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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

Sarcopenia definitions as predictors of fracture risk independent of FRAX, falls and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A meta-analysis
Sarcopenia definitions as predictors of fracture risk independent of FRAX, falls and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A meta-analysis

Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height 2 (ALM/ht 2) 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/ht 2 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 2), 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.

EPIDEMIOLOGY, FALLS, FRACTURE, FRAX, INTERACTION, OSTEOPOROSIS, SARCOPENIA
0884-0431
1235-1244
Harvey, Nicholas
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Orwoll, Eric
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Kwok, Timothy
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Karlsson, Magnus
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Rosengren, Bjorn E.
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Ribom, Eva
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Cauley, Jane A.
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Cawthon, Peggy M.
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Ensrud, Kristine
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Liu, Enwu
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Cruz-Jentoft, Alfonso Jose
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Fielding, Roger A.
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Cooper, Cyrus
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Kanis, John A.
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Lorentzon, Mattias
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Ohlsson, Claes
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Mellström, Dan
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Johansson, Helena
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McCloskey, E.V.
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Harvey, Nicholas
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Orwoll, Eric
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Kwok, Timothy
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Karlsson, Magnus
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Rosengren, Bjorn E.
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Ribom, Eva
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Cauley, Jane A.
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Cawthon, Peggy M.
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Ensrud, Kristine
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Liu, Enwu
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Cruz-Jentoft, Alfonso Jose
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Fielding, Roger A.
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Cooper, Cyrus
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Kanis, John A.
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Lorentzon, Mattias
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Ohlsson, Claes
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Mellström, Dan
178bfc48-331d-4dec-bda0-45e72d303f6e
Johansson, Helena
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McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de

Harvey, Nicholas, Orwoll, Eric, Kwok, Timothy, Karlsson, Magnus, Rosengren, Bjorn E., Ribom, Eva, Cauley, Jane A., Cawthon, Peggy M., Ensrud, Kristine, Liu, Enwu, Cruz-Jentoft, Alfonso Jose, Fielding, Roger A., Cooper, Cyrus, Kanis, John A., Lorentzon, Mattias, Ohlsson, Claes, Mellström, Dan, Johansson, Helena and McCloskey, E.V. (2021) Sarcopenia definitions as predictors of fracture risk independent of FRAX, falls and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A meta-analysis. Journal of Bone and Mineral Research, 36 (7), 1235-1244. (doi:10.1002/jbmr.4293).

Record type: Article

Abstract

Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height 2 (ALM/ht 2) 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/ht 2 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 2), 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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nch MrOS sarco defn 2021_03_01 R1 - Accepted Manuscript
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Accepted/In Press date: 16 March 2021
e-pub ahead of print date: 8 April 2021
Published date: July 2021
Additional Information: Funding Information: We thank the participants of MrOs US, Sweden, and Hong Kong. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. MrOS Sweden is supported by the Swedish Research Council, ALF/LUA research grants in Gothenburg, and the King Gustav V and Queen Victoria Frimurarestiftelse Research Foundation. The work was also supported by the UK Medical Research Council (4050502589 [MRC LEU]). RAF is supported by the US Department of Agriculture (USDA), under agreement No. 58‐1950‐4‐003. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the USDA. Publisher Copyright: © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Keywords: EPIDEMIOLOGY, FALLS, FRACTURE, FRAX, INTERACTION, OSTEOPOROSIS, SARCOPENIA

Identifiers

Local EPrints ID: 447923
URI: http://eprints.soton.ac.uk/id/eprint/447923
ISSN: 0884-0431
PURE UUID: 194fb4b6-4286-4fec-90df-d5da35dd581f
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 26 Mar 2021 17:30
Last modified: 18 Mar 2024 05:05

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Contributors

Author: Nicholas Harvey ORCID iD
Author: Eric Orwoll
Author: Timothy Kwok
Author: Magnus Karlsson
Author: Bjorn E. Rosengren
Author: Eva Ribom
Author: Jane A. Cauley
Author: Peggy M. Cawthon
Author: Kristine Ensrud
Author: Enwu Liu
Author: Alfonso Jose Cruz-Jentoft
Author: Roger A. Fielding
Author: Cyrus Cooper ORCID iD
Author: John A. Kanis
Author: Mattias Lorentzon
Author: Claes Ohlsson
Author: Dan Mellström
Author: Helena Johansson
Author: E.V. McCloskey

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