Rheumatology Department, University of Lille, CHU Lille, ULR 4490 - MABLab, Lille, France.
Public Health Department, University of Lille, CHU Lille, ULR 2694 - METRICS, CERIM, Lille, France.
J Bone Miner Res. 2023 Oct;38(10):1422-1434. doi: 10.1002/jbmr.4884. Epub 2023 Aug 3.
Studies on the fracture risk in presarcopenic and sarcopenic patients report contradictory results. The objective was to assess whether presarcopenia and sarcopenia are associated with an increase in fracture risk. We conducted a retrospective study using the UK Biobank cohort and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was evaluated using hand-grip strength (HGS) and muscle mass using the skeletal muscle index (SMI; from bioimpedance analysis). Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, and sarcopenia as low HGS and low SMI. Fracture events were recorded as "fracture" (location compatible with an osteoporotic origin) and "major osteoporotic fracture" (MOF), as listed in the FRAX tool. Associations were assessed using Cox proportional hazards models, adjusted for sarcopenia and osteoporosis risk factors. Adjusted hazard ratios (HR ) and their 95% confidence intervals (CI) were reported. A total of 387,025 participants (women 54.4%; median age 58.0 years; interquartile range [IQR] 51.0-63.0 years) were included. At baseline, there were 18,257 (4.7%) presarcopenic participants-subgroup 1 (low HGS only), 7940 (2.1%) presarcopenic participants-subgroup 2 (low SMI only), and 1124 (0.3%) sarcopenic participants. Over a median follow-up of 12.0 years (IQR 11.4-12.6 years), 18,300 (4.7%) participants were diagnosed with at least one incident fracture. Presarcopenic (subgroups 1 and 2) and sarcopenic status were significantly associated with a higher risk of fracture (respectively adjusted HRs: HR = 1.26 [1.19-1.33], HR = 1.20 [1.11-1.30], HR = 1.30 [1.08-1.56]) and with a higher risk of MOF (respectively adjusted HRs: HR = 1.30 [1.21-1.40], HR = 1.19 [1.08-1.72], HR = 1.18 [0.93-1.49]). In a middle-aged population, the fracture and MOF risks were higher in both presarcopenic and sarcopenic participants compared with nonsarcopenic participants. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
在患有肌少症前期和肌少症患者的骨折风险研究中，结果相互矛盾。本研究旨在评估肌少症前期和肌少症是否与骨折风险增加有关。我们使用英国生物银行队列和欧洲老年人肌少症工作组 2 （EWGSOP2）标准进行了一项回顾性研究。肌肉力量使用握力（HGS）进行评估，肌肉质量使用骨骼肌指数（SMI；通过生物阻抗分析）进行评估。肌少症前期通过文献中提供的两种定义进行定义，即低 HGS 伴正常 SMI 和正常 HGS 伴低 SMI，肌少症则定义为低 HGS 和低 SMI。骨折事件被记录为“骨折”（与骨质疏松症起源相容的部位）和“主要骨质疏松性骨折”（MOF），如 FRAX 工具中列出的那样。使用 Cox 比例风险模型评估相关性，调整了肌少症和骨质疏松症的风险因素。报告了调整后的风险比（HR）及其 95%置信区间（CI）。共纳入 387025 名参与者（女性 54.4%；中位年龄 58.0 岁；四分位距 [IQR] 51.0-63.0 岁）。基线时，有 18257 名（4.7%）肌少症前期参与者-亚组 1（仅低 HGS）、7940 名（2.1%）肌少症前期参与者-亚组 2（仅低 SMI）和 1124 名（0.3%）肌少症参与者。在中位随访 12.0 年（IQR 11.4-12.6 年）期间，有 18300 名（4.7%）参与者被诊断出至少发生一次骨折。肌少症前期（亚组 1 和 2）和肌少症状态与更高的骨折风险（分别调整后的 HR：HR=1.26 [1.19-1.33]，HR=1.20 [1.11-1.30]，HR=1.30 [1.08-1.56]）和更高的 MOF 风险（分别调整后的 HR：HR=1.30 [1.21-1.40]，HR=1.19 [1.08-1.72]，HR=1.18 [0.93-1.49]）显著相关。在中年人群中，与非肌少症患者相比，肌少症前期和肌少症患者的骨折和 MOF 风险更高。
