Non-Pharmacological Interventions in Osteosarcopenia: A Systematic Review

Area of Science:

• Geriatric Medicine
• Bone and Muscle Health
• Exercise Physiology

Background:

• Osteosarcopenia is a geriatric syndrome characterized by concurrent bone loss (osteopenia/osteoporosis) and muscle loss (sarcopenia).
• This condition significantly elevates the risk of falls, fractures, and mortality in older adults.
• Current research lacks comprehensive understanding of effective non-pharmacological interventions for osteosarcopenia.

Purpose of the Study:

• To evaluate the efficacy of non-pharmacological interventions, specifically exercise and nutritional strategies, on musculoskeletal outcomes in adults with osteosarcopenia.
• To synthesize findings from randomized controlled trials (RCTs) to inform clinical practice and future research directions.

Main Methods:

• A systematic review of RCTs was conducted, adhering to PRISMA guidelines and registered with PROSPERO (CRD42020179292).
• Searched electronic databases for RCTs investigating exercise and/or nutritional supplementation (protein, vitamin D, calcium, creatine) in adults with osteosarcopenia.
• Included studies assessed musculoskeletal measures such as bone mineral density (BMD), bone strength, muscle mass/strength, physical performance, and falls/fractures.

Main Results:

• Two RCTs involving 106 older adults with osteosarcopenia met the inclusion criteria, focusing on progressive resistance training (RT).
• Moderate-quality evidence indicates RT enhances muscle mass, strength, and quality, with strength and quality improvements preceding muscle mass gains.
• Low-quality evidence suggests RT may increase lumbar spine BMD and maintain hip BMD, with no significant effect on bone turnover or physical performance.

Conclusions:

• Chronic progressive resistance training (RT) is a safe and effective intervention for older adults with osteosarcopenia, promoting muscle and bone health.
• RT demonstrates efficacy in increasing muscle mass, strength, and quality, alongside improvements in bone mineral density (BMD).
• Further research is needed to investigate the impact of nutritional interventions like protein, vitamin D, calcium, or creatine in this high-risk population.