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Loss in DXA-estimated total body lean mass but not fat mass predicts incident major osteoporotic fracture and hip fracture independently from FRAX: A registry-based cohort study

Loss in DXA-estimated total body lean mass but not fat mass predicts incident major osteoporotic fracture and hip fracture independently from FRAX: A registry-based cohort study
Loss in DXA-estimated total body lean mass but not fat mass predicts incident major osteoporotic fracture and hip fracture independently from FRAX: A registry-based cohort study
Introduction Weight loss, and especially muscle loss, adversely affects skeletal health. The FRAX® tool considers baseline body mass index, but not body composition nor changes in its components over time. Our aim was to compare the independent associations between prior loss in DXA-estimated TBLM and TBFM and subsequent fracture risk. Methods We identified women and men age 40 years or older with two DXA assessments at least 1 year apart (median interval 3.3 years). TBLM and TBFM were estimated from weight, sex, and DXA of the spine and hip. Incident fractures and deaths were ascertained from linked population-based health service data after the date of the second DXA. Hazard ratios (HRs) from Cox regression models were used to study time to fracture from prior loss in TBLM and TBFM adjusted for FRAX-related covariates. Results The study population consisted of 9622 individuals (mean age 67 [SD 10] years, 95% female). We identified 692 subjects with incident major osteoporotic fracture [MOF] and 194 with hip fracture. Mean TBLM loss was significantly greater in those with incident MOF and hip fracture (P < 0.001) while TBFM loss was only significantly greater in those with incident hip fracture (P < 0.001). Each SD greater TBLM loss was associated with 10–13% increased MOF risk and 29–38% increased hip fracture risk, adjusted for TBFM loss and other covariates. Prior TBFM loss was not associated with fractures when adjusted for TBLM loss. Conclusions Prior loss in total body lean mass, but not in fat mass, is associated with increased fracture risk, particularly hip fracture, independent of other risk factors. This is consistent with the hypothesis that muscle loss (sarcopenia) adversely impacts skeletal health and fracture risk.
Body composition, Dual-energy x-ray absorptiometry, FRAX, Fractures, Osteoporosis, Sarcopenia
1862-3522
Leslie, William D.
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Schousboe, John T.
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Morin, Suzanne N.
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Martineau, Patrick
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Lix, Lisa M.
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Johansson, Helena
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McCloskey, Eugene V.
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Harvey, Nicholas
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Kanis, John A.
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Leslie, William D.
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Schousboe, John T.
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Morin, Suzanne N.
68489af8-f604-4f28-88e0-60add9fde4ae
Martineau, Patrick
dbd7ccec-32e2-4120-b7df-dc0c2504828a
Lix, Lisa M.
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Johansson, Helena
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McCloskey, Eugene V.
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Harvey, Nicholas
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Kanis, John A.
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Leslie, William D., Schousboe, John T., Morin, Suzanne N., Martineau, Patrick, Lix, Lisa M., Johansson, Helena, McCloskey, Eugene V., Harvey, Nicholas and Kanis, John A. (2020) Loss in DXA-estimated total body lean mass but not fat mass predicts incident major osteoporotic fracture and hip fracture independently from FRAX: A registry-based cohort study. Archives of Osteoporosis, 15 (1), [96].

Record type: Article

Abstract

Introduction Weight loss, and especially muscle loss, adversely affects skeletal health. The FRAX® tool considers baseline body mass index, but not body composition nor changes in its components over time. Our aim was to compare the independent associations between prior loss in DXA-estimated TBLM and TBFM and subsequent fracture risk. Methods We identified women and men age 40 years or older with two DXA assessments at least 1 year apart (median interval 3.3 years). TBLM and TBFM were estimated from weight, sex, and DXA of the spine and hip. Incident fractures and deaths were ascertained from linked population-based health service data after the date of the second DXA. Hazard ratios (HRs) from Cox regression models were used to study time to fracture from prior loss in TBLM and TBFM adjusted for FRAX-related covariates. Results The study population consisted of 9622 individuals (mean age 67 [SD 10] years, 95% female). We identified 692 subjects with incident major osteoporotic fracture [MOF] and 194 with hip fracture. Mean TBLM loss was significantly greater in those with incident MOF and hip fracture (P < 0.001) while TBFM loss was only significantly greater in those with incident hip fracture (P < 0.001). Each SD greater TBLM loss was associated with 10–13% increased MOF risk and 29–38% increased hip fracture risk, adjusted for TBFM loss and other covariates. Prior TBFM loss was not associated with fractures when adjusted for TBLM loss. Conclusions Prior loss in total body lean mass, but not in fat mass, is associated with increased fracture risk, particularly hip fracture, independent of other risk factors. This is consistent with the hypothesis that muscle loss (sarcopenia) adversely impacts skeletal health and fracture risk.

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More information

Accepted/In Press date: 1 June 2020
e-pub ahead of print date: 25 June 2020
Keywords: Body composition, Dual-energy x-ray absorptiometry, FRAX, Fractures, Osteoporosis, Sarcopenia

Identifiers

Local EPrints ID: 442280
URI: http://eprints.soton.ac.uk/id/eprint/442280
ISSN: 1862-3522
PURE UUID: e3366edf-be81-4d6d-a302-4687eccdb988
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 10 Jul 2020 16:31
Last modified: 26 Nov 2021 05:57

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Contributors

Author: William D. Leslie
Author: John T. Schousboe
Author: Suzanne N. Morin
Author: Patrick Martineau
Author: Lisa M. Lix
Author: Helena Johansson
Author: Eugene V. McCloskey
Author: Nicholas Harvey ORCID iD
Author: John A. Kanis

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