It is known that elderly individuals with sarcopenia are at a greater risk of falling and bone fractures. However, there are no universally accepted criteria for diagnosing these individuals, and consequently no consistent way to identify those at risk for these injuries.
According to research published in Calcified Tissue International, the best definition for diagnosing those with the condition and therefore identifying those at risk for falling and bone fractures may be the International Working Group on Sarcopenia (IWGS) definition.
To determine which definition would most accurately diagnose sarcopenia, and predict falls and bone fractures, Michael Clynes, MD, PhD, from the MRC Lifecourse Epidemiology Unit at the University of Southamptom, UK and colleagues assessed 156 men with a mean (SD) age of 76.0 (2.54) years and 142 women with a mean age of 76.2 (2.60) years according to three sarcopenia definitions — including the European Working Group for Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS), and the Foundation for the National Institutes of Health Sarcopenia Project (FNIH).
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They also assessed participants with a system recently developed to diagnose “dysmobility syndrome,” which is an attempt to combine adverse musculoskeletal phenotypes, including sarcopenia and osteoporosis, to identify those most at risk for falls and fractures.
The researchers measured body composition and areal bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA), determined the participants’ gait speed with a 3 meter walk test, and assessed grip strength with a Jamar hand-held dynamometer. They acquired detailed falls and fracture history with questionnaires.
According to the various sarcopenia definitions, 3.3% of participants had sarcopenia with the EWGSOP definition, 8.3% had sarcopenia with the IWGS definition, and 2.0% had sarcopenia with the FNIH definition. Twenty-four percent of participants had dysmobility syndrome.
Those with dysmobility syndrome reported a significantly higher number of falls than those without it, but they did not report a higher rate of bone fractures. Those diagnosed with sarcopenia according to the IWGS definition reported significantly higher numbers of falls in the last year as well as fractures (falls in the last year: OR 2.51 CI 1.09, 5.81 p=0.03; fractures OR 2.50 CI 1.05, 5.92 p=0.04). These significant associations were not seen with the EWGSOP definition.
“The IWGS definition of sarcopenia appears to be an effective means of identifying individuals at risk of adverse musculoskeletal events, such as falls and fracture,” said Dr. Clynes in a press release. “The findings enable us to more effectively predict those at increased risk of falls and fractures. By defining sarcopenia, health care professionals can target treatment to at-risk individuals.”
Although the researchers have demonstrated the IWGS diagnostic criteria to be an effective way of diagnosing sarcopenia and identifying those at risk for falls and bone fractures, they note that the EWGSOP may also be shown as effective in a larger study example. Further research is needed to assess these sarcopenia definitions and dysmobility syndrome before clinical implications can be fully appreciated.
Disclosures: Cyrus Cooper, FMedSci, has received consultancy fees and honoraria from Servier, Eli Lilly, Merck, Amgen, Alliance, Novartis, Medtronic, GSK, and Roche. Bjoern Buehring, MD, has received grants from Lilly, Extendicare Foundation, and GE Healthcare. Elaine Dennsion, MD, PhD, has received speaking fees from Lilly.
Clynes MA, Edwards MH, Buehring B, et al. Definitions of Sarcopenia: Associations with Previous Falls and Fracture in a Population Sample. Calcif Tissue Int. 2015; doi:10.1007/s00223-015-0044-z.