Osteosarcopenia: Difference between revisions
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== Introduction == | == Introduction == | ||
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. [[Sarcopenia]] and [[osteopenia]] are independent risk factors for several conditions, including fractures and falls. 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 in elderly|falls]] | 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<ref>Paintin J, Cooper C, Dennison E. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963675/ Osteosarcopenia]. British journal of hospital medicine. 2018 May 2;79(5):253-8.</ref><ref>Binkley N, Buehring B. Beyond FRAX®: [https://www.sciencedirect.com/science/article/abs/pii/S1094695009001541?via%3Dihub It's time to consider “sarco-osteopenia”]. Journal of Clinical Densitometry. 2009;4(12):413-6.</ref>. [[Sarcopenia]] and [[osteopenia]] are independent risk factors for several conditions, including [[Fracture|fractures]] and [[Falls in elderly|falls]]. 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 in elderly|falls]]<ref name=":0">Balogun S, Winzenberg T, Wills K, Scott D, Callisaya M, Cicuttini F, Jones G, Aitken D. [https://www.sciencedirect.com/science/article/abs/pii/S0167494319300196?via%3Dihub 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.</ref>, [[fracture]]<ref name=":0" />, poor mobility<ref name=":1">Kirk B, Zanker J, Duque G. [https://onlinelibrary.wiley.com/doi/full/10.1002/jcsm.12567 Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers]. Journal of Cachexia, Sarcopenia and Muscle. 2020 Jun;11(3):609-18.</ref>, impaired quality of life<ref name=":1" /> and mortality<ref name=":0" />. | ||
== Prevalence == | == Prevalence == | ||
Unlike [[osteopenia]]/[[osteoporosis]], several clinical definitions of [[sarcopenia]] have been proposed (see [[sarcopenia]]). 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. With the global population ageing, the proportion of individuals with osteosarcopenia is projected to increase, irrespective of the definition of [[sarcopenia]] considered. | Unlike [[osteopenia]]/[[osteoporosis]], several clinical definitions of [[sarcopenia]] have been proposed (see [[sarcopenia]]). 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<ref name=":1" />. 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 == | == Pathophysiology: Bone muscle interaction == | ||
[[Bone]] and [[muscle]] are anatomically and functionally interconnected. 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. Hence, bone modelling and remodelling are biomechanically influenced by the muscle. 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. The [https://www.youtube.com/watch?v=TZ2mAaeu9AA video] provides a further discussion on the pathophysiology of osteosarcopenia. | [[Bone]] and [[muscle]] are anatomically and functionally interconnected<ref>Michael A Clynes, Celia L Gregson, Olivier Bruyère, Cyrus Cooper, Elaine M Dennison, [https://doi.org/10.1093/rheumatology/keaa755 Osteosarcopenia: where osteoporosis and sarcopenia collide], ''Rheumatology'', Volume 60, Issue 2, February 2021, Pages 529–537</ref>. 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. Hence, bone modelling and remodelling are biomechanically influenced by the muscle. 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. The [https://www.youtube.com/watch?v=TZ2mAaeu9AA video] provides a further discussion on the pathophysiology of osteosarcopenia. | ||
{{#ev:youtube|TZ2mAaeu9AA|600}} <ref>IOF/ESCEO 'Osteosarcopenia Understanding bone, muscle and fat interactions. Available from: https://www.youtube.com/watch?v=TZ2mAaeu9AA [last accessed 22/04/2023]</ref> | {{#ev:youtube|TZ2mAaeu9AA|600}} <ref>IOF/ESCEO 'Osteosarcopenia Understanding bone, muscle and fat interactions. Available from: https://www.youtube.com/watch?v=TZ2mAaeu9AA [last accessed 22/04/2023]</ref> | ||
== Risk factors == | == Risk factors == | ||
Osteosarcopenia has shared risk factors with other chronic diseases, including physical inactivity and high adiposity. 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. Interestingly, increasing years of schooling was related to a lower prevalence of osteosarcopenia, although the pathway explaining this relationship is unclear. The presence of chronic diseases, including [[diabetes]], also increases the risk of osteosarcopenia. | Osteosarcopenia has shared risk factors with other chronic diseases, including physical inactivity and high adiposity<ref name=":1" />. 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. Interestingly, increasing years of schooling was related to a lower prevalence of osteosarcopenia, although the pathway explaining this relationship is unclear. The presence of chronic diseases, including [[diabetes]], also increases the risk of osteosarcopenia. | ||
