Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis

Age-related loss of muscle and bone (sarcopenia and osteoporosis), increases the risk of falls and fractures and consequently leads to a substantial economic burden for the society. The combined condition, osteosarcopenia, may identify patients at a higher risk of those outcomes and could be relevant for assessment and treatment in clinical practice.

To evaluate the current knowledge of the prevalence of osteosarcopenia and the fracture risk in older people.

A systematic literature review was conducted until 10th March 2018. A total of 1105 papers were detected, whereof 1049 and 29 were excluded by title/abstracts and full-text assessment, respectively. Twenty-seven original papers were included in the systematic review, whereof 17 were suitable for meta-analysis.

The prevalence of osteosarcopenia varied (5-37%) depending on the classification of sarcopenia and whether participants were classified initially according to sarcopenia or osteoporosis. In patients with low-energy osteoporotic fractures, sarcopenia was present in 7.8-58% and 1.3-96.3% of the cases, women and men, respectively. The meta-analysis of prevalence of sarcopenia in patients with low-energy fracture (n = 9) was 46% (95% CI 44, 48; p < 0.001). The relative risk of fracture (sarcopenic versus non-sarcopenic) in meta-analysis of four studies was 1.37 (95% CI 1.18, 1.59; p < 0.001). Mean bone mineral density (n = 5) and T-score (n = 3) of femoral neck was significantly lower in sarcopenic participants [- 0.07 g/cm² (95% CI 0.08, 0.06) and - 0.34 (95% CI - 0.46, - 0.23), respectively].

Osteosarcopenia is frequent and the relative risk of fracture is higher among sarcopenic patients. A standard and strict classification of sarcopenia is needed to assess its true relationship and consequences.