Department of Geriatrics and Gerontology, Federal University of São Paulo, 1500 Sena Madureira Avenue, São Paulo, Brazil.
Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3 WCHRE Building, 176 Furlong Road, St. Albans, VIC, 3021, Australia.
Osteoporos Int. 2017 Oct;28(10):2781-2790. doi: 10.1007/s00198-017-4151-8. Epub 2017 Jul 22.
As the world's population ages, the prevalence of chronic diseases increases. Sarcopenia and osteoporosis are two conditions that are associated with aging, with similar risk factors that include genetics, endocrine function, and mechanical factors. Additionally, bone and muscle closely interact with each other not only anatomically, but also chemically and metabolically. Fat infiltration, a phenomenon observed in age-related bone and muscle loss, is highly prevalent and more severe in sarcopenic and osteoporotic subjects. Clinically, when individuals suffer a combination of both disorders, negative outcomes such as falls, fractures, loss of function, frailty, and mortality increase, thus generating significant personal and socio-economic costs. Therefore, it is suggested that when bone mineral density loss is synchronic with decreased muscle mass, strength, and function, it should be interpreted as a single diagnosis of osteosarcopenia, which may be preventable and treatable. Simple interventions such as resistance training, adequate protein and calcium dietary intake, associated with maintenance of appropriate levels of vitamin D, have a dual positive effect on bone and muscle, reducing falls, fractures, and, consequently, disability. It is essential that fracture prevention approaches-including postfracture management-involve assessment and treatment of both osteoporosis and sarcopenia. This is of particular importance as in older persons the combination of osteopenia/osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. This review summarizes osteosarcopenia epidemiology, pathophysiology, diagnosis, outcomes, and management strategies.
随着世界人口老龄化，慢性病的患病率不断上升。肌少症和骨质疏松症是与衰老相关的两种病症，具有相似的风险因素，包括遗传、内分泌功能和机械因素。此外，骨骼和肌肉不仅在解剖学上相互作用，而且在化学和代谢上也相互作用。脂肪浸润是一种与年龄相关的骨骼和肌肉丧失有关的现象，在肌少症和骨质疏松症患者中非常普遍，而且更为严重。临床上，当个体同时患有这两种疾病时，跌倒、骨折、功能丧失、虚弱和死亡等负面后果会增加，从而产生重大的个人和社会经济成本。因此，建议当骨矿物质密度下降与肌肉质量、力量和功能下降同时发生时，应将其解释为一种单一的诊断，即骨质疏松-肌少症，这种疾病可能是可以预防和治疗的。简单的干预措施，如抗阻训练、充足的蛋白质和钙的饮食摄入，以及适当水平的维生素 D 的维持，对骨骼和肌肉都有双重积极作用，可以降低跌倒、骨折的风险，从而减少残疾。骨折预防方法（包括骨折后的管理）必须包括对骨质疏松症和肌少症的评估和治疗。这一点尤其重要，因为在老年人中，骨量减少/骨质疏松症和肌少症的组合已被提议作为更易发生机构化、跌倒和骨折的脆弱个体的一个亚组。本综述总结了骨质疏松-肌少症的流行病学、病理生理学、诊断、结局和管理策略。
