Ferrucci L, Baroni M, Ranchelli A, Lauretani F, Maggio M, Mecocci P, Ruggiero C
Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Andrea delle Fratte, 06100, Perugia, Italy.
Curr Pharm Des. 2014;20(19):3178-97. doi: 10.2174/13816128113196660690.
Aging is associated with a progressive loss of bone-muscle mass and strength. When the decline in mass and strength reaches critical thresholds associated with adverse health outcomes, they are operationally considered geriatric conditions and named, respectively, osteoporosis and sarcopenia. Osteoporosis and sarcopenia share many of the same risk factors and both directly or indirectly cause higher risk of mobility limitations, falls, fractures and disability in activities of daily living. This is not surprising since bones adapt their morphology and strength to the long-term loads exerted by muscle during anti-gravitational and physical activities. Non-mechanical systemic and local factors also modulate the mechanostat effect of muscle on bone by affecting the bidirectional osteocyte-muscle crosstalk, but the specific pathways that regulate these homeostatic mechanisms are not fully understood. More research is required to reach a consensus on cut points in bone and muscle parameters that identify individuals at high risk for adverse health outcomes, including falls, fractures and disability. A better understanding of the muscle-bone physiological interaction may help to develop preventive strategies that reduce the burden of musculoskeletal diseases, the consequent disability in older persons and to limit the financial burden associated with such conditions. In this review, we summarize age-related bone-muscle changes focusing on the biomechanical and homeostatic mechanisms that explain bone-muscle interaction and we speculate about possible pathological events that occur when these mechanisms become impaired. We also report some recent definitions of osteoporosis and sarcopenia that have emerged in the literature and their implications in clinical practice. Finally, we outline the current evidence for the efficacy of available anti-osteoporotic and proposed antisarcopenic interventions in older persons.
衰老与骨肌肉质量和力量的逐渐丧失有关。当质量和力量的下降达到与不良健康结果相关的临界阈值时，它们在临床上被视为老年病症，分别称为骨质疏松症和肌肉减少症。骨质疏松症和肌肉减少症有许多相同的风险因素，并且都直接或间接导致更高的活动受限、跌倒、骨折和日常生活活动能力丧失的风险。这并不奇怪，因为骨骼会根据肌肉在抗重力和体育活动中施加的长期负荷来调整其形态和强度。非机械性的全身和局部因素也通过影响骨细胞与肌肉的双向串扰来调节肌肉对骨骼的机械稳态效应，但调节这些稳态机制的具体途径尚未完全了解。需要更多的研究来就骨骼和肌肉参数的切点达成共识，这些切点可识别出具有不良健康结果高风险的个体，包括跌倒、骨折和残疾。更好地理解肌肉与骨骼的生理相互作用可能有助于制定预防策略，以减轻肌肉骨骼疾病的负担、老年人随之而来的残疾，并限制与此类疾病相关的经济负担。在这篇综述中，我们总结了与年龄相关的骨肌肉变化，重点关注解释骨肌肉相互作用的生物力学和稳态机制，并推测当这些机制受损时可能发生的病理事件。我们还报告了文献中出现的骨质疏松症和肌肉减少症的一些最新定义及其在临床实践中的意义。最后，我们概述了目前关于现有抗骨质疏松药物和拟议的抗肌肉减少症干预措施对老年人疗效的证据。
