Zhan Zhenrun, Zhang Yongze, Wu Jiayong, Lin Jiebin, Yan Sunjie
Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
Sci Rep. 2025 Mar 19;15(1):9473. doi: 10.1038/s41598-025-93988-1.
This study aims to compare the predictive efficacy of different diagnostic criteria for sarcopenia in forecasting the occurrence of osteoporosis (OP) and fractures. Utilizing data from the Global Health Data Exchange, the burden of musculoskeletal disorders (MSDs) was assessed through indicators including incidence, prevalence, and disability-adjusted life years. Trends in MSD burden were analyzed using the Joinpoint regression model to calculate the average annual percentage change. A retrospective cohort study was conducted on clinical data from 8180 patients who received care at the Endocrinology Department of the First Affiliated Hospital of Fujian Medical University between April 2008 and June 2024. Patients were categorized into four groups based on sarcopenia diagnostic criteria established by the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS), the Asian Working Group on Sarcopenia 2019 (AWGS 2019), and the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. We compared demographic data, chronic disease history, body composition, bone mineral density, FRAX fracture risk, and the incidence of osteoporosis to evaluate the predictive validity of each diagnostic criterion for osteoporosis and fracture risk in patients with sarcopenia. (1) The prevalence of sarcopenia, as defined by the IWGS, FNIH, EWGSOP, and AWGS 2019 diagnostic criteria, was 39.2%, 28.3%, 55.0%, and 30.1%, respectively. (2) After adjusting for age, gender, and body mass index (BMI), a significant association between osteoporosis and sarcopenia was observed across all four diagnostic criteria (all P < 0.05). Furthermore, sarcopenia, as determined by the EWGSOP and AWGS 2019 criteria, was associated with a moderate-to-high risk of major osteoporotic fractures and hip fractures within the next 10 years (P < 0.05). (3) Spearman's correlation coefficients for sarcopenia with Procollagen type I N-terminal propeptide (PINP), appendicular lean mass (ALM), ALM/height squared (Ht), and ALM/BMI were - 0.034, - 0.308, - 0.261, and - 0.252, respectively. PINP, ALM, ALM/Ht, and ALM/BMI were identified as significant factors influencing osteoporosis, with odds ratios of 0.996, 0.765, 0.535, and 0.010, respectively. The burden of MSDs is increasing in China and globally, driven primarily by population aging. Sarcopenia is significantly associated with osteoporosis and a moderate-to-high risk of fracture when diagnosed using the FNIH and EWGSOP criteria. PINP and ALM are protective factors against osteoporosis development in patients with sarcopenia.
本研究旨在比较不同肌少症诊断标准对预测骨质疏松症（OP）和骨折发生的预测效力。利用全球卫生数据交换中心的数据，通过发病率、患病率和伤残调整生命年等指标评估肌肉骨骼疾病（MSD）负担。使用Joinpoint回归模型分析MSD负担趋势，以计算年均变化百分比。对2008年4月至2024年6月期间在福建医科大学附属第一医院内分泌科接受治疗的8180例患者的临床数据进行回顾性队列研究。根据老年人肌少症欧洲工作组（EWGSOP）、国际肌少症工作组（IWGS）、2019年亚洲肌少症工作组（AWGS 2019）和美国国立卫生研究院基金会（FNIH）肌少症项目制定的肌少症诊断标准，将患者分为四组。我们比较了人口统计学数据、慢性病病史、身体成分、骨密度、FRAX骨折风险和骨质疏松症发病率，以评估各诊断标准对肌少症患者骨质疏松症和骨折风险的预测效度。（1）根据IWGS、FNIH、EWGSOP和AWGS 2019诊断标准定义的肌少症患病率分别为39.2%、28.3%、55.0%和30.1%。（2）在调整年龄、性别和体重指数（BMI）后，所有四种诊断标准下均观察到骨质疏松症与肌少症之间存在显著关联（所有P < 0.05）。此外, 根据EWGSOP和AWGS 2019标准确定的肌少症与未来10年内发生主要骨质疏松性骨折和髋部骨折的中高风险相关（P < 0.05）。（3）肌少症与I型前胶原N端前肽（PINP）、四肢瘦体重（ALM）、ALM/身高平方（Ht）和ALM/BMI的Spearman相关系数分别为-0.034、-0.308、-0.261和-0.252。PINP、ALM、ALM/Ht和ALM/BMI被确定为影响骨质疏松症的重要因素，其比值比分别为0.996、0.765、0.535和0.010。在中国和全球范围内，MSD负担主要受人口老龄化驱动而不断增加。当使用FNIH和EWGSOP标准进行诊断时，肌少症与骨质疏松症以及中高骨折风险显著相关。PINP和ALM是肌少症患者预防骨质疏松症发生的保护因素。
