Abstract
Summary
In this study, we compare the extent to which seven available definitions of sarcopenia and two related definitions predict the rate of falling. Our results suggest that the definitions of Baumgartner and Cruz-Jentoft best predict the rate of falls among sarcopenic versus non-sarcopenic community-dwelling seniors.
Introduction
The purpose of the study is to compare the extent to which seven available definitions of sarcopenia and two related definitions predict the prospective rate of falling.
Methods
We studied a cohort of 445 seniors (mean age 71 years, 45 % men) living in the community who were followed with a detailed fall assessment for 3 years. For comparing the rate of falls in sarcopenic versus non-sarcopenic individuals, we used multivariate Poisson regression analyses adjusting for gender and treatment (original intervention tested vitamin D plus calcium against placebo). Of the seven available definitions, three were based on low lean mass alone (Baumgartner, Delmonico 1 and 2) and four required both low muscle mass and decreased performance in a functional test (Fielding, Cruz-Jentoft, Morley, Muscaritoli). The two related definitions were based on low lean mass alone (Studenski 1) and low lean mass contributing to weakness (Studenski 2).
Results
Among 445 participants, 231 fell, sustaining 514 falls over the 3-year follow-up. The prospective rate of falls in sarcopenic versus non-sarcopenic individuals was best predicted by the Baumgartner definition based on low lean mass alone (RR = 1.54; 95 % CI 1.09–2.18) with 11 % prevalence of sarcopenia and the Cruz-Jentoft definition based on low lean mass plus decreased functional performance (RR = 1.82; 95 % CI 1.24–2.69) with 7.1 % prevalence of sarcopenia. Consistently, fall rate was non-significantly higher in sarcopenic versus non-sarcopenic individuals based on the definitions of Delmonico 1, Fielding, and Morley.
Conclusion
Among the definitions investigated, the Baumgartner definition and the Cruz-Jentoft definition had the highest validity for predicting the rate of falls.
This is a preview of subscription content, access via your institution.

References
Eberstadt N, Groth H. Europe’s coming demographic challenge: unlocking the value of health. American Enterprise Institute for Health Policy Research. 2007
Book S. Alliance for aging research. http://www.agingresearch.org. 2013
Commission E. Healthy ageing: a keystone of a sustainable Europe. http://ec.europa.eu/health/ph_information/indicators/docs/healthy_ageing_en.pdf. 2007
Visser M, Schaap LA (2011) Consequences of sarcopenia. Clin Geriatr Med 27(3):387–399
Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R (2004) The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 52(1):80–85
WHO. A glossary of terms for community health care and services. http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf. 2004
CDC. The state of aging and health in America 2013. http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf. 2013
Commission E. Healthy ageing: a key stone for a sustainable Europe. http://ec.europa.eu/health/archive/ph_information/indicators/docs/healthy_ageing_en.pdf. 2007
Motion Ai. Aging in motion: the facts about sarcopenia. http://www.aginginmotion.org/wpcontent/uploads/2011/04/sarcopenia_fact_sheet.pdf. 2013
Sayer AA (2010) Sarcopenia. BMJ 341:c4097
Evans WJ. Endpoints and indicators for the older population. http://www.ema.europa.eu/docs/en_GB/document_library/Presentation/2012/04/WC500125114.pdf. 2012
Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156
van Kan Abellan G, Andre E, Bischoff Ferrari HA (2009) Carla task force on sarcopenia: propositions for clinical trials. J Nutr Health Aging 13(8):700–707
Visser M (2009) Towards a definition of sarcopenia—results from epidemiologic studies. J Nutr Health Aging 13(8):713–716
Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423
Fielding RA, Vellas B, Evans WJ et al (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(4):249–256
Morley JE, Abbatecola AM, Argiles JM et al (2011) Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 12(6):403–409
Vellas B, Pahor M, Manini T et al (2013) Designing pharmaceutical trials for sarcopenia in frail older adults: EU/US task force recommendations. J Nutr Health Aging 17(7):612–618
