Osteoporosis International

, Volume 29, Issue 7, pp 1653–1657 | Cite as

Could bioelectric impedance spectroscopy (BIS) measured appendicular intracellular water serve as a lean mass measurement in sarcopenia definitions? A pilot study

  • E. Siglinsky
  • B. Buehring
  • D. Krueger
  • N. BinkleyEmail author
  • Y. Yamada
Short Communication



DXA lean mass measurement for sarcopenia diagnosis is not always possible. Bioelectric impedance spectroscopy (BIS), a portable technology, is a potential alternative to DXA-measured lean mass. This pilot study explores the possibility and proposes an arbitrarily chosen potential cut-point for appendicular intracellular water corrected by height (aICW/ht2).


Sarcopenia definitions often include DXA lean mass measurement. However, DXA is not always available. We explored the potential of a less-expensive mobile method, bioelectric impedance spectroscopy (BIS), to assess lean mass for sarcopenia determination. We hypothesized that BIS-measured appendicular intracellular water (aICW/ht2) would correlate with DXA-measured appendicular lean mass (ALM)/ht2 and with functional parameters. If so, establishing an aICW/ht2 cut-point in sarcopenia definitions may be feasible.


Sixty-one community-dwelling women, mean age 79.9, had BIS and DXA lean mass, grip strength, gait speed, and jumping mechanography assessments. BIS aICW was calculated using limb length and intracellular water resistance. aICW/ht2 was compared to DXA-measured ALM/ht2 by linear regression. The European Working Group ALM/ht2 and an exploratory aICW/ht2 cut-point were utilized.


In this cohort, ALM/ht2 and aICW/ht2 were moderately correlated, R2 = 0.55, p < 0.0001. Lean mass was low in 7 and normal in 44 by BIS and DXA. Those with low aICW/ht2 had lower grip strength (p = 0.04) and jump power (p = 0.0002) than those with normal aICW/ht2 and ALM/ht2. Subjects with low ALM/ht2 had lower jump power (p = 0.0006) but were not different in gait speed or grip strength.


BIS aICW is correlated with DXA-measured ALM directly, and when height adjusted. An aICW/ht2 cut-point of 6.5 L/m2 identified 70% of women with low ALM/ht2. Women with low lean mass by DXA and BIS had poorer function measured by jump power. These pilot data support further evaluation of BIS measurement inclusion into sarcopenia definitions.


BIS Body composition DXA Sarcopenia 


Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2018_4475_MOESM1_ESM.doc (62 kb)
ESM 1 (DOC 61 kb)


