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      Sarcopenia and osteoporosis are interrelated in geriatric inpatients Translated title: Sarkopenie und Osteoporose sind bei geriatrischen Krankenhauspatienten miteinander assoziiert

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          Abstract

          Background

          Sarcopenia and osteoporosis share an underlying pathology and reinforce each other in terms of negative outcomes.

          Objective

          To evaluate the extent of concomitance of sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP) and osteoporosis as defined by the World Health Organization (WHO) in geriatric inpatients and their relationship to nutritional and functional status.

          Material and methods

          A cross-sectional analysis of geriatric inpatients from the sarcopenia in geriatric elderly (SAGE) study. Measurements included dual X‑ray absorptiometry for bone mineral density and appendicular muscle mass; gait speed and hand grip strength, the Barthel index, body mass index (BMI) and the mini nutritional assessment short form (MNA-SF).

          Results

          Of the 148 patients recruited for SAGE, 141 (84 women, 57 men; mean age 80.6 ± 5.5 years) had sufficient data to be included in this ancillary investigation: 22/141 (15.6%) were only osteoporotic, 19/141 (13.5%) were only sarcopenic and 20/141 (14.2%) osteosarcopenic (i.e. both sarcopenia and osteoporosis). The prevalence of osteoporosis was higher in sarcopenic than in non-sarcopenic individuals (51.3% vs. 21.6%, p < 0.001). Sarcopenic, osteoporotic and osteosarcopenic subjects had a lower BMI, MNA-SF, handgrip and gait speed ( p < 0.05) than the reference group (those neither osteoporotic nor sarcopenic, n = 80). The Barthel index was lower for sarcopenic and osteosarcopenic ( p < 0.05) but not for osteoporotic ( p = 0.07) subjects. The BMI and MNA-SF were lower in osteosarcopenia compared to sarcopenia or osteoporosis alone ( p < 0.05) while there were no differences in functional criteria.

          Conclusion

          Osteoporosis and sarcopenia are linked to nutritional deficits and reduced function in geriatric inpatients. Co-occurrence (osteosarcopenia) is common and associated with a higher degree of malnutrition than osteoporosis or sarcopenia alone.

          Zusammenfassung

          Hintergrund

          Sarkopenie und Osteoporose haben gemeinsame Pathomechanismen und wirken synergistisch bezüglich negativer Gesundheitsoutcomes.

          Ziel der Arbeit

          Evaluation, in welchem Ausmaß Sarkopenie (nach Definition der European Working Group on Sarcopenia in Older People) und Osteoporose (nach Definition der Weltgesundheitsorganisation) in einem Kollektiv geriatrischer Krankenhauspatienten gleichzeitig vorkommen und mit welchen nutritiven und funktionellen Charakteristika sie verknüpft sind.

          Material und Methoden

          Wir führten eine Querschnittsanalyse an den Teilnehmern der Sarcopenia-in-Geriatric-Elderly(SAGE)-Studie durch. Gemessen wurden die Knochendichte und Extremitätenmuskelmasse mittels Dualröntgenabsorptiometrie, Gehgeschwindigkeit, Handkraft, Barthel-Index, Body-Mass-Index (BMI) und Mini Nutritional Assessment Short Form (MNA-SF).

          Ergebnisse

          Von 141 auswertbaren Teilnehmern (84 Frauen, 57 Männer, Durchschnittsalter 80,6± 5,5 Jahre) waren 22 (15,6 %) nur osteoporotisch, 19 (13,5 %) nur sarkopen und 20 (14,2 %) osteosarkopen (sowohl osteoporotisch als auch sarkopen). Die Osteoporoseprävalenz war höher für sarkopene als nichtsarkopene Individuen (51,3 % vs. 21,6 %, p <  0,001). Sarkopene, osteoporotische und osteosarkopene Patienten hatten schlechtere BMI-, MNA-SF-, Handkraft- und Gehgeschwindigkeitswerte ( p <  0,05) als die Kontrollgruppe (weder osteoporotisch noch sarkopen, n =  80). Der Barthel-Index war erniedrigt bei den sarkopenen und osteosarkopenen ( p < 0,05), aber nicht bei den osteoporotischen Teilnehmern ( p < 0,07). Osteosarkopene Patienten wiesen gegenüber bloß sarkopenen oder osteoporotischen Patienten einen niedrigeren BMI- und MNA-SF-Wert auf ( p < 0,05), ohne dass sich eine Differenz in funktionellen Kriterien nachweisen ließ.

          Diskussion

          Osteoporose und Sarkopenie sind bei geriatrischen Krankenhauspatienten mit nutritiven und funktionellen Defiziten und einer reduzierten Funktionsfähigkeit verknüpft. Die Überlappung der beiden Krankheitsentitäten ist häufig. Osteosarkopene Patienten haben einen besonders schlechten Ernährungsstatus.

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          Most cited references14

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          Osteosarcopenia: where bone, muscle, and fat collide.

