老年人脆性骨折风险预测中的肌肉参数:范围综述。
Muscle parameters in fragility fracture risk prediction in older adults: A scoping review.
机构信息
Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and Joint, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Internal Medicine Unit, Department of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
出版信息
J Cachexia Sarcopenia Muscle. 2024 Apr;15(2):477-500. doi: 10.1002/jcsm.13418. Epub 2024 Jan 29.
Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA-ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of 'fragility fractures', 'muscle health assessment' and 'risk'. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community-dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty-seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person-years (MPY). The median (interquartile range) sample size was 1642 (921-5756), age 69.2 (63.5-73.6) years, follow-up 10.0 (4.4-12.0) years and number of incident fragility fractures 166 (88-277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in-depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3-creatine dilution test, lean mass indexes and artificial intelligence methods.
骨质疏松性骨折中有一半发生在骨密度正常/骨质疏松的患者或估计风险处于中低水平的患者中。肌肉测量已被证明可独立于骨密度对骨折风险产生影响。本研究旨在回顾肌肉健康(肌肉质量/数量/质量、力量和功能)的测量及其与脆性骨折事件的相关性,并总结其在临床实践中的应用。本范围综述遵循 PRISMA-ScR 报告指南。我们的检索策略涵盖了“脆性骨折”、“肌肉健康评估”和“风险”这三个广泛的概念。我们从 Medline Ovid SP、EMBASE、Web of Science 核心合集和 Google Scholar 中检索了 14745 篇参考文献。我们纳入了社区居住的年龄超过 50 岁的成年人的原始和前瞻性研究,这些研究分析了至少一项肌肉参数与脆性骨折事件之间的相关性。我们系统地从每项研究中提取了 17 项内容,包括方法学、一般特征和结果。数据以表格形式总结,并以调整后的森林图形式呈现。67 篇文章符合纳入标准。总共,我们研究了 60 个肌肉参数或指标,以及 322 个骨折风险比,涉及 280 万人年(MPY)。中位数(四分位距)样本量为 1642(921-5756),年龄 69.2(63.5-73.6)岁,随访时间 10.0(4.4-12.0)年,脆性骨折事件 166 例(88-277 例)。28(2.0%)、64(2.5%)和 10(0.2MPY)项分析显示,肌肉质量越低,与脆性骨折事件的相关性越高/无/低。53(1.3%)、57(1.7MPY)和 0 项分析显示,肌肉力量越低,与骨折的相关性越高/无/低。63(1.9%)、45(1.0MPY)和 0 项分析显示,肌肉功能越低,与骨折的相关性越高/无/低。深入分析显示了每个单一的肌肉参数如何与每种脆性骨折亚型相关。本综述总结了肌肉健康的标志物及其与脆性骨折的相关性。肌肉力量和功能的测量似乎更能预测骨折风险。其中,握力和步态速度可能是纳入临床实践最实用的测量方法,如评估肌肉减少症或进一步的骨折风险评估评分。肌肉质量的测量似乎不能预测脆性骨折,可能需要进一步研究,如 D3-肌酸稀释试验、瘦体重指数和人工智能方法。