age, and it is more prevalent among women compared to men[6]. Interestingly, increasing years of schooling was related to a lower prevalence of osteosarcopenia, although the pathway explaining this relationship is unclear[12]. The presence of chronic diseases, including diabetes, also increases the risk of osteosarcopenia[12].

Clinical assessment[edit | edit source]

The assessment of osteosarcopenia includes detailed history (including previous medical records), risk factors assessment, physical examination and assessment of muscle and bone quality using DEXA[6]. Osteoporosis can be ascertained using bone mineral density measured via DEXA, and sarcopenic status can be evaluated using DEXA-assessed appendicular lean muscle mass.

Rapid assessment of osteosarcopenia may be challenging in clinical practice because DEXA is required to measure bone and muscle mass. Rapid screening tools such as the SARC-F questionnaire may be used to identify probable sarcopenia, and FRAX may be used in the absence of BMD. Potential osteosarcopenia identified using SARC-F and FRAX tools should be followed by a formal diagnosis using DEXA.

Physiotherapy management[edit | edit source]

Physiotherapy intervention for patients with osteosarcopenia may be individualised to accommodate individual patient's circumstances. Generally, physiotherapy management will include resistive and high/low weight-bearing exercises. Progressive resistance exercise will help improve muscle strength and bone microarchitecture by stimulating osteoblastogenesis and muscle protein synthesis[4][13][14]. Other physiotherapy management may include exercises to improve balance and functional capacity.

Multidisciplinary Osteosarcopenia Care: Individuals with osteosarcopenia may have other comorbidities and need to be managed in partnership with other health professionals, including rheumatologists, endocrinologists, occupational therapists, pharmacists, and dieticians. Dieticians may help with nutritional support, including dietary protein, and rheumatologists/ endocrinologists may help with medications to manage osteoporosis. Pharmacists may help advise patients with their medications and work with rheumatologists/endocrinologists to help patients address challenges with polypharmacy.

References[edit | edit source]

  1. Paintin J, Cooper C, Dennison E. Osteosarcopenia. British journal of hospital medicine. 2018 May 2;79(5):253-8.
  2. Binkley N, Buehring B. Beyond FRAX®: It's time to consider “sarco-osteopenia”. Journal of Clinical Densitometry. 2009;4(12):413-6.
  3. 3.0 3.1 Balogun S, Winzenberg T, Wills K, Scott D, Jones G, Aitken D, Callisaya ML. Prospective associations of low muscle mass and function with 10-year falls risk, incident fracture and mortality in community-dwelling older adults. The journal of nutrition, health & aging. 2017 Jul;21:843-8.
  4. 4.0 4.1 Lee YH, Lee PH, Lin LF, Liao CD, Liou TH, Huang SW. Effects of progressive elastic band resistance exercise for aged osteosarcopenic adiposity women. Experimental gerontology. 2021 May 1;147:111272.
  5. 5.0 5.1 5.2 Balogun S, Winzenberg T, Wills K, Scott D, Callisaya M, Cicuttini F, Jones G, Aitken D. Prospective associations of osteosarcopenia and osteodynapenia with incident fracture and mortality over 10 years in community-dwelling older adults. Archives of gerontology and geriatrics. 2019 May 1;82:67-73.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 Kirk B, Zanker J, Duque G. Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers. Journal of Cachexia, Sarcopenia and Muscle. 2020 Jun;11(3):609-18.
  7. Michael A Clynes, Celia L Gregson, Olivier Bruyère, Cyrus Cooper, Elaine M Dennison, Osteosarcopenia: where osteoporosis and sarcopenia collide, Rheumatology, Volume 60, Issue 2, February 2021, Pages 529–537
  8. Cianferotti L, Brandi ML. Muscle–bone interactions: basic and clinical aspects. Endocrine. 2014 Mar;45:165-77.
  9. 9.0 9.1 Lara-Castillo N, Johnson ML. Bone-muscle mutual interactions. Current osteoporosis reports. 2020 Aug;18:408-21.
  10. Kaji H. Interaction between muscle and bone. Journal of bone metabolism. 2014 Feb 28;21(1):29-40.
  11. IOF/ESCEO 'Osteosarcopenia Understanding bone, muscle and fat interactions. Available from: https://www.youtube.com/watch?v=TZ2mAaeu9AA [last accessed 22/04/2023]
  12. 12.0 12.1 Fahimfar N, Zahedi Tajrishi F, Gharibzadeh S, Shafiee G, Tanha K, Heshmat R, Nabipour I, Raeisi A, Jalili A, Larijani B, Ostovar A. Prevalence of osteosarcopenia and its association with cardiovascular risk factors in Iranian older people: Bushehr Elderly Health (BEH) Program. Calcified tissue international. 2020 Apr;106:364-70.
  13. Daly RM, Gianoudis J, Kersh ME, Bailey CA, Ebeling PR, Krug R, Nowson CA, Hill K, Sanders KM. Effects of a 12‐month supervised, community‐based, multimodal exercise program followed by a 6‐month research‐to‐practice transition on bone mineral density, trabecular microarchitecture, and physical function in older adults: a randomized controlled trial. Journal of Bone and Mineral Research. 2020 Mar;35(3):419-29.
  14. Kirk B, Mooney K, Amirabdollahian F, Khaiyat O. Exercise and dietary-protein as a countermeasure to skeletal muscle weakness: Liverpool Hope University—Sarcopenia Aging Trial (LHU-SAT). Front Physiol 2019; 10: 445.