Skip to main content
Log in

Gender-Specific Associations of Appendicular Muscle Mass with BMD in Elderly Italian Subjects

Calcified Tissue International Aims and scope Submit manuscript

Cite this article


Currently used diagnostic measures for sarcopenia are based on the evaluation of appendicular skeletal muscle mass (ASMM) divided by height-squared (ASMMI). This study aimed to investigate the associations between different operational definitions of appendicular muscle mass and BMD at different skeletal sites in aging Italian men and women. In 1199 consecutive healthy Italian subjects, aged 55 years or more (854 women, age 64.2 ± 6.4 years and 165 men, age 65.3 ± 6.1 years), we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD),at total hip (TH-BMD), at total body (WB-BMD) and at the right hand (H-BMD) and body composition parameters [ASMM, ASMMI, ASMM/Weight, total lean mass and total fat mass by DXA]. In all subjects, we also measured sex hormones, 25-hydroxyvitamin D and bone turnover markers. In men, both ASMM and ASMMI were positively correlated with BMD at all sites, whereas in women, ASMM and ASMMI did not show any significant correlation with BMD. In men, multiple regression analyses showed that ASMM was positively associated (p < 0.01) with FN-BMD, TH-BMD and H-BMD; however, these associations were no longer present when lean mass was included. In women, both fat mass and lean mass were found positively associated with BMD at all sites. In conclusion, among the different operational measures of the ASMM, only ASMM was significantly associated with BMD in elderly men, but not in elderly women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others


  1. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 285:785–795

    Article  Google Scholar 

  2. WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129

    Google Scholar 

  3. Felson DT, Zhang Y, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573

    Article  PubMed  CAS  Google Scholar 

  4. Khosla S, Atkinson EJ, Riggs BL, Melton LJ 3rd (1996) Relationship between body composition and bone mass in women. J Bone Miner Res 11:857–863

    Article  PubMed  CAS  Google Scholar 

  5. Nguyen TV, Center JR, Eisman JA (2000) Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index. J Bone Miner Res 15:322–331

    Article  PubMed  CAS  Google Scholar 

  6. Wang MC, Bachrach LK, Van Loan M, Hudes M, Flegal KM, Crawford PB (2005) The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone 37:474–481

    Article  PubMed  CAS  Google Scholar 

  7. Gonnelli S, Caffarelli C, Del Santo K, Cadirni A, Guerriero C, Lucani B, Franci B, Nuti R (2008) The relationship of ghrelin and adiponectin with bone mineral density and bone turnover markers in elderly men. Calcif Tissue Int 83:55–60

    Article  PubMed  CAS  Google Scholar 

  8. Reid IR (2010) Fat and Bone. Arch Biochem Biopsy 503:20–27

    Article  CAS  Google Scholar 

  9. Yoo HJ, Park MS, Yang SJ, Kim TN, Lim KI, Kang HJ, Song W, Baik SH, Choi DS, Choi KM (2012) The differential relationship between fat mass and bone mineral density by gender and menopausal status. J Bone Miner Metab 30:47–53

    Article  PubMed  Google Scholar 

  10. Gonnelli S, Caffarelli C, Tanzilli L, Alessi C, Tomai Pitinca MD, Rossi S, Campagna MS, Nuti R (2013) The associations of body composition and fat distribution with bone mineral density in elderly Italian men and women. J Clin Densitom 16:168–177

    Article  PubMed  Google Scholar 

  11. Zhao LJ, Jiang H, Papasian CJ, Maulik D, Drees B, Hamilton J, Deng HW (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23:17–29

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Choi HS, Kim KJ, Kim KM, Hur NW, Rhee Y, Han DS, Lee EJ, Lim SK (2010) Relationship between visceral adiposity and bone mineral density in Korean adults. Calcif Tissue Int 87:218–225

    Article  PubMed  CAS  Google Scholar 

  13. Pluijm SM, Visser M, Smit JH, Popp-Snijders C, Roos JC, Lips P (2001) Determinants of bone mineral density in older men and women: body composition as mediator. J Bone Miner Res 16:2142–2151

    Article  PubMed  CAS  Google Scholar 

  14. Genaro PS, Pereira GA, Pinheiro MM, Szejnfeld VL, Martini LA (2010) Influence of body composition on bone mass in postmenopausal osteoporotic women. Arch Gerontol Geriatr 51:295–298

    Article  PubMed  Google Scholar 

  15. Verschueren S, Gielen E, O’Neill TW, Pye SR, Adams JE, Ward KA, Wu FC, Szulc P, Laurent M, Claessens F, Vanderschueren D, Boonen S (2013) Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men. Osteoporos Int 24:87–98

    Article  PubMed  CAS  Google Scholar 

  16. Kirchengast S, Huber J (2012) Sex-specific associations between soft tissue body composition and bone mineral density among older adults. Ann Hum Biol 39:206–213

