Clinical Manifestations and Factors Associated with Osteosarcopenic Obesity Syndrome: A Cross-Sectional Study in Koreans with Obesity


Demonstrating the clinical consequences of osteosarcopenic obesity (OSO) is complex. This study evaluated clinical manifestations and factors associated with bone and muscle loss in Koreans with obesity. This cross-sectional observational study enrolled Koreans with obesity aged ≥ 50 years from the Korea National Health and Nutrition Examination Survey. Clinical manifestations were compared among four groups: obesity (O), sarcopenic obesity (SO), osteopenic obesity (OO), and OSO. Factors associated with appendicular skeletal muscle mass (ASM) or bone mineral density (BMD) were evaluated. OSO increases with age in both sexes. Men with SO and OSO had increased cardiometabolic diseases and markers, percentages of body fat (BF %), and trunk fat (TF %), and decreased limb fat percentage (LF %). Women with SO and OSO had increased metabolic markers, BF %, and TF % but those with OSO had increased cardiometabolic diseases and lower LF %. Both sexes with OSO had decreased ASM and vitamin D, and higher vitamin D deficiency. BF % was negatively associated with ASM and femur BMD in both sexes. TF % was negatively and LF % was positively associated with ASM in both sexes and with femur BMD in women. Vitamin D was positively associated with femur BMD in men and with ASM and BMD at all sites in women. ASM and BMD were positively associated with each other. Appendicular muscle loss is metabolically significant regardless of bone loss in men; however, appendicular muscle loss with bone loss is metabolically more significant in women. Regional body composition, fat distribution, and vitamin D deficiency were associated with OSO phenotype in both sexes.

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Fig. 1



Alanine aminotransferase


Appendicular skeletal muscle mass


Aspartate aminotransferase

BF %:

Body fat percentage


Bone mineral density


Body mass index


Confidence interval




Cerebrovascular accident


Diastolic blood pressure


Dual-energy X-ray absorptiometry


Fat mass




Glycated hemoglobin


High-density lipoprotein cholesterol




Homeostasis model assessment of insulin resistance






Intact parathyroid hormone


Korea National Health and Nutrition Examination Surveys


Low-density lipoprotein cholesterol

LF %:

Limb fat percentage


Lean mass


Metabolic syndrome


Myocardial infarction








Osteopenic obesity


Osteosarcopenic obesity


Systolic blood pressure


Standard deviation


Sarcopenic obesity


Total cholesterol

TF %:

Trunk fat percentage




Type 2 diabetes


Waist circumference




25-hydroxyvitamin D


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We wish to acknowledge the Korea Centers for Disease Control and Prevention who performed the KNHANES. This work was supported by research fund of Catholic Kwandong University (CKURF-201805490001).

Author information




YMK and SK set up the study, analyzed the data, and wrote the manuscript. YJW and SHK contributed to the data analysis and reviewed/edited the manuscript. All authors contributed to the interpretation of results, critically revised the manuscript, and approved the final manuscript. SHK was the guarantor.

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Correspondence to Se Hwa Kim.

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Yoo Mee Kim, Sunghoon Kim, Young Jun Won, and Se Hwa Kim confirm that they have no conflict of interest related to this study.

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All procedures on participants were performed in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Each participant gave written informed consent.

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Kim, Y.M., Kim, S., Won, Y.J. et al. Clinical Manifestations and Factors Associated with Osteosarcopenic Obesity Syndrome: A Cross-Sectional Study in Koreans with Obesity. Calcif Tissue Int 105, 77–88 (2019).

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  • Appendicular skeletal muscle mass
  • Bone mineral density
  • Body fat
  • Bone loss
  • Muscle loss
  • Osteosarcopenic obesity