Osteoporosis International

, Volume 25, Issue 9, pp 2189–2198 | Cite as

Early-stage chronic kidney disease, insulin resistance, and osteoporosis as risk factors of sarcopenia in aged population: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008–2009

  • J. E. KimEmail author
  • Y.-h. Lee
  • J. H. Huh
  • D. R. Kang
  • Y. Rhee
  • S.-K. Lim
Original Article



Sarcopenia means the progressive loss of skeletal muscle mass and strength with aging. In this study, we found that insulin resistance, chronic kidney disease stage 3, and osteoporosis at the femur neck were closely associated with sarcopenia in elderly men. These conditions modified to slow down the progression of sarcopenia.


Sarcopenia is known to have multiple contributing factors; however, its modifiable risk factors have not yet been determined. The aim of this study was to identify the most influential and modifiable risk factors for sarcopenia in elderly.


This was a population-based, cross-sectional study using data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008–2009. This study included 940 men and 1,324 women aged 65 years and older who completed a body composition analysis using dual-energy X-ray absorptiometry. Sarcopenia was defined as an appendicular skeletal muscle mass divided by height2 of less than 1 standard deviation below the sex-specific mean for a younger reference group.


Using univariate analysis, age, body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA-IR), limitations in daily activities, regular exercise, high-risk drinking, family income, osteoporosis, daily energy, and protein intake were associated with sarcopenia in men; age, BMI, limitations in daily activities, regular exercise, occupation, osteoporosis at the total hip, and daily energy intake were associated with sarcopenia in women. In the multivariate logistic regression analysis, HOMA-IR ≥2.5 (odds ratio [OR] for sarcopenia, 2.27; 95 % confidence interval [CI], 1.21–4.25), chronic kidney disease stage 3 (OR, 3.13; 95 % CI, 1.14–8.61), and osteoporosis at the femur neck (OR, 6.83; 95 % CI, 1.08–43.41) were identified as risk factors for sarcopenia in men.


Insulin resistance, chronic kidney disease, and osteoporosis at the femur neck should be modified to prevent the acceleration of skeletal muscle loss in elderly men.


Chronic kidney disease Insulin resistance Osteoporosis Sarcopenia 



This work was supported by a National Research Foundation (NRF) of Korea grant funded by the Korea government (MEST) (No. 20110001024).

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

198_2014_2745_MOESM1_ESM.tif (968 kb)
Supplemental Figure 1 (A) Odds ratio for sarcopenia when insulin resistance (HOMA-IR ≥ 2.5) and osteoporosis at the femur neck interacted (P < 0.05). Age, BMI, eGFR, serum vitamin D level, regular exercise, daily protein, and calcium intake were adjusted. (B) Odds ratio for sarcopenia when CKD stage 3 (30 ≤ eGFR < 60) and osteoporosis at the femur neck interacted (P < 0.05). Age, BMI, HOMA-IR, serum vitamin D level, regular exercise, daily protein, and calcium intake were adjusted (TIFF 967 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • J. E. Kim
    • 1
    Email author
  • Y.-h. Lee
    • 1
  • J. H. Huh
    • 1
  • D. R. Kang
    • 2
  • Y. Rhee
    • 1
  • S.-K. Lim
    • 1
  1. 1.Division of Endocrinology and Metabolism, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Biostatistics Collaboration UnitYonsei University College of MedicineSeoulRepublic of Korea

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