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Sarcopenia, Osteoporosis and the Burden of Prevalent Vertebral Fractures: A Cross-Sectional Study of 350 Women With Hip Fracture

Marco Di Monaco 1, Carlotta Castiglioni 2, Francesca Bardesono 3, Edoardo Milano 2, Giuseppe Massazza 3

DOI: 10.23736/S1973-9087.20.05991-2

Abstract
Background: The concurrent presence of sarcopenia and osteoporosis may enhance fracture risk.

Aim: To evaluate the association between sarcopenia, osteoporosis, or the concurrent presence of both the conditions (osteosarcopenia) and the burden (number and severity) of vertebral fractures in women with hip fracture.

Design: Cross-sectional study.

Population: We studied 350 women with subacute hip fracture.

Methods: Lateral radiographs of the spine were taken 18.2±4.5 days after fracture occurrence and the spine deformity index (SDI) was calculated. Body composition was assessed by dual-energy x-ray absorptiometry. Low muscle mass was identified with appendicular lean mass <15.02 kg and low bone mineral density with a femoral T-score <-2.5. Results: The presence of sarcopenia (P=0.033) and osteoporosis (P=0.032) was associated with the SDI scores independently of each other and independently of age, percentage of body fat and hip-fracture type. The 350 women were categorized into 3 groups according to the absence of both osteoporosis and sarcopenia (N=25), presence of either osteoporosis or sarcopenia (N=95) or presence of osteosarcopenia (N=230). We found a significant difference in SDI scores across the 3 groups: x² (2, N=350) = 15.29; P<0.001. The categorization of the 350 women into the 3 groups was associated with the SDI scores (P=0.001) independently of age, percentage of body fat and hip-fracture type. Conclusions: Both osteoporosis and sarcopenia were independently associated with the burden of prevalent vertebral fractures in women with hip fracture. The concurrent presence of sarcopenia and osteoporosis was associated with a higher SDI score than the presence of only one of the 2 conditions. Clinical rehabilitation impact: Subjects with both low bone mass and low muscle mass should be considered at particularly high risk for vertebral fractures. Interventions targeting both the components of the muscle-bone unit, including exercise, nutrition, and possibly new medications, should be investigated to optimize fracture prevention.