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Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX®, Falls, and BMD in the Osteoporotic Fractures in Men (MrOS) Study : A Meta-Analysis

Harvey, Nicholas C. ; Orwoll, Eric ; Kwok, Timothy ; Karlsson, Magnus K. LU ; Rosengren, Björn E. LU ; Ribom, Eva ; Cauley, Jane A. ; Cawthon, Peggy M. ; Ensrud, Kristine and Liu, Enwu , et al. (2021) In Journal of Bone and Mineral Research 36(7). p.1235-1244
Abstract

Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height2 (ALM/ht2) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX®) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht2 only), Morley, the International Working Group on... (More)

Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height2 (ALM/ht2) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX®) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht2 only), Morley, the International Working Group on Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP1 and 2), Asian Working Group on Sarcopenia, Foundation for the National Institutes of Health (FNIH) 1 and 2 (using ALM/body mass index [BMI], incorporating muscle strength and/or physical performance measures plus ALM/ht2), and Sarcopenia Definitions and Outcomes Consortium (gait speed and grip strength). Associations were adjusted for age and time since baseline and reported as hazard ratio (HR) for first incident fracture, here major osteoporotic fracture (MOF; clinical vertebral, hip, distal forearm, proximal humerus). Further analyses adjusted additionally for FRAX-MOF probability (n = 7531; calculated ± fnBMD), prior falls (y/n), or fnBMD T-score. Results were synthesized by meta-analysis. In 5660 men in USA, 2764 Sweden and 1987 Hong Kong (mean ages 73.5, 75.4, and 72.4 years, respectively), sarcopenia prevalence ranged from 0.5% to 35%. Sarcopenia status, by all definitions except those of FNIH, was associated with incident MOF (HR = 1.39 to 2.07). Associations were robust to adjustment for prior falls or FRAX probability (without fnBMD); adjustment for fnBMD T-score attenuated associations. EWGSOP2 severe sarcopenia (incorporating chair stand time, gait speed, and grip strength plus ALM) was most predictive, albeit at low prevalence, and appeared only modestly influenced by inclusion of fnBMD. In conclusion, the predictive value for fracture of sarcopenia definitions based on ALM is reduced by adjustment for fnBMD but strengthened by additional inclusion of physical performance measures.

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Contribution to journal
publication status
published
subject
keywords
EPIDEMIOLOGY, FALLS, FRACTURE, FRAX, INTERACTION, OSTEOPOROSIS, SARCOPENIA
in
Journal of Bone and Mineral Research
volume
36
issue
7
pages
1235 - 1244
publisher
Wiley-Blackwell
external identifiers
  • scopus:85104020815
  • pmid:33831257
ISSN
0884-0431
DOI
10.1002/jbmr.4293
language
English
LU publication?
yes
id
9f159982-06c9-47c2-83d5-8451321e5d84
date added to LUP
2021-04-23 06:45:46
date last changed
2022-06-30 16:13:04
@article{9f159982-06c9-47c2-83d5-8451321e5d84,
  abstract     = {{<p>Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height<sup>2</sup> (ALM/ht<sup>2</sup>) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX<sup>®</sup>) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht<sup>2</sup> only), Morley, the International Working Group on Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP1 and 2), Asian Working Group on Sarcopenia, Foundation for the National Institutes of Health (FNIH) 1 and 2 (using ALM/body mass index [BMI], incorporating muscle strength and/or physical performance measures plus ALM/ht<sup>2</sup>), and Sarcopenia Definitions and Outcomes Consortium (gait speed and grip strength). Associations were adjusted for age and time since baseline and reported as hazard ratio (HR) for first incident fracture, here major osteoporotic fracture (MOF; clinical vertebral, hip, distal forearm, proximal humerus). Further analyses adjusted additionally for FRAX-MOF probability (n = 7531; calculated ± fnBMD), prior falls (y/n), or fnBMD T-score. Results were synthesized by meta-analysis. In 5660 men in USA, 2764 Sweden and 1987 Hong Kong (mean ages 73.5, 75.4, and 72.4 years, respectively), sarcopenia prevalence ranged from 0.5% to 35%. Sarcopenia status, by all definitions except those of FNIH, was associated with incident MOF (HR = 1.39 to 2.07). Associations were robust to adjustment for prior falls or FRAX probability (without fnBMD); adjustment for fnBMD T-score attenuated associations. EWGSOP2 severe sarcopenia (incorporating chair stand time, gait speed, and grip strength plus ALM) was most predictive, albeit at low prevalence, and appeared only modestly influenced by inclusion of fnBMD. In conclusion, the predictive value for fracture of sarcopenia definitions based on ALM is reduced by adjustment for fnBMD but strengthened by additional inclusion of physical performance measures.</p>}},
  author       = {{Harvey, Nicholas C. and Orwoll, Eric and Kwok, Timothy and Karlsson, Magnus K. and Rosengren, Björn E. and Ribom, Eva and Cauley, Jane A. and Cawthon, Peggy M. and Ensrud, Kristine and Liu, Enwu and Cruz-Jentoft, Alfonso J. and Fielding, Roger A. and Cooper, Cyrus and Kanis, John A. and Lorentzon, Mattias and Ohlsson, Claes and Mellström, Dan and Johansson, Helena and McCloskey, Eugene}},
  issn         = {{0884-0431}},
  keywords     = {{EPIDEMIOLOGY; FALLS; FRACTURE; FRAX; INTERACTION; OSTEOPOROSIS; SARCOPENIA}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1235--1244}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Bone and Mineral Research}},
  title        = {{Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX<sup>®</sup>, Falls, and BMD in the Osteoporotic Fractures in Men (MrOS) Study : A Meta-Analysis}},
  url          = {{http://dx.doi.org/10.1002/jbmr.4293}},
  doi          = {{10.1002/jbmr.4293}},
  volume       = {{36}},
  year         = {{2021}},
}