Skip to main content


Log in

Association of possible sarcopenic obesity with osteoporosis and fragility fractures in postmenopausal women

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript



Possible sarcopenic obese women had a decreased likelihood of osteoporosis but an increased likelihood of fragility fractures compared with non-sarcopenic non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese women had lower values of trabecular bone score than non-sarcopenic non-obese and sarcopenia-only women.


The coexistence of possible sarcopenia and obesity may have opposing effects on osteoporosis. This study aimed to investigate whether possible sarcopenic obesity is associated with osteoporosis or fragility fracture.


In this cross-sectional study of 1007 postmenopausal women from Taiwan, bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry (DXA), and bone microarchitecture was evaluated using the trabecular bone score (TBS) derived from a lumbar spine image acquired by DXA. According to the definition of sarcopenia by the 2019 Asian Working Group for Sarcopenia, possible sarcopenia was defined by either low muscle strength or reduced physical performance. Obesity was defined as a body mass index of ≥ 27 kg/m2. Based on the presence of possible sarcopenia and obesity, study participants were classified as follows: control (non-sarcopenic non-obese), sarcopenic (non-obese), obese (non-sarcopenic), and sarcopenic obese. Prevalent fragility fractures were determined by retrospectively reviewing medical records.


In this study, 10.1% of participants were classified as sarcopenic obese, 9.1% as obese, 35.2% as sarcopenic, and 45.6% as control. Relative to the control group, the sarcopenic obese group (OR, 0.28; 95% CI 0.18, 0.46) and obese group (OR, 0.38; 95% CI 0.23, 0.61) had a decreased likelihood of osteoporosis. However, the sarcopenic obese group (OR, 2.29; 95% CI 1.31, 4.00) and obese group (OR, 1.94; 95% CI 1.04, 3.62) had an increased likelihood of fragility fractures than with the control group. In addition, the sarcopenic obese group had a higher likelihood of fragility fractures than the sarcopenic group. Possible sarcopenic obese women also had significantly lower TBS values than those in the control and sarcopenic groups.


Possible sarcopenic obese women had a lower likelihood of osteoporosis but a higher likelihood of fragility fractures than non-sarcopenic non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese individuals had lower values of TBS than non-sarcopenic non-obese and sarcopenia-only women.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.


  1. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS et al (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15(2):95–101.

    Article  PubMed  Google Scholar 

  2. Edwards MH, Gregson CL, Patel HP, Jameson KA, Harvey NC, Sayer AA et al (2013) Muscle size, strength, and physical performance and their associations with bone structure in the Hertfordshire Cohort Study. J Bone Miner Res 28(11):2295–2304.

    Article  PubMed  Google Scholar 

  3. Lima RM, de Oliveira RJ, Raposo R, Neri SGR, Gadelha AB (2019) Stages of sarcopenia, bone mineral density, and the prevalence of osteoporosis in older women. Arch Osteoporos 14(1):38.

    Article  PubMed  Google Scholar 

  4. Locquet M, Beaudart C, Reginster JY, Bruyere O (2019) Association between the decline in muscle health and the decline in bone health in older individuals from the SarcoPhAge Cohort. Calcif Tissue Int 104(3):273–284.

    Article  CAS  PubMed  Google Scholar 

  5. Ribot C, Pouilles JM, Bonneu M, Tremollieres F (1992) Assessment of the risk of post-menopausal osteoporosis using clinical factors. Clin Endocrinol (Oxf) 36(3):225–228.

    Article  CAS  PubMed  Google Scholar 

  6. Chung JH, Hwang HJ, Shin HY, Han CH (2016) Association between sarcopenic obesity and bone mineral density in middle-aged and elderly Korean. Ann Nutr Metab 68(2):77–84.

    Article  CAS  PubMed  Google Scholar 

  7. Scott D, Chandrasekara SD, Laslett LL, Cicuttini F, Ebeling PR, Jones G (2016) Associations of sarcopenic obesity and dynapenic obesity with bone mineral density and incident fractures over 5–10 years in community-dwelling older adults. Calcif Tissue Int 99(1):30–42.

    Article  CAS  PubMed  Google Scholar 

  8. Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG et al (2017) Sarcopenic obesity and its temporal associations with changes in bone mineral density, incident falls, and fractures in older men: the concord health and ageing in men project. J Bone Miner Res 32(3):575–583.

    Article  CAS  PubMed  Google Scholar 

  9. Gandham A, Mesinovic J, Jansons P, Zengin A, Bonham MP, Ebeling PR et al (2021) Falls, fractures, and areal bone mineral density in older adults with sarcopenic obesity: a systematic review and meta-analysis. Obes Rev 22(5):e13187.

    Article  CAS  PubMed  Google Scholar 

  10. Donini LM, Busetto L, Bauer JM, Bischoff S, Boirie Y, Cederholm T et al (2020) Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clin Nutr 39(8):2368–2388.

