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Determinants of muscle density and clinical outcomes: findings from the Hertfordshire Cohort Study

Determinants of muscle density and clinical outcomes: findings from the Hertfordshire Cohort Study
Determinants of muscle density and clinical outcomes: findings from the Hertfordshire Cohort Study

Purpose: the age-related loss of skeletal muscle mass and strength is associated with adverse health outcomes. However, to date, peripheral quantitative computed tomography (pQCT)-derived muscle density has been little studied. We used a well characterised cohort of older adults to identify lifestyle and anthropometric determinants of pQCT-derived muscle density measured 11 years later, and to report relationships between pQCT-derived muscle density with history of falls and prevalent fractures. 

Methods: a lifestyle questionnaire was administered to 197 men and 178 women, aged 59–70 at baseline. After a median of 11.5 (IQR 10.9, 12.3) years, pQCT (Stratec XCT2000) of the radius and tibia was performed to measure forearm muscle density (FMD) and calf muscle density (CMD). Presence of falls and fractures since the age of 45 were determined through participant recall; vertebral fractures were also ascertained through vertebral fracture assessment using iDXA. Total hip BMD (TH aBMD) was assessed using DXA. Baseline characteristics in relation to muscle density at follow-up were examined using linear regression; associations between muscle density and prior falls and fractures were investigated using logistic regression. All analyses were adjusted for sex and age. 

Results: mean (SD) age at muscle density measurement was 76.3 (2.6) years. Mean (SD) FMD was 79.9 (3.1) and 77.2 (3.2) among males and females, respectively; CMD was 80.7 (2.6) and 78.5 (2.6) among males and females, respectively. Significant sex-differences in muscle density were observed at each site (p < 0.001). Female sex, lower weight, and lower body mass index were associated (p < 0.05) with both lower FMD and CMD. Additional correlates of lower CMD included older age and shorter stature. Lifestyle measures were not associated with muscle density in this cohort. Lower FMD was related to increased risk of previous fracture (odds ratio (95 % CI) per SD lower FMD: 1.42 (1.07, 1.89), p = 0.015) but not after adjustment for TH aBMD (p > 0.08). No significant relationships were seen between muscle density and falls. 

Conclusion: female sex, older age, and lower BMI were associated with subsequent lower muscle density in older community-dwelling adults. Lower FMD was related to increased risk of previous fracture. Changes in muscle density over time might precede adverse outcomes such as falls and fractures and may be a long-term predictor of frailty. It could be also suggested that muscle density could be a more clinically meaningful surrogate of functional decline and disability than muscle size or mass, but more studies are needed to support this notion.

Determinants, Fall, Fracture, Muscle density, Peripheral quantitative computed tomography
8756-3282
Laskou, Faidra
3959d6e2-ccfa-4d97-8311-16f27b893365
Westbury, Leo
5ed45df3-3df7-4bf9-bbad-07b63cd4b281
Fuggle, Nicholas
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Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Patel, Harnish
a1b095f6-0fe3-427a-b6fb-6247bd63f39c
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Ward, Kate
39bd4db1-c948-4e32-930e-7bec8deb54c7
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1
Laskou, Faidra
3959d6e2-ccfa-4d97-8311-16f27b893365
Westbury, Leo
5ed45df3-3df7-4bf9-bbad-07b63cd4b281
Fuggle, Nicholas
9ab0c81a-ac67-41c4-8860-23e0fdb1a900
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Patel, Harnish
a1b095f6-0fe3-427a-b6fb-6247bd63f39c
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Ward, Kate
39bd4db1-c948-4e32-930e-7bec8deb54c7
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1

Laskou, Faidra, Westbury, Leo, Fuggle, Nicholas, Harvey, Nicholas, Patel, Harnish, Cooper, Cyrus, Ward, Kate and Dennison, Elaine (2022) Determinants of muscle density and clinical outcomes: findings from the Hertfordshire Cohort Study. Bone, 164, [116521]. (doi:10.1016/j.bone.2022.116521).

Record type: Article

Abstract

Purpose: the age-related loss of skeletal muscle mass and strength is associated with adverse health outcomes. However, to date, peripheral quantitative computed tomography (pQCT)-derived muscle density has been little studied. We used a well characterised cohort of older adults to identify lifestyle and anthropometric determinants of pQCT-derived muscle density measured 11 years later, and to report relationships between pQCT-derived muscle density with history of falls and prevalent fractures. 