          As the world's population ages, the prevalence of chronic diseases increases. Sarcopenia and osteoporosis are two conditions that are associated with aging, with similar risk factors that include genetics, endocrine function, and mechanical factors. Additionally, bone and muscle closely interact with each other not only anatomically, but also chemically and metabolically. Fat infiltration, a phenomenon observed in age-related bone and muscle loss, is highly prevalent and more severe in sarcopenic and osteoporotic subjects. Clinically, when individuals suffer a combination of both disorders, negative outcomes such as falls, fractures, loss of function, frailty, and mortality increase, thus generating significant personal and socio-economic costs. Therefore, it is suggested that when bone mineral density loss is synchronic with decreased muscle mass, strength, and function, it should be interpreted as a single diagnosis of osteosarcopenia, which may be preventable and treatable. Simple interventions such as resistance training, adequate protein and calcium dietary intake, associated with maintenance of appropriate levels of vitamin D, have a dual positive effect on bone and muscle, reducing falls, fractures, and, consequently, disability. It is essential that fracture prevention approaches-including postfracture management-involve assessment and treatment of both osteoporosis and sarcopenia. This is of particular importance as in older persons the combination of osteopenia/osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. This review summarizes osteosarcopenia epidemiology, pathophysiology, diagnosis, outcomes, and management strategies.
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            Osteoporosis and sarcopenia: two diseases or one?

            Purpose of review This article reviews recently published evidence for common pathways explaining bone and muscle wasting in normal ageing and pathological conditions. Recent findings Numerous studies support the concept of a bone–muscle unit, where constant cross-talking between the two tissues takes place, involving molecules released by the skeletal muscle secretome, which affects bone, and osteokines secreted by the osteoblasts and osteocytes, which, in turn, impact muscle cells. Summary New chemical entities aiming at concomitantly treating osteoporosis and sarcopenia could be developed by targeting pathways that centrally regulate bone and muscle or emerging pathways that facilitate the communication between the two tissues.
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              Prevention and management of osteoporosis.

              (2003)
              Bone is hard tissue that is in a constant state of flux, being built up by bone-forming cells called osteoblasts while also being broken down or resorbed by cells known as osteoclasts. During childhood and adolescence, bone formation is dominant; bone length and girth increase with age, ending at early adulthood when peak bone mass is attained. Males generally exhibit a longer growth period, resulting in bones of greater size and overall strength. In males after the age of 20, bone resorbtion becomes predominant, and bone mineral content declines about 4% per decade. Females tend to maintain peak mineral content until menopause, after which time it declines about 15% per decade. Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist. Osteoporosis occurs primarily as a result of normal ageing, but can arise as a result of impaired development of peak bone mass (e.g. due to delayed puberty or undernutrition) or excessive bone loss during adulthood (e.g. due to estrogen deficiency in women, undernutrition, or corticosteroid use). Osteoporosis-induced fractures cause a great burden to society. Hip fractures are the most serious, as they nearly always result in hospitalization, are fatal about 20% of the time, and produce permanent disability about half the time. Fracture rates increase rapidly with age and the lifetime risk of fracture in 50 year-old women is about 40%, similar to that for coronary heart disease. In 1990, there were 1.7 million hip fractures alone worldwide; with changes in population demographics, this figure is expected to rise to 6 million by 2050. To help describe the nature and consequences of osteoporosis, as well as strategies for its prevention and management, a WHO Scientific Group meeting of international experts was held in Geneva, which resulted in this technical report. This monograph describes in detail normal bone development and the causes and risk factors for developing osteoporosis. The burden of osteoporosis is characterized in terms of mortality, morbidity, and economic costs. Methods for its prevention and treatment are discussed in detail for both pharmacological and non-pharmacological approaches. For each approach, the strength of the scientific evidence is presented. The report also provides cost-analysis information for potential interventions, and discusses important aspects of developing national policies to deal with osteoporosis. Recommendations are made to the general population, care providers, health administrators, and researchers. Lastly, national organizations and support groups are listed by country.
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                Author and article information

                Contributors
                +43-4483-56201 , j.reiss@salk.at
                Journal
                Z Gerontol Geriatr
                Z Gerontol Geriatr
                Zeitschrift Fur Gerontologie Und Geriatrie
                Springer Medizin (Heidelberg )
                0948-6704
                1435-1269
                2 May 2019
                2 May 2019
                2019
                : 52
                : 7
                : 688-693
                Affiliations
                [1 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Geriatric Medicine, Christian-Doppler-Klinik, , Paracelsus Medical University Salzburg, ; Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
                [2 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Endocrinology and Nuclear Medicine, Landeskrankenhaus, , Paracelsus Medical University Salzburg, ; Müllner Hauptstraße 48, 5020 Salzburg, Austria
                [3 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Clinical Nutrition, Christian-Doppler-Klinik, , Paracelsus Medical University Salzburg, ; Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
                [4 ]Salzkammergut-Klinikum Gmunden, Miller-von-Aichholz-Straße 49, 4810 Gmunden, Austria
                Article
                1553
                10.1007/s00391-019-01553-z
                6817738
                31049683
                34f0358e-3d88-4856-bf70-3a2d9685b2ca
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 14 May 2018
                : 9 December 2018
                : 12 April 2019
                Funding
                Funded by: Paracelsus Medical University
                Categories
                Original Contribution
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

                osteosarcopenia,muscle-bone-unit,bone-muscle-continuum,sarco-osteoporosis,osteosarkopenie,muskel-knochen-einheit,knochen-muskel-kontinuum,sarkoosteoporose

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