== Clinical assessment == | == Clinical assessment == | ||
The assessment of osteosarcopenia includes detailed history (including previous medical records), risk factors assessment, physical examination and assessment of muscle and bone quality using [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]]. Osteoporosis can be ascertained using bone mineral density measured via DEXA, and sarcopenic status can be evaluated using [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]]-assessed appendicular lean muscle mass. | The assessment of osteosarcopenia includes detailed history (including previous medical records), risk factors assessment, physical examination and assessment of muscle and bone quality using [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]]. Osteoporosis can be ascertained using bone mineral density measured via DEXA, and sarcopenic status can be evaluated using [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]]-assessed appendicular lean muscle mass. | ||
Rapid assessment of osteosarcopenia may be challenging in clinical practice because [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]] is required to measure bone and muscle mass. Rapid screening tools such as the [[SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia|SARC-F]] questionnaire may be used to identify probable [[sarcopenia]], and [[Fracture Risk Assessment (FRAX) Tool|FRAX]] | Rapid assessment of osteosarcopenia may be challenging in clinical practice because [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]] is required to measure bone and muscle mass. Rapid screening tools such as the [[SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia|SARC-F]] questionnaire may be used to identify probable [[sarcopenia]], and [[Fracture Risk Assessment (FRAX) Tool|FRAX]] may be used in the absence of [[Bone Density|BMD]]. Potential osteosarcopenia identified using [[SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia|SARC-F]] and [[Fracture Risk Assessment (FRAX) Tool|FRAX]] tools should be followed by a formal diagnosis using [[Dual Energy X-ray Absorptiometry (DEXA Scan)|DEXA]]. | ||
== Physiotherapy management == | == Physiotherapy management == | ||
Revision as of 05:41, 22 April 2023
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Original Editor - Saliu Balogun
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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 and falls. 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[3], fracture[3], poor mobility[4], impaired quality of life[4] and mortality[3].
Prevalence[edit | edit source]
Unlike osteopenia/osteoporosis, several clinical definitions of sarcopenia have been proposed (see sarcopenia). 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[4]. 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[5]. 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. Hence, bone modelling and remodelling are biomechanically influenced by the muscle. 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. 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[4]. 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. Interestingly, increasing years of schooling was related to a lower prevalence of osteosarcopenia, although the pathway explaining this relationship is unclear. The presence of chronic diseases, including diabetes, also increases the risk of osteosarcopenia.
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. 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]
Individuals with osteosarcopenia may have other comorbidities; hence, physiotherapy management may be individualised. Generally, physiotherapy management will include resistive and high/low weight-bearing exercises combined with medications to manage osteoporosis. Progressive resistance exercise will help improve muscle strength and bone microarchitecture by stimulating osteoblastogenesis and muscle protein synthesis. Other physiotherapy management may include exercises to improve balance and functional capacity.
References[edit | edit source]
- ↑ Paintin J, Cooper C, Dennison E. Osteosarcopenia. British journal of hospital medicine. 2018 May 2;79(5):253-8.
- ↑ Binkley N, Buehring B. Beyond FRAX®: It's time to consider “sarco-osteopenia”. Journal of Clinical Densitometry. 2009;4(12):413-6.
- ↑ 3.0 3.1 3.2 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.
- ↑ 4.0 4.1 4.2 4.3 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.
- ↑ 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
- ↑ IOF/ESCEO 'Osteosarcopenia Understanding bone, muscle and fat interactions. Available from: https://www.youtube.com/watch?v=TZ2mAaeu9AA [last accessed 22/04/2023]
