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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/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. © 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)..
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.
3434a7e2-291f-44cd-bd8a-7dde0a13b0ab
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
ce487fb4-d360-4aac-9d17-9466d6cba145
Orwoll, Eric
65da4e11-2b2e-44fa-9a56-f60aac992f19
Kwok, Timothy
88a3ef90-93a0-4d8a-9c87-9a4945f307c5
Karlsson, Magnus
85188a16-227b-4a86-a4cc-7b222ca26c5c
Rosengren, Bjorn E.
3434a7e2-291f-44cd-bd8a-7dde0a13b0ab
Ribom, Eva
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Cauley, Jane A.
fbc60b0d-09fd-445d-83df-b61521bcf775
Cawthon, Peggy M.
135b12d2-41a8-4a6d-bd42-a484b930b286
Ensrud, Kristine
827f9bd5-65d5-4382-a4bd-081d81f89ae6
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Cruz-Jentoft, Alfonso Jose
bd1054e6-e6b7-4f15-856b-a3de3887064d
Fielding, Roger A.
36b26592-ce59-4443-ab26-185919da78c0
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Ohlsson, Claes
98168752-6ef1-40c6-b873-9361cc99358b
Mellström, Dan
178bfc48-331d-4dec-bda0-45e72d303f6e
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
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/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. © 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)..

Text
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
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

Catalogue record

Date deposited: 26 Mar 2021 17:30
Last modified: 26 Nov 2021 02:48

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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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