School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
Medical School, The University Western Australia, Perth, Western Australia, Australia.
Osteoporos Int. 2019 Jan;30(1):167-176. doi: 10.1007/s00198-018-4755-7. Epub 2018 Nov 19.
Numerous sarcopenia definitions are not associated with increased falls-related hospitalization risk over 5 years to 9.5 years in older community-dwelling Australian women. Measures of muscle strength and physical function, but not appendicular lean mass (measured by dual-energy X-ray absorptiometry) may help discriminate the risk of falls-related hospitalization.
The aim of this prospective, population-based cohort study of 903 Caucasian-Australian women (mean age 79.9 ± 2.6 years) was to compare the clinical utility of four sarcopenia definitions for the prediction of falls-related hospitalization over 9.5 years.
The four definitions were the United States Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP), and modified FNIH (AUS-POP) and EWGSOP (AUS-POP) definitions using Australian population-specific cut points (< 2 SD below the mean of young healthy Australian women). Components of sarcopenia including muscle strength, physical function, and appendicular lean mass (ALM) were quantified using hand grip strength, timed-up-and-go (TUG), and dual-energy X-ray absorptiometry (DXA), respectively. Incident 9.5-year falls-related hospitalization were captured by linked data.
Baseline prevalence of sarcopenia according to FNIH (9.4%), EWGSOP (24.1%), AUS-POP (12.0%), and AUS-POP (10.7%) differed substantially. Sarcopenia did not increase the relative hazard ratio (HR) for falls-related hospitalization before or after adjustment for age (aHR): FNIH aHR 1.00 95%CI (0.69-1.47), EWGSOP aHR 1.20 95%CI (0.93-1.54), AUS-POP aHR 0.96 95%CI (0.68-1.35), and AUS-POP aHR 1.33 95%CI (0.94-1.88). When examining individual components of sarcopenia, only muscle strength and physical function but not ALM (adjusted for height or BMI) were associated with falls-related hospitalization.
Current definitions of sarcopenia were not associated with falls-related hospitalization risk in this cohort of community-dwelling older Australian women. Finally, measures of muscle strength and physical function, but not ALM (measured by DXA) may help discriminate the risk of falls-related hospitalization.
本前瞻性、基于人群的队列研究纳入了 903 名高加索裔澳大利亚女性（平均年龄 79.9±2.6 岁），旨在比较四种肌少症定义预测 9.5 年内与跌倒相关的住院风险的临床效用。
四种定义分别为美国国立卫生研究院基金会（FNIH）、欧洲老年人肌少症工作组（EWGSOP），以及使用澳大利亚人群特异性切点（年轻健康澳大利亚女性平均值的<2 个标准差）修改后的 FNIH（AUS-POP）和 EWGSOP（AUS-POP）定义。肌少症的组成部分，包括肌肉力量、身体功能和四肢瘦体重（ALM），分别使用握力、计时起立行走（TUG）和双能 X 射线吸收法（DXA）进行量化。通过关联数据捕获 9.5 年的跌倒相关住院事件。
根据 FNIH（9.4%）、EWGSOP（24.1%）、AUS-POP（12.0%）和 AUS-POP（10.7%）定义，基线时肌少症的患病率差异很大。在调整年龄后，肌少症并未增加与跌倒相关的住院风险的相对危险比（HR）：FNIH HR 1.00（95%CI：0.69-1.47）、EWGSOP HR 1.20（95%CI：0.93-1.54）、AUS-POP HR 0.96（95%CI：0.68-1.35）和 AUS-POP HR 1.33（95%CI：0.94-1.88）。当检查肌少症的各个组成部分时，只有肌肉力量和身体功能，而不是 ALM（根据身高或 BMI 进行调整）与跌倒相关的住院相关。
在本队列中，目前的肌少症定义与社区居住的澳大利亚老年女性跌倒相关住院风险无关。最后，肌肉力量和身体功能的测量值，而不是 DXA 测量的 ALM，可能有助于区分跌倒相关住院的风险。