Studenski S (2009) What are the outcomes of treatment among patients with sarcopenia? J Nutr Health Aging 13(8):733–736
Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS (2001) Sarcopenia. J Lab Clin Med 137(4):231–243
Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147(8):755–763
Delmonico MJ, Harris TB, Lee JS et al (2007) Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc 55(5):769–774
Delmonico MJ, Harris TB, Visser M et al (2009) Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90(6):1579–1585
Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127(5 Suppl):990S–991S
von Haehling S, Morley JE, Anker SD (2010) An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachex Sarcopenia Muscle 1(2):129–133
Lang T, Streeper T, Cawthon P, Baldwin K, Taaffe DR, Harris TB (2010) Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporos Int 21(4):543–559
Muscaritoli M, Anker SD, Argiles J et al (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 29(2):154–159
Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and nonfatal falls among older adults. Injur Prevent 12:290–295, 2006
Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P (2001) Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 54(8):837–844
Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284
Sterling DA, O’Connor JA, Bonadies J (2001) Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma 50(1):116–119
Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41(5):733–746
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676
Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B (2006) Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med 166(4):424–430
Buchner DM, Hornbrook MC, Kutner NG et al (1993) Development of the common data base for the FICSIT trials. J Am Geriatr Soc 41(3):297–308
Preece MA, O’Riordan JL, Lawson DE, Kodicek E (1974) A competitive protein-binding assay for 25-hydroxycholecalciferol and 25-hydroxyergocalciferol in serum. Clin Chim Acta 54(2):235–242
Gallagher D, Visser M, De Meersman RE et al (1997) Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol 83(1):229–239
Pichard C, Kyle UG, Bracco D, Slosman DO, Morabia A, Schutz Y (2000) Reference values of fat-free and fat masses by bioelectrical impedance analysis in 3393 healthy subjects. Nutrition (Burbank, Los Angeles County, Calif) 16(4):245–254
Kelly TL, Wilson KE, Heymsfield SB (2009) Dual energy X-ray absorptiometry body composition reference values from NHANES. PLoS One 4(9):e7038
Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50(5):889–896
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(5):547–558
Visser M, Deeg DJ, Lips P, Harris TB, Bouter LM (2000) Skeletal muscle mass and muscle strength in relation to lower-extremity performance in older men and women. J Am Geriatr Soc 48(4):381–386
Scott D, Hayes A, Sanders KM, Aitken D, Ebeling PR, Jones G (2014) Operational definitions of sarcopenia and their associations with 5-year changes in falls risk in community-dwelling middle-aged and older adults. Osteoporos Int 25(1):187–193
Murphy RA, Ip EH, Zhang Q et al (2014) Transition to sarcopenia and determinants of transitions in older adults: a population-based study. J Gerontol A Biol Sci Med Sci 69(6):751–758
Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Stud Group Osteop Int 4(6):368–381
Correa-de-Araujo R, Hadley E (2014) Skeletal muscle function deficit: a new terminology to embrace the evolving concepts of sarcopenia and age-related muscle dysfunction. J Gerontol A Biol Sci Med Sci 69(5):591–594
Cummings SR, Nevitt MC, Kidd S (1988) Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 36(7):613–616
Bischoff-Ferrari HA (2011) The role of falls in fracture prediction. Curr Osteoporos Rep 9(3):116–121
Newman AB, Kupelian V, Visser M et al (2003) Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 51(11):1602–1609
Funding sources
The study was funded by the Baugarten Foundation and the International Foundation for the Promotion of Nutrition Research and Nutrition Education.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bischoff-Ferrari, H.A., Orav, J.E., Kanis, J.A. et al. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 26, 2793–2802 (2015). https://doi.org/10.1007/s00198-015-3194-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-015-3194-y
Keywords
- Community-dwelling seniors
- Comparative performance
- Falls
- Prevalence
- Sarcopenia