  1. 1.
    Dawson-Hughes B, Bischoff-Ferrari H (2016) Considerations concerning the definition of sarcopenia. Osteoporos Int 27:3139–3144CrossRefPubMedGoogle Scholar
  2. 2.
    Bischoff-Ferrari HA, Orav JE, Kanis JA, Rizzoli R, Schlogl M, Staehelin HB, Willett WC, Dawson-Hughes B (2015) Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 26:2793–2802CrossRefPubMedGoogle Scholar
  3. 3.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, de Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12:249–256CrossRefPubMedGoogle Scholar
  4. 4.
    Binkley N, Blank RD, Leslie WD, Lewiecki EM, Eisman JA, Bilezikian JP (2017) Osteoporosis in crisis: It’s time to focus on fracture. J Bone Miner Res 32:1391–1394CrossRefPubMedGoogle Scholar
  5. 5.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Studenski SA, Peters KW, Alley DE et al (2014) The FNIH Sarcopenia Project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69:547–558CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Anonymous (2010) Dual energy x-ray absorptiometry for bone mineral density and body composition assessment. IAEA Human Health Series, II edn, p 21Google Scholar
  8. 8.
    Buehring B, Fidler E, Yamada Y et al (2016) Assessment of muscle/lean mass measurement: comparison of methods for sarcopenia determination. Osteoporos Int 27:S53–S54Google Scholar
  9. 9.
    Yamada Y, Buehring B, Krueger D, Binkley N, Schoeller DA (2014) Improving muscle mass measurement using bioelectrical impedance spectroscopy. J Clin Densitom 17:401–402CrossRefGoogle Scholar
  10. 10.
    Krueger D, Siglinsky E, Buehring B, Binkley N (2016) Total body less head measurement is most appropriate for lean mass assessment in adults. J Clin Densitom 20:128–129CrossRefPubMedGoogle Scholar
  11. 11.
    Yamada Y, Watanabe Y, Ikenaga M, Yokoyama K, Yoshida T, Morimoto T, Kimura M (2013) Comparison of single- or multifrequency bioelectrical impedance analysis and spectroscopy for assessment of appendicular skeletal muscle in the elderly. J Appl Physiol 115:812–818CrossRefPubMedGoogle Scholar
  12. 12.
    Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH (1987) Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing. Phys Ther 67:1342–1347CrossRefPubMedGoogle Scholar
  13. 13.
    Buehring B, Krueger D, Binkley N (2010) Jumping mechanography: a potential tool for sarcopenia evaluation in older individuals. J Clin Densitom 13:283–291CrossRefPubMedGoogle Scholar
  14. 14.
    Singh H, Kim D, Kim E, Bemben MG, Anderson M, Seo DI, Bemben DA (2014) Jump test performance and sarcopenia status in men and women, 55 to 75 years of age. J Geriatr Phys Ther 37:76–82CrossRefPubMedGoogle Scholar
  15. 15.
    Siglinsky E, Krueger D, Ward RE, Caserotti P, Strotmeyer ES, Harris TB, Binkley N, Buehring B (2015) Effect of age and sex on jumping mechanography and other measures of muscle mass and function. J Musculoskelet Neuronal Interact 15:301–308PubMedPubMedCentralGoogle Scholar
  16. 16.
    Buehring B, Krueger D, Fidler E, Gangnon R, Heiderscheit B, Binkley N (2015) Reproducibility of jumping mechanography and traditional measures of physical and muscle function in older adults. Osteoporos Int 26:819–825CrossRefPubMedGoogle Scholar
  17. 17.
    Hannam K, Hartley A, Clark EM, Aihie Sayer A, Tobias JH, Gregson CL (2017) Feasibility and acceptability of using jumping mechanography to detect early components of sarcopenia in community-dwelling older women. J Musculoskelet Neuronal Interact 17:246–257PubMedPubMedCentralGoogle Scholar
  18. 18.
    Yamada Y, Ikenaga M, Takeda N, Morimura K, Miyoshi N, Kiyonaga A, Kimura M, Higaki Y, Tanaka H (2014) Estimation of thigh muscle cross-sectional area by single- and multi-frequency segmental bioelectrical impedance analysis in the elderly. J Appl Physiol 15:176–182CrossRefGoogle Scholar
  19. 19.
    Bartok C, Schoeller DA (2004) Estimation of segmental muscle volume by bioelectrical impedance spectroscopy. J Appl Physiol 96:161–166CrossRefPubMedGoogle Scholar
  20. 20.
    Yamada Y, Buehring B, Krueger D, Anderson RM, Schoeller DA, Binkley N (2017) Electrical properties assessed by bioelectrical impedance spectroscopy as biomarkers of age-related loss of skeletal muscle quantity and quality. J Gerontol A Biol Sci Med Sci 72:1180–1186CrossRefPubMedGoogle Scholar
  21. 21.
    Buehring B, Siglinsky E, Krueger D, Evans W, Hellerstein M, Yamada Y, Binkley N (2017) Comparison of muscle/lean mass measurement methods: correlation with functional and biochemical testing. Osteoporos Int.
  22. 22.
    Bossuyt PM, Reitsma JB, Bruns DE et al (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ h5527:351Google Scholar
  23. 23.
    Yamada Y, Nishizawa M, Uchiyama T, Kasahara Y, Shindo M, Miyachi M, Tanaka S (2017) Developing and validating an age-independent equation using multi-frequency bioelectrical impedance analysis for estimation of appendicular skeletal muscle mass and establishing a cutoff for sarcopenia. Int J Environ Res Public Health 14:E809CrossRefPubMedGoogle Scholar
  24. 24.
    Binkley N, Buehring B (2009) Beyond FRAX: it’s time to consider “sarco-osteopenia”. J Clin Densitom 12:413–416CrossRefPubMedGoogle Scholar
  25. 25.
    JafariNasabian P, Inglis JE, Kelly OJ, Ilich JZ (2017) Osteosarcopenic obesity in women: impact, prevalence, and management challenges. Int J Women's Health 9:33–42CrossRefGoogle Scholar
  26. 26.
    Ilich JZ, Kelly OJ, Inglis JE (2016) Osteosarcopenic obesity syndrome: what is it and how can it be identified and diagnosed? Curr Gerontol Geriatr Res 2016:7325973CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ilich JZ, Inglis JE, Kelly OJ, McGee DL (2015) Osteosarcopenic obesity is associated with reduced handgrip strength, walking abilities, and balance in postmenopausal women. Osteoporos Int 26:2587–2595CrossRefPubMedGoogle Scholar
  28. 28.
    Wang JG, Zhang Y, Chen HE, Li Y, Cheng XG, Xu L, Guo Z, Zhao XS, Sato T, Cao QY, Chen KM, Li B (2013) Comparison of two bioelectrical impedance analysis devices with dual energy X-ray absorptiometry and magnetic resonance imaging in the estimation of body composition. J Strength Cond Res 27:236–243CrossRefPubMedGoogle Scholar
  29. 29.
    Stefanaki C, Peppa M, Boschiero D, Chrousos GP (2016) Healthy overweight/obese youth: early osteosarcopenic obesity features. Eur J Clin Investig 46:767–778CrossRefGoogle Scholar
  30. 30.
    Tsigos C, Stefanaki C, Lambrou GI, Boschiero D, Chrousos GP (2015) Stress and inflammatory biomarkers and symptoms are associated with bioimpedance measures. Eur J Clin Investig 45:126–134CrossRefGoogle Scholar
  31. 31.
    Schols AM, Dingemans AM, Soeters PB, Wouters EF (1990) Within-day variation of bioelectrical resistance measurements in patients with chronic obstructive pulmonary disease. Clin Nutr 9:266–271CrossRefPubMedGoogle Scholar
  32. 32.
    Kushner RF, Gudivaka R, Schoeller DA (1996) Clinical characteristics influencing bioelectrical impedance analysis measurements. Am J Clin Nutr 64:423S–427SCrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.University of Wisconsin Osteoporosis Clinical Research ProgramMadisonUSA

Personalised recommendations