    Article  PubMed  Google Scholar 

  11. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48(1):16–31.

    Article  PubMed  Google Scholar 

  12. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K et al (2020) Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 21(3):300–7.e2.

    Article  PubMed  Google Scholar 

  13. Lin YH, Chen HC, Hsu NW, Chou P, Teng MMH (2021) Hand grip strength in predicting the risk of osteoporosis in Asian adults. J Bone Miner Metab 39(2):289–294.

    Article  PubMed  Google Scholar 

  14. Lin YH, Teng MMH (2020) Comparing self-assessment, functional, and anthropometric techniques in predicting osteoporosis. Arch Osteoporos 15(1):132.

    Article  PubMed  Google Scholar 

  15. Stuck AK, Bachmann M, Füllemann P, Josephson KR, Stuck AE (2020) Effect of testing procedures on gait speed measurement: a systematic review. PLoS ONE 15(6):e0234200.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bohannon RW (2008) Population representative gait speed and its determinants. J Geriatr Phys Ther 31(2):49–52.

    Article  PubMed  Google Scholar 

  17. Chang HT, Hsu NW, Chen HC, Tsao HM, Lo SS, Chou P (2018) Associations between body mass index and subjective health outcomes among older adults: findings from the Yilan study, Taiwan. Int J Environ Res Public Health. 15(12):2645.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N et al (2014) Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 29(3):518–530.

    Article  PubMed  Google Scholar 

  19. (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–95.

  20. Krohn K, Schwartz EN, Chung YS, Lewiecki EM (2019) Dual-energy X-ray absorptiometry monitoring with trabecular bone score: 2019 ISCD official position. J Clin Densitom 22(4):501–505.

    Article  PubMed  Google Scholar 

  21. Shevroja E, Aubry-Rozier B, Hans G, Gonzalez- Rodriguez E, Stoll D, Lamy O et al (2019) Clinical performance of the updated trabecular bone score (TBS) algorithm, which accounts for the soft tissue thickness: the OsteoLaus study. J Bone Miner Res 34(12):2229–2237.

    Article  PubMed  Google Scholar 

  22. Cohen A, Dempster DW, Recker RR, Lappe JM, Zhou H, Zwahlen A et al (2013) Abdominal fat is associated with lower bone formation and inferior bone quality in healthy premenopausal women: a transiliac bone biopsy study. J Clin Endocrinol Metab 98(6):2562–2572.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Zhang P, Peterson M, Su GL, Wang SC (2015) Visceral adiposity is negatively associated with bone density and muscle attenuation. Am J Clin Nutr 101(2):337–343.

    Article  CAS  PubMed  Google Scholar 

  24. Andersen S, Frederiksen KD, Hansen S, Brixen K, Gram J, Støving RK (2014) Bone structure and estimated bone strength in obese patients evaluated by high-resolution peripheral quantitative computed tomography. Calcif Tissue Int 95(1):19–28.

    Article  CAS  PubMed  Google Scholar 

  25. Sornay-Rendu E, Boutroy S, Vilayphiou N, Claustrat B, Chapurlat RD (2013) In obese postmenopausal women, bone microarchitecture and strength are not commensurate to greater body weight: the Os des Femmes de Lyon (OFELY) study. J Bone Miner Res 28(7):1679–1687.

    Article  CAS  PubMed  Google Scholar 

  26. Evans AL, Paggiosi MA, Eastell R, Walsh JS (2015) Bone density, microstructure and strength in obese and normal weight men and women in younger and older adulthood. J Bone Miner Res 30(5):920–928.

    Article  PubMed  Google Scholar 

  27. Shapses SA, Pop LC, Wang Y (2017) Obesity is a concern for bone health with aging. Nutr Res 39:1–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV et al (2006) (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61(10):1059–1064.

    Article  PubMed  Google Scholar 

  29. Bohannon RW (2019) Grip strength: an indispensable biomarker for older adults. Clin Interv Aging 14:1681–1691.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references


This work was supported by grants CHGH110-(N)20 and CHGH111-(N)21 from the Cheng Hsin General Hospital, Taipei, Taiwan.

Author information

Authors and Affiliations



Yen-Huai Lin and Michael Mu Huo Teng initiated the study, and all authors contributed to its design. Yen-Huai Lin and Michael Mu Huo Teng managed the data collection, performed the data analysis, and wrote the first draft of the manuscript. Yen-Huai Lin and Michael Mu Huo Teng are collectively responsible for interpreting the results and critically reviewed subsequent drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael Mu Huo Teng.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants 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. This study was approved by the institutional review board of Cheng Hsin General Hospital (IRB no. (660)107A-32).

Consent to participate

Informed consent was obtained from all the participants included in the study.

Conflict of interest


Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, YH., Teng, M.M.H. Association of possible sarcopenic obesity with osteoporosis and fragility fractures in postmenopausal women. Arch Osteoporos 17, 65 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: