TY - JOUR
T1 - Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis
AU - Yeung, Suey S. Y.
AU - Reijnierse, Esmee M.
AU - Pham, Vivien K.
AU - Trappenburg, Marijke C.
AU - Lim, Wen Kwang
AU - Meskers, Carel G. M.
AU - Maier, Andrea B.
N1 - Funding Information:
based on low muscle mass alone: Baumgartner et al.,24–28 Delmonico et al.,24,27Newman et al.,25 Cheng et al.,29 Scott et al.,28 Sanada et al.,30,31 Levine and Crimmins,28 and Bouchard et al..28 Other definitions are based on both low muscle mass and low muscle strength/physical performance: European Working Group on Sarcopenia in Older People (EWGSOP),24,25,28,32–52 Asian Working Group for Sarcopenia (AWGS),18,51,53,54 Foundation for the National Institutes of Health (FNIH),24,25,27,35,44,46,55 International Working Group on Sarcopenia (IWGS),24,25,27,35 Society for Sarcopenia, Cachexia, and Wasting Disorders (SCWD),24,27 and ESPEN Special Interest Group on ‘cachexia-anorexia in chronic wasting diseases’ and ‘nutrition in geriatrics’.24 In cases where studies applied multiple sarcopenia definitions, results based on the EWGSOP definition52 were prioritized over the Baumgartner definition56 and other definitions.57–68
Funding Information:
ALM, appendicular lean mass; AMM, appendicular muscle mass; ASM, appendicular skeletal muscle mass; AWGS, Asia Working Group for Sarcopenia; BIA, bioelectrical impedance analysis; BMI, body mass index; DXA, dual energy X-ray absorptiometry; EWGSOP, European Working Group on Sarcopenia in Older People; F, females; FNIH, Foundation for the National Institutes of Health; GS, gait speed; HGS, handgrip strength; ht, height; IWGS, International Working Group on Sarcopenia; KES, knee extension strength; M, males; MAMC, mid-arm muscle circumference; N, sample size; NA, not applicable; NG, not given; SCWD, Society for Sarcopenia, Cachexia, and Wasting Disorders; SM, skeletal muscle; SMM, skeletal muscle mass; SMI, skeletal muscle index; SPPB, short physical performance battery; TUG, Timed Up & Go.
Funding Information:
Figure 1 Forest plots of odds ratio for falls in sarcopenic individuals vs. non-sarcopenic individuals, stratified by (A) study design; (B) study population; (C) sex; (D) sarcopenia definition; (E) continent; and (F) study quality. AWGS, Asia Working Group for Sarcopenia; CI, confidence interval; EWGSOP, European Working Group on Sarcopenia in Older People; FNIH, Foundation for the National Institutes of Health; IWGS, International Working Group on Sarcopenia; OR, odds ratio.
Funding Information:
Figure 2 Forest plots of odds ratio for fractures in sarcopenic individuals vs. non-sarcopenic individuals, stratified by (A) study design; (B) study population; (C) sex; (D) sarcopenia definition; (E) continent; and (F) study quality. AWGS, Asia Working Group for Sarcopenia; CI, confidence interval; EWGSOP, European Working Group on Sarcopenia in Older People; FNIH, Foundation for the National Institutes of Health; IWGS, International Working Group on Sarcopenia; OR, odds ratio.
Funding Information:
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie-Sklodowska-Curie grant agreement no. 675003 (PANINI programme) and no. 689238 (PreventIT). The funders had no role in the design and conduct of the study, data collection and analysis, interpretation of data, or preparation of the manuscript.
Publisher Copyright:
© 2019 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I
2 statistics. The search identified 2771 studies. Thirty-six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non-sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty-three studies (45 926 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (cross-sectional studies: OR 1.60; 95% CI 1.37–1.86, P < 0.001, I
2 = 34%; prospective studies: OR 1.89; 95% CI 1.33–2.68, P < 0.001, I
2 = 37%) and fractures (cross-sectional studies: OR 1.84; 95% CI 1.30–2.62, P = 0.001, I
2 = 91%; prospective studies: OR 1.71; 95% CI 1.44–2.03, P = 0.011, I
2 = 0%) compared with non-sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent, and study quality. The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures.
AB - Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I
2 statistics. The search identified 2771 studies. Thirty-six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non-sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty-three studies (45 926 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (cross-sectional studies: OR 1.60; 95% CI 1.37–1.86, P < 0.001, I
2 = 34%; prospective studies: OR 1.89; 95% CI 1.33–2.68, P < 0.001, I
2 = 37%) and fractures (cross-sectional studies: OR 1.84; 95% CI 1.30–2.62, P = 0.001, I
2 = 91%; prospective studies: OR 1.71; 95% CI 1.44–2.03, P = 0.011, I
2 = 0%) compared with non-sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent, and study quality. The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures.
KW - Falls
KW - Fractures
KW - Meta-analysis
KW - Sarcopenia
UR - http://www.scopus.com/inward/record.url?scp=85064571570&partnerID=8YFLogxK
U2 - 10.1002/jcsm.12411
DO - 10.1002/jcsm.12411
M3 - Review article
C2 - 30993881
VL - 10
SP - 485
EP - 500
JO - Journal of Cachexia, Sarcopenia and Muscle
JF - Journal of Cachexia, Sarcopenia and Muscle
SN - 2190-5991
IS - 3
ER -