Lytras Aristides, Tolis George
Department of Endocrinology and Metabolism, Hippokrateion General Hospital, Athens, Greece.
Curr Opin Clin Nutr Metab Care. 2007 Sep;10(5):604-10. doi: 10.1097/MCO.0b013e3282cfa32f.
Bone loss and muscle wasting are associated with increased morbidity and mortality in the elderly, most frequently as a result of fractures associated with poor neuromuscular conditioning leading to accidental falls. This paper reviews data that link pathways of the immune and endocrine systems with bone and muscle pathophysiology, as well as data on the impact of nutrition and physical activity on these systems.
The growth hormone-insulin-like growth factor I axis and deficiencies in sex steroid hormones in aging appear linked with changes in the hypothalamic-pituitary-adrenal axis and immune function, accompanied by increased activity of the tumour necrosis factor-alpha axis. This is associated with activation of the RANK/RANKL/osteoprotegerin pathway and insulin resistance, affecting muscle and bone physiology. Vitamin D deficiency contributes to bone loss and muscle wasting, whereas other nutritional defects such as zinc or magnesium deficiencies may further complicate these catabolic states.
As nutritional deficiencies responsible for bone and muscle derangement are correctable factors, careful nutritional assessment, in addition to evaluation of endocrine and immune status, may provide clinically important information allowing successful management of elderly patients in danger of neuromuscular dysfunction, accidental falls and bone fractures.
骨质流失和肌肉萎缩与老年人发病率和死亡率增加相关，最常见的原因是与神经肌肉调节不良相关的骨折导致意外跌倒。本文综述了将免疫和内分泌系统途径与骨骼和肌肉病理生理学联系起来的数据，以及营养和体育活动对这些系统影响的数据。
衰老过程中生长激素 - 胰岛素样生长因子I轴以及性类固醇激素缺乏似乎与下丘脑 - 垂体 - 肾上腺轴变化和免疫功能有关，同时肿瘤坏死因子 - α轴活性增加。这与RANK/RANKL/骨保护素途径的激活和胰岛素抵抗相关，影响肌肉和骨骼生理。维生素D缺乏导致骨质流失和肌肉萎缩，而其他营养缺陷如锌或镁缺乏可能使这些分解代谢状态进一步复杂化。
由于导致骨骼和肌肉紊乱的营养缺乏是可纠正因素，除了评估内分泌和免疫状态外，仔细的营养评估可能提供重要的临床信息，从而成功管理有神经肌肉功能障碍、意外跌倒和骨折风险的老年患者。
