Fries Nadja, Kotti Angeliki, Woisetschläger Mischa, Spångeus Anna
Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Radiology, Linköping University Hospital, Linköping, Sweden.
BMC Geriatr. 2025 Feb 1;25(1):72. doi: 10.1186/s12877-025-05707-0.
Sarcopenia is a skeletal muscle disease primarily associated with ageing and progressive muscle decline and increases the risk of falls. The purpose of the present study was to investigate risk factors, including sarcopenia, for severe falls compared to non-severe falls. In addition, we wanted to explore possible associations between sarcopenia, bone mineral density (BMD), adipose tissue as well as clinical scores assessing frailty, nutritional status, and fall risk.
This retrospective cohort study included 101 older patients that had experienced a fall incident during in-patient care at a geriatric ward between 2018 and 2020. The fall incidents were categorized into severe or non-severe falls. Clinical data, including risk assessment scores were retrospectively obtained from the participants' medical records. Body composition, including skeletal muscle quantity (SKM), adipose tissues, and BMD were assessed from abdominal CT-scans performed for any reason maximal 6 months before or after the fall. Skeletal muscle index ratio (SMI-ratio) was calculated using SKM cm/height m and divided with previous described cut off values for sarcopenia. An SMI ratio < 100% indicated sarcopenia.
The severe fall group showed higher grade of sarcopenia compared to the non-severe fall group (SMI ratio of 71% vs. 83%, p = 0.041) as well as lower, though statistically non-significant, BMI and subcutaneous adipose tissue (SAT) (BMI 22 [20-24] vs. 24 [22-27] kg/m, p = 0.108, and SAT 95 ± 70 cm² vs. 141 ± 94 cm², p = 0.124). Overweight was more common in non-severe than severe fall group (43% vs. 14%, p = 0.048). SMI ratio correlated negatively with frailty and positive with BMI and the following body composition measurements: intramuscular-, subcutaneous, and visceral adipose tissue (IMAT, SAT and VAT). No correlation with other clinical risk assessment scores nor spine T-score was found. In the multivariate analysis, higher level of frailty, male sex as well as lower BMI, VAT and SAT remained as risk factors for low SMI ratio.
These results underscore the importance of addressing sarcopenia and related risk factors, including malnutrition, in the management and prevention of severe falls in the elderly population. Body composition analyzed in CT-scans could add value in this risk assessment. This analysis could be conducted opportunistically during CT scans performed for other purposes.
肌肉减少症是一种主要与衰老和进行性肌肉衰退相关的骨骼肌疾病，会增加跌倒风险。本研究的目的是调查与非严重跌倒相比，严重跌倒的风险因素，包括肌肉减少症。此外，我们还想探讨肌肉减少症、骨密度（BMD）、脂肪组织以及评估衰弱、营养状况和跌倒风险的临床评分之间可能存在的关联。
这项回顾性队列研究纳入了101名老年患者，他们在2018年至2020年期间在老年病房住院治疗期间发生了跌倒事件。跌倒事件分为严重跌倒或非严重跌倒。包括风险评估评分在内的临床数据是从参与者的病历中回顾性获取的。身体成分，包括骨骼肌量（SKM）、脂肪组织和骨密度，是根据在跌倒前或跌倒后最多6个月因任何原因进行的腹部CT扫描评估的。骨骼肌指数比（SMI-ratio）通过SKM厘米/身高米计算得出，并与先前描述的肌肉减少症临界值进行比较。SMI比率<100%表示存在肌肉减少症。
与非严重跌倒组相比，严重跌倒组的肌肉减少症程度更高（SMI比率分别为71%和83%，p = 0.041），BMI和皮下脂肪组织（SAT）较低，尽管在统计学上无显著差异（BMI分别为22[20 - 24]和24[22 - 27]kg/m²，p = 0.108；SAT分别为95±70 cm²和141±94 cm²，p = 0.124）。超重在非严重跌倒组比严重跌倒组更常见（43%对14%，p = 0.048）。SMI比率与衰弱呈负相关，与BMI以及以下身体成分测量值呈正相关：肌内脂肪、皮下脂肪和内脏脂肪组织（IMAT、SAT和VAT）。未发现与其他临床风险评估评分以及脊柱T评分存在相关性。在多变量分析中，较高的衰弱水平、男性以及较低的BMI、VAT和SAT仍然是低SMI比率的风险因素。
这些结果强调了在管理和预防老年人群严重跌倒时，应对肌肉减少症及相关风险因素（包括营养不良）的重要性。CT扫描中分析的身体成分在这种风险评估中可能具有附加价值。这种分析可以在因其他目的进行CT扫描时机会性地进行。
