Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
J Am Geriatr Soc. 2022 Aug;70(8):2379-2385. doi: 10.1111/jgs.17905. Epub 2022 Jun 3.
Several international study groups adopted appendicular skeletal muscle mass (ASM) index adjusted by (1) height squared, (2) weight, and (3) body mass index (BMI) in the diagnosis of sarcopenia. However, different prevalence rates of sarcopenia by each index and clinical implications were not well known. The purpose of this study was to compare the differences in (1) the percentage of sarcopenia in hip fracture patients and (2) the relative mortality rate according to the sarcopenia criteria of three ASM indices.
Between January 2009 and December 2020, 1003 older adult hip fracture patients at a tertiary institution were eligible and retrospectively reviewed for this study. Based on the ASM measured on dual-energy X-ray absorptiometry, three indices were calculated, and sarcopenia was diagnosed. The proportion of sarcopenia was evaluated according to each index. One, two, and five-year mortality rates were compared between each sarcopenia group and a normal musculature group, based on ASM criteria.
The proportion of sarcopenia patients differed according to three ASM indices. The proportion of sarcopenic patients by ASM/height index was higher than those of the other two indices in both male and female hip fracture patients. In male patients, 61% were sarcopenic by ASM/height index, 37% by ASM/weight index, and 44% by ASM/BMI index. In female patients, 26%, 11%, and 14% were sarcopenic, respectively. Among the three indices, only ASM/height had significant correlations with all 1-, 2-, and 5-year mortality rates.
The prevalence of sarcopenia in hip fracture patients differed substantially according to ASM indices. Sarcopenic hip fracture patients had a higher mortality rate than those with normal musculature. The 1-year, 2-year, and 5-year mortality rates were discriminated by ASM/height criteria in both men and women. Future prospective studies in a larger cohort are warranted.
几个国际研究小组采用了（1）身高平方、（2）体重和（3）体重指数（BMI）校正的四肢骨骼肌质量（ASM）指数来诊断肌肉减少症。然而，不同指数诊断出的肌肉减少症的患病率和临床意义尚不清楚。本研究的目的是比较（1）髋部骨折患者中肌肉减少症的百分比和（2）根据三种 ASM 指数的肌肉减少症标准，相对死亡率的差异。
在 2009 年 1 月至 2020 年 12 月期间，对一家三级医疗机构的 1003 名老年髋部骨折患者进行了回顾性研究。基于双能 X 射线吸收法测量的 ASM，计算了三个指数，并诊断出肌肉减少症。根据每个指数评估肌肉减少症的比例。根据 ASM 标准，比较了每个肌肉减少症组与正常肌肉组之间的一年、两年和五年死亡率。
根据三种 ASM 指数，肌肉减少症患者的比例有所不同。在男性和女性髋部骨折患者中，ASM/身高指数的肌肉减少症患者比例均高于其他两个指数。在男性患者中，61%的患者为 ASM/身高指数的肌肉减少症患者，37%的患者为 ASM/体重指数的肌肉减少症患者，44%的患者为 ASM/BMI 指数的肌肉减少症患者。在女性患者中，分别有 26%、11%和 14%为肌肉减少症患者。在这三个指数中，只有 ASM/身高与所有 1 年、2 年和 5 年死亡率均有显著相关性。
髋部骨折患者的肌肉减少症患病率因 ASM 指数而异。患有肌肉减少症的髋部骨折患者的死亡率高于肌肉正常的患者。ASM/身高标准可以区分男性和女性的 1 年、2 年和 5 年死亡率。需要在更大的队列中进行前瞻性研究。
