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老年人的肌肉减少症和骨质疏松症:一项系统评价和荟萃分析。

Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis.

作者信息

Nielsen Barbara Rubek, Abdulla Jawdat, Andersen Hanne Elkjær, Schwarz Peter, Suetta Charlotte

机构信息

Medical Department M, Amager and Hvidovre Hospital, Valdemar Hansens Vej 1-23, 2610, Glostrup, Denmark.

Department of Endocrinology, Rigshospitalet and Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.

出版信息

Eur Geriatr Med. 2018 Aug;9(4):419-434. doi: 10.1007/s41999-018-0079-6. Epub 2018 Jul 13.

DOI:10.1007/s41999-018-0079-6
PMID:34674498
Abstract

BACKGROUND

Age-related loss of muscle and bone (sarcopenia and osteoporosis), increases the risk of falls and fractures and consequently leads to a substantial economic burden for the society. The combined condition, osteosarcopenia, may identify patients at a higher risk of those outcomes and could be relevant for assessment and treatment in clinical practice.

AIM

To evaluate the current knowledge of the prevalence of osteosarcopenia and the fracture risk in older people.

METHOD

A systematic literature review was conducted until 10th March 2018. A total of 1105 papers were detected, whereof 1049 and 29 were excluded by title/abstracts and full-text assessment, respectively. Twenty-seven original papers were included in the systematic review, whereof 17 were suitable for meta-analysis.

RESULTS

The prevalence of osteosarcopenia varied (5-37%) depending on the classification of sarcopenia and whether participants were classified initially according to sarcopenia or osteoporosis. In patients with low-energy osteoporotic fractures, sarcopenia was present in 7.8-58% and 1.3-96.3% of the cases, women and men, respectively. The meta-analysis of prevalence of sarcopenia in patients with low-energy fracture (n = 9) was 46% (95% CI 44, 48; p < 0.001). The relative risk of fracture (sarcopenic versus non-sarcopenic) in meta-analysis of four studies was 1.37 (95% CI 1.18, 1.59; p < 0.001). Mean bone mineral density (n = 5) and T-score (n = 3) of femoral neck was significantly lower in sarcopenic participants [- 0.07 g/cm (95% CI 0.08, 0.06) and - 0.34 (95% CI - 0.46, - 0.23), respectively].

CONCLUSION

Osteosarcopenia is frequent and the relative risk of fracture is higher among sarcopenic patients. A standard and strict classification of sarcopenia is needed to assess its true relationship and consequences.

摘要

背景

与年龄相关的肌肉和骨骼流失(肌肉减少症和骨质疏松症)会增加跌倒和骨折的风险,从而给社会带来巨大的经济负担。肌肉减少性骨质疏松症这一合并病症,可能会识别出发生上述后果风险更高的患者,并且可能与临床实践中的评估和治疗相关。

目的

评估目前关于老年人肌肉减少性骨质疏松症患病率及骨折风险的认识。

方法

截至2018年3月10日进行了一项系统的文献综述。共检索到1105篇论文,其中分别有1049篇和29篇通过标题/摘要及全文评估被排除。27篇原创论文被纳入系统综述,其中17篇适合进行荟萃分析。

结果

肌肉减少性骨质疏松症的患病率因肌肉减少症的分类以及参与者最初是根据肌肉减少症还是骨质疏松症进行分类而有所不同(5%-37%)。在低能量骨质疏松性骨折患者中,肌肉减少症在女性和男性病例中的发生率分别为7.8%-58%和1.3%-96.3%。对低能量骨折患者(n = 9)中肌肉减少症患病率的荟萃分析结果为46%(95%置信区间44, 48;p < 0.001)。四项研究的荟萃分析中,骨折的相对风险(肌肉减少症患者与非肌肉减少症患者相比)为1.37(95%置信区间1.18, 1.59;p < 0.001)。肌肉减少症患者的股骨颈平均骨密度(n = 5)和T值(n = 3)显著更低[-0.07 g/cm²(95%置信区间0.08, 0.06)和-0.34(95%置信区间-0.46, -0.23)]。

结论

肌肉减少性骨质疏松症很常见,肌肉减少症患者的骨折相对风险更高。需要对肌肉减少症进行标准且严格的分类,以评估其真实关系和后果。

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