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Association between low lean mass and low bone mineral density in 653 women with hip fracture: does the definition of low lean mass matter?

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Abstract

Background and aims

Loss of both muscle and bone mass results in fragility fractures with increased risk of disability, poor quality of life, and death. Our aim was to assess the association between low appendicular lean mass (aLM) defined according to different criteria and low bone mineral density (BMD) in hip-fracture women.

Methods

Six hundred fifty-three women admitted to our rehabilitation hospital underwent dual energy X-ray absorptiometry 19.1 ± 4.1 (mean ± SD) days after hip-fracture occurrence. Low aLM was identified according to either Baumgartner’s definition (aLM/height2 less than two standard deviations below the mean of the young reference group) or FNIH criteria: aLM <15.02 kg, or aLM adjusted for body mass index (BMI) <0.512. Low BMD was diagnosed with a T-score <−2.5 at the unfractured femoral neck.

Results

Using Baumgartner’s definition, the association between low aLM/height2 and low BMD was significant: χ 2(1, n = 653) = 8.52 (p = 0.004), but it was erased by adjustments for age and fat mass. Using the FNIH definition the association between low aLM and low BMD was significant: χ 2(1, n = 653) = 42.5 (p < 0.001), and it was confirmed after adjustment for age and fat mass (p < 0.001). With the FNIH definition based on aLM/BMI ratio the association between low aLM/BMI ratio and low BMD was nonsignificant: χ 2(1, n = 653) = 0.003 (p = 0.957).

Conclusions

The association between low aLM and low BMD in women with hip fracture dramatically depends on the adopted definition of low aLM. FNIH threshold for aLM (<15.02 kg) emerges as a useful tool to capture women with damage of the muscle-bone unit.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Strada Santa Margherita 136, 10131, Turin, Italy

    Marco Di Monaco, Carlotta Castiglioni, Roberto Di Monaco & Rosa Tappero

  2. Department of Culture, Politics, and Society, University of Turin, Lungodora Siena 100, 10100, Turin, Italy

    Marco Di Monaco, Carlotta Castiglioni, Roberto Di Monaco & Rosa Tappero

Authors
  1. Marco Di Monaco
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  2. Carlotta Castiglioni
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  3. Roberto Di Monaco
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  4. Rosa Tappero
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Correspondence to Marco Di Monaco.

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On behalf of all the authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Di Monaco, M., Castiglioni, C., Di Monaco, R. et al. Association between low lean mass and low bone mineral density in 653 women with hip fracture: does the definition of low lean mass matter?. Aging Clin Exp Res 29, 1271–1276 (2017). https://doi.org/10.1007/s40520-017-0724-9

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  • DOI: https://doi.org/10.1007/s40520-017-0724-9

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