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Prevalence of Sarcopenia and Relationships Between Muscle and Bone in Indian Men and Women

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Abstract

Both ethnicity and age are important determinants of musculoskeletal health. We aimed to determine the prevalence of sarcopenia, assess the suitability of current diagnostic guidelines, and explore muscle-bone relationships in adults from India. A total of 1009 young (20–35 years) and 1755 older (> 40 years) men and women from existing studies were collated and pooled for the analysis. Dual-energy x-ray absorptiometry measured areal bone mineral density (aBMD) at the hip and spine, and fat and lean mass; hand dynamometer measured hand grip strength (HGS). Indian-specific cut-points for appendicular lean mass (ALM), ALM index (ALMI) and HGS were calculated from young Indian (-2SD mean) populations. Sarcopenia was defined using cut-points from The Foundations for the National Institutes of Health (FNIH), revised European Working Group on Sarcopenia in Older People (EWGSOP2), Asian Working Group for Sarcopenia (AWGS), and Indian-specific cut-points. Low lean mass cut-points were then compared for their predictive ability in identifying low HGS. The relationship between muscle variables (ALM, ALMI, HGS) and aBMD was explored, and sex differences were tested. Indian-specific cut-points (men-HGS:22.93 kg, ALM:15.41 kg, ALMI:6.03 kg/m2; women-HGS:10.76 kg, ALM:9.95 kg, ALMI:4.64 kg/m2) were lower than existing definitions. The Indian-specific definition had the lowest, while EWGSOP2 ALMI had the highest predictive ability in detecting low HGS (men:AUC = 0.686, women:AUC = 0.641). There were sex differences in associations between aBMD and all muscle variables, with greater positive associations in women than in men. The use of appropriate cut-points for diagnosing low lean mass and physical function is necessary in ethnic populations for accurate sarcopenia assessment. Muscle-bone relationships are more tightly coupled during ageing in Indian women than men.

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Funding

This work was supported by the Australian Academy of Sciences, Australia-India Early and Mid-Career Fellowships (AZ). The third survey wave of APCAPS was funded by Wellcome Trust Strategic Award (084774). IMS was funded by the Wellcome Trust project Grant (GR070797MF). NDBC was funded by the Indian Council of Medical Research, British Heart Foundation, the Wellcome Trust UK, the Medical Research Council UK, the National Institute for Health Research Nutrition and Metabolism Biomedical Research Unit, University of Southampton and the National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford.

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Authors and Affiliations

  1. Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Clayton, VIC, Australia

    Ayse Zengin, David Scott & Peter R. Ebeling

  2. Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India

    Bharati Kulkarni

  3. Hirabai Cowasji Jehangir Medical Research Institute, Pune, India

    Anuradha V. Khadilkar, Neha Kajale & Veena Ekbote

  4. Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India

    Nikhil Tandon

  5. Department of Paediatrics, Sunder Lal Jain Hospital, New Delhi, India

    Santosh K. Bhargava

  6. Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India

    Harshpal Singh Sachdev & Shikha Sinha

  7. Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School – Western Campus, The University of Melbourne, St Albans, VIC, Australia

    David Scott

  8. Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia

    David Scott

  9. Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK

    Sanjay Kinra

  10. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK

    Caroline H. D. Fall

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  1. Ayse Zengin
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  2. Bharati Kulkarni
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Contributions

AZ, BK, AVK, NK, VE, NT, SKB, HSS, SS, SK, CHDF and PRE designed and conducted the study; AZ, BK, NK, SS, DS and PRE analysed the data; AZ, BK, AVK, NK, VE, NT, SKB, HSS, SS, SK, DS, CHDF and PRE interpreted the data; AZ, BK, AVK, NK, VE, NT, SKB, HSS, SS, SK, DS, CHDF and PRE prepared the manuscript and are responsible for the final content. All authors read and approved the final manuscript.

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Correspondence to Ayse Zengin.

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All studies received ethics approval, please see Methods for further details.

Human and Animal Rights and Informed Consent

Informed consent was obtained from all individual participants included in the study. All studies were performed in line with the principles of the Declaration of Helsinki. Approval was granted by Ethics Committees for each study, further details can be found in the Study Design, containing details on each study.

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Zengin, A., Kulkarni, B., Khadilkar, A.V. et al. Prevalence of Sarcopenia and Relationships Between Muscle and Bone in Indian Men and Women. Calcif Tissue Int 109, 423–433 (2021). https://doi.org/10.1007/s00223-021-00860-1

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