Prevalence of osteosarcopenia in postmenopausal women: a systematic review and meta-analysis

Osteosarcopenia (OSP) is defined as the coexistence of osteoporosis (OP) and sarcopenia (SP), and is associated with increased risks of falls, fractures, and frailty. Postmenopausal women are particularly susceptible due to estrogen deficiency, however, its overall prevalence in this population remains unclear.

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251142908). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to 15 October 2025. Eligible studies reported OSP prevalence (or data enabling its calculation) in postmenopausal women, with OP and SP defined by recognized criteria (WHO, EWGSOP, AWGS or equivalents). Two reviewers independently performed study selection, data extraction, and quality assessment using the JBI checklist. Pooled prevalence was estimated using generalized linear mixed models and random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity, influence analyses, publication bias, and exploratory subgroup analyses by diagnostic criteria, economic level, geographic region, and population source were conducted. Meta-regression evaluated the effect of mean age.

Sixteen studies involving 7,631 postmenopausal women and 1,421 OSP cases were included. The pooled prevalence of OSP was 15.6% (95% CI: 9.6-24.3%; I²=97.1%). Using consistent criteria, prevalence was 20.1% (95% CI: 10.7-34.4%) for WHO + AWGS 2019 and 12.7% (95% CI: 2.3-47.5%) for WHO + EWGSOP 2018. Exploratory subgroup analyses showed higher prevalence estimates in developing versus developed regions (18.0% vs. 12.7%), Asian versus non-Asian countries (18.7% vs. 8.2%), and hospital-based versus community-based populations (26.4% vs. 8.7%). No significant study-level association between mean age and OSP prevalence was observed in meta-regression analyses based on the 14 studies with available mean age data. Most studies were of high quality, and no significant publication bias was detected.

This meta-analysis found a pooled OSP prevalence of 15.6% among postmenopausal women across included studies. Given high heterogeneity, this estimate should be interpreted with caution, as it reflects diverse settings and diagnostic approaches. Exploratory subgroup analyses suggested higher prevalence in developing regions, Asian populations, and hospital‑based settings. Standardized criteria and integrated bone‑muscle assessment may improve early identification and management of OSP in this high-risk population.