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Sarcopenia, osteoporosis and the burden of prevalent vertebral fractures: a cross-sectional study of 350 women with hip fracture.

BACKGROUND
The concurrent presence of sarcopenia and osteoporosis may enhance fracture risk.


AIM
To evaluate the association between sarcopenia, osteoporosis, or the concurrent presence of both the conditions (osteosarcopenia) and the burden (number and severity) of vertebral fractures in women with hip fracture.


DESIGN
Cross-sectional study.


POPULATION
We studied 350 women with subacute hip fracture.


METHODS
Lateral radiographs of the spine were taken 18.2±4.5 days after fracture occurrence and the spine deformity index (SDI) was calculated. Body composition was assessed by dual-energy x-ray absorptiometry. Low muscle mass was identified with appendicular lean mass <15.02 kg and low bone mineral density with a femoral T-score <-2.5.


RESULTS
The presence of sarcopenia (P=0.033) and osteoporosis (P=0.032) was associated with the SDI scores independently of each other and independently of age, percentage of body fat and hip-fracture type. The 350 women were categorized into 3 groups according to the absence of both osteoporosis and sarcopenia (N=25), presence of either osteoporosis or sarcopenia (N=95) or presence of osteosarcopenia (N=230). We found a significant difference in SDI scores across the 3 groups: x² (2, N=350) = 15.29; P<0.001. The categorization of the 350 women into the 3 groups was associated with the SDI scores (P=0.001) independently of age, percentage of body fat and hip-fracture type.


CONCLUSIONS
Both osteoporosis and sarcopenia were independently associated with the burden of prevalent vertebral fractures in women with hip fracture. The concurrent presence of sarcopenia and osteoporosis was associated with a higher SDI score than the presence of only one of the 2 conditions.


CLINICAL REHABILITATION IMPACT
Subjects with both low bone mass and low muscle mass should be considered at particularly high risk for vertebral fractures. Interventions targeting both the components of the muscle-bone unit, including exercise, nutrition, and possibly new medications, should be investigated to optimize fracture prevention.