Methods: a lifestyle questionnaire was administered to 197 men and 178 women, aged 59–70 at baseline. After a median of 11.5 (IQR 10.9, 12.3) years, pQCT (Stratec XCT2000) of the radius and tibia was performed to measure forearm muscle density (FMD) and calf muscle density (CMD). Presence of falls and fractures since the age of 45 were determined through participant recall; vertebral fractures were also ascertained through vertebral fracture assessment using iDXA. Total hip BMD (TH aBMD) was assessed using DXA. Baseline characteristics in relation to muscle density at follow-up were examined using linear regression; associations between muscle density and prior falls and fractures were investigated using logistic regression. All analyses were adjusted for sex and age. 

Results: mean (SD) age at muscle density measurement was 76.3 (2.6) years. Mean (SD) FMD was 79.9 (3.1) and 77.2 (3.2) among males and females, respectively; CMD was 80.7 (2.6) and 78.5 (2.6) among males and females, respectively. Significant sex-differences in muscle density were observed at each site (p < 0.001). Female sex, lower weight, and lower body mass index were associated (p < 0.05) with both lower FMD and CMD. Additional correlates of lower CMD included older age and shorter stature. Lifestyle measures were not associated with muscle density in this cohort. Lower FMD was related to increased risk of previous fracture (odds ratio (95 % CI) per SD lower FMD: 1.42 (1.07, 1.89), p = 0.015) but not after adjustment for TH aBMD (p > 0.08). No significant relationships were seen between muscle density and falls. 

Conclusion: female sex, older age, and lower BMI were associated with subsequent lower muscle density in older community-dwelling adults. Lower FMD was related to increased risk of previous fracture. Changes in muscle density over time might precede adverse outcomes such as falls and fractures and may be a long-term predictor of frailty. It could be also suggested that muscle density could be a more clinically meaningful surrogate of functional decline and disability than muscle size or mass, but more studies are needed to support this notion.

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Accepted/In Press date: 12 August 2022
e-pub ahead of print date: 17 August 2022
Published date: November 2022
Additional Information: Funding Information: CC, EMD and NCH acknowledge funding from the UK Medical Research Council ( MC_PC_21003 ; MC_PC_21001 ). Funding Information: All study participants provided written informed consent and ethical approval was obtained from the Hertfordshire Research Ethics Committee (reference 07/MRE01/30). The baseline Hertfordshire Cohort Study had ethical approval from the Hertfordshire and Bedfordshire Local Research Ethics Committee and the follow-up had ethical approval from the East and North Hertfordshire Ethical Committees. FL and HPP are supported by the NIHR Southampton Biomedical Research Centre and the University of Southampton. This report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. These funding bodies had no role in writing of the manuscript or decision to submit for publication. NRF is supported by Dunhill Medical Trust. CC, EMD and NCH acknowledge funding from the UK Medical Research Council (MC_PC_21003; MC_PC_21001). Funding Information: FL and HPP are supported by the NIHR Southampton Biomedical Research Centre and the University of Southampton . This report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. These funding bodies had no role in writing of the manuscript or decision to submit for publication. Funding Information: NRF is supported by Dunhill Medical Trust . Publisher Copyright: © 2022 The Authors
Keywords: Determinants, Fall, Fracture, Muscle density, Peripheral quantitative computed tomography

Identifiers

Local EPrints ID: 470151
URI: http://eprints.soton.ac.uk/id/eprint/470151
ISSN: 8756-3282
PURE UUID: 405a6b30-76b6-4632-93d8-916e8f319216
ORCID for Faidra Laskou: ORCID iD orcid.org/0000-0002-8481-6343
ORCID for Leo Westbury: ORCID iD orcid.org/0009-0008-5853-8096
ORCID for Nicholas Fuggle: ORCID iD orcid.org/0000-0001-5463-2255
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Kate Ward: ORCID iD orcid.org/0000-0001-7034-6750
ORCID for Elaine Dennison: ORCID iD orcid.org/0000-0002-3048-4961

Catalogue record

Date deposited: 04 Oct 2022 16:37
Last modified: 20 Jan 2024 03:04

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Contributors

Author: Faidra Laskou ORCID iD
Author: Leo Westbury ORCID iD
Author: Nicholas Fuggle ORCID iD
Author: Nicholas Harvey ORCID iD
Author: Harnish Patel
Author: Cyrus Cooper ORCID iD
Author: Kate Ward ORCID iD
Author: Elaine Dennison ORCID iD

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