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Osteosarcopenia: where bone, muscle, and fat collide

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Abstract

As the world’s population ages, the prevalence of chronic diseases increases. Sarcopenia and osteoporosis are two conditions that are associated with aging, with similar risk factors that include genetics, endocrine function, and mechanical factors. Additionally, bone and muscle closely interact with each other not only anatomically, but also chemically and metabolically. Fat infiltration, a phenomenon observed in age-related bone and muscle loss, is highly prevalent and more severe in sarcopenic and osteoporotic subjects. Clinically, when individuals suffer a combination of both disorders, negative outcomes such as falls, fractures, loss of function, frailty, and mortality increase, thus generating significant personal and socio-economic costs. Therefore, it is suggested that when bone mineral density loss is synchronic with decreased muscle mass, strength, and function, it should be interpreted as a single diagnosis of osteosarcopenia, which may be preventable and treatable. Simple interventions such as resistance training, adequate protein and calcium dietary intake, associated with maintenance of appropriate levels of vitamin D, have a dual positive effect on bone and muscle, reducing falls, fractures, and, consequently, disability. It is essential that fracture prevention approaches—including postfracture management—involve assessment and treatment of both osteoporosis and sarcopenia. This is of particular importance as in older persons the combination of osteopenia/osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. This review summarizes osteosarcopenia epidemiology, pathophysiology, diagnosis, outcomes, and management strategies.

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Authors and Affiliations

  1. Department of Geriatrics and Gerontology, Federal University of São Paulo, 1500 Sena Madureira Avenue, São Paulo, Brazil

    H. P. Hirschfeld

  2. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3 WCHRE Building, 176 Furlong Road, St. Albans, VIC, 3021, Australia

    R. Kinsella & G. Duque

  3. Department of Medicine, Melbourne Medical School - Western Health, The University of Melbourne, St. Albans, VIC, 3021, Australia

    G. Duque

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Hirschfeld, H.P., Kinsella, R. & Duque, G. Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 28, 2781–2790 (2017). https://doi.org/10.1007/s00198-017-4151-8

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