    Article  PubMed  Google Scholar 

  17. Shin D, Kim S, Kim KH, Park SM (2014) Importance of fat mass and lean mass on bone health in men: the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Osteoporos Int 25:467–474

    Article  PubMed  CAS  Google Scholar 

  18. Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127(5 Suppl):990S–991S

    PubMed  CAS  Google Scholar 

  19. Cooper C, Dere W, Evans W, Kanis JA, Rizzoli R, Sayer AA, Sieber CC, Kaufman JM, Abellan van Kan G, Boonen S, Adachi J, Mitlak B, Tsouderos Y, Rolland Y, Reginster JY (2012) Frailty and sarcopenia: definitions and outcome parameters. Osteoporos Int 23:1839–1848

    Article  PubMed  CAS  Google Scholar 

  20. Abellan van Kan G, Houles M, Vellas B (2012) Identifying sarcopenia. Curr Opin Clin Nutr Metab Care 15:436–441

    Article  PubMed  Google Scholar 

  21. Clark BC, Manini TM (2008) Sarcopenia =/= dynapenia. J Gerontol A Biol Sci Med Sci 63:829–834

    Article  PubMed  Google Scholar 

  22. 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 25:187–193

    Article  PubMed  CAS  Google Scholar 

  23. Coin A, Sarti S, Ruggiero E, Giannini S, Pedrazzoni M, Minisola S, Rossini M, Del Puente A, Inelmen EM, Manzato E, Sergi G (2013) Prevalence of sarcopenia based on different diagnostic criteria using DEXA and appendicular skeletal muscle mass reference values in an Italian population aged 20 to 80. J Am Med Dir Assoc 14:507–512

    Article  PubMed  Google Scholar 

  24. Huh JH, Song MK, Park KH, Kim KJ, Kim JE, Rhee YM, Lim SK (2014) Gender-specific pleiotropic bone-muscle relationship in the elderly from a nationwide survey (KNHANES IV). Osteoporos Int 25:1053–1061

    Article  PubMed  CAS  Google Scholar 

  25. Brownbill RA, Ilich JZ (2002) Validation of the use of the hand for estimating bone mineral density in other skeletal sites by DXA in healthy and osteoarthritic women. J Clin Densitom 5:273–282

    Article  PubMed  Google Scholar 

  26. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763

    Article  PubMed  CAS  Google Scholar 

  27. 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 50:889–896

    Article  PubMed  Google Scholar 

  28. Reid IR (2002) Relationships among body mass, its components, and bone. Bone 31:547–555

    Article  PubMed  CAS  Google Scholar 

  29. Karasik D, Kiel DP (2010) Evidence for pleiotropic factors in genetics of the musculoskeletal system. Bone 46:1226–1237

    Article  PubMed  CAS  Google Scholar 

  30. Mudali S, Dobs AS (2004) Effects of testosterone on body composition of the aging male. Mech Ageing Dev 125:297–304

    Article  PubMed  CAS  Google Scholar 

  31. Lee SG, Lee YH, Kim KJ, Lee W, Kwon OH, Kim JH (2013) Additive association of vitamin D insufficiency and sarcopenia with low femoral bone mineral density in non institutionalized elderly population: the Korea National Health and Nutrition Examination Surveys 2009–2010. Osteoporos Int 24:2789–2799

    Article  PubMed  CAS  Google Scholar 

  32. 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 39:412–423

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bijlsma AY, Meskers MC, Molendijk M, Westendorp RG, Sipilä S, Stenroth L, Sillanpää E, McPhee JS, Jones DA, Narici M, Gapeyeva H, Pääsuke M, Seppet E, Voit T, Barnouin Y, Hogrel JY, Butler-Browne G, Maier AB (2013) Diagnostic measures for sarcopenia and bone mineral density. Osteoporos Int 24:2681–2691

    Article  PubMed  CAS  Google Scholar 

  34. Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R (2012) Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients. Arch Gerontol Geriatr 55:48–52

    Article  Google Scholar 

  35. Woods JL, Woods JL, Iuliano-Burns S, Walker KZ (2011) Weight loss in elderly women in low-level care and its association with transfer to high-level care and mortality. Clin Interv Aging 6:311–317

    PubMed  PubMed Central  Google Scholar 

  36. Sjöblom S, Suuronen J, Rikkonen T, Honkanen R, Kröger H, Sirola J (2013) Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas 75:175–180

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

S. Gonnelli, C. Caffarelli, S. Cappelli, S. Rossi, N. Giordano, and R. Nuti declare that they have nothing to disclose.

Human and Animal Rights and Informed Consent

All procedures performed in the present study 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. Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to S. Gonnelli.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gonnelli, S., Caffarelli, C., Cappelli, S. et al. Gender-Specific Associations of Appendicular Muscle Mass with BMD in Elderly Italian Subjects. Calcif Tissue Int 95, 340–348 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: