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Body Composition and Falls Risk in Older Adults

  • Cecilia Xu
  • Peter R. Ebeling
  • David ScottEmail author
Physical Therapy and Rehabilitation (O Addison, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Physical Therapy and Rehabilitation

Abstract

Purpose of Review

To explore evidence for associations between body composition and falls in older adults and interventions that may reduce falls through improving body composition.

Recent Findings

Both sarcopenia (low skeletal muscle mass, strength and quality) and obesity appear to increase falls risk, but relationships with falls-related injury may differ. Nevertheless, perceptions of obesity as a protective factor for fractures have been challenged in recent years. Emerging research suggests that combined entities such as sarcopenic obesity also increase risk of falls, although effects of conditions such as osteosarcopenic obesity are yet to be determined. While lifestyle interventions targeting physical function reduce falls risk, it is unclear whether changes in body composition alone are beneficial.

Summary

Obesity and sarcopenia are important risk factors for falls in older adults. Further research is required to clarify the effects of combined conditions on falls and to evaluate whether improved body composition directly prevents falls.

Keywords

Body composition Falls Fracture Sarcopenia Sarcopenic obesity Osteosarcopenic obesity 

Notes

Compliance with Ethical Standards

Conflict of Interest

Cecilia Xu, Peter R. Ebeling and David Scott each declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bergen G, Stevens M, Burns E Falls and fall injuries among adults aged ≥65 years—United States, 2014. Centers for Disease Control and Prevention 2016.Google Scholar
  2. 2.
    Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults—United States. J Saf Res. 2016;58:99–103.CrossRefGoogle Scholar
  3. 3.
    Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma. 2001;50(1):116–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Berry SD, Miller RR. Falls: epidemiology, pathophysiology, and relationship to fracture. Curr Osteoporos Rep. 2008;6(4):149–54.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992-1994. Acad Emerg Med. 2000;7(2):134–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Burns E, Kakara R. Deaths from Falls Among Persons Aged >/=65 Years—United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2018;67:509–514.Google Scholar
  7. 7.
    Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26(3):189–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002;42(1):17–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention. Important facts about falls. Centers for Disease Control; 2017.Google Scholar
  11. 11.
    Frames CW, Soangra R, Lockhart TE, Lach J, Ha DS, Roberto KA, et al. Dynamical properties of postural control in obese community-dwelling older adults (DAGGER). Sensors (Basel) 2018;18(6).Google Scholar
  12. 12.
    Rossi-Izquierdo M, Santos-Perez S, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Gayoso-Diz P, Del-Rio-Valeiras M, et al. Impact of obesity in elderly patients with postural instability. Aging Clin Exp Res. 2016;28(3):423–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Melzer I, Oddsson LI. Altered characteristics of balance control in obese older adults. Obes Res Clin Pract. 2016;10(2):151–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Hita-Contreras F, Martinez-Amat A, Lomas-Vega R, Alvarez P, Mendoza N, Romero-Franco N, et al. Relationship of body mass index and body fat distribution with postural balance and risk of falls in Spanish postmenopausal women. Menopause. 2013;20(2):202–8.PubMedGoogle Scholar
  15. 15.
    Neri SGR, Gadelha AB, Correia ALM, Pereira JC, de David AC, Lima RM. Obesity is associated with altered plantar pressure distribution in older women. J Appl Biomech. 2017;33(5):323–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Garman CR, Franck CT, Nussbaum MA, Madigan ML. A bootstrapping method to assess the influence of age, obesity, gender, and gait speed on probability of tripping as a function of obstacle height. J Biomech. 2015;48(6):1229–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Mignardot JB, Olivier I, Promayon E, Nougier V. Origins of balance disorders during a daily living movement in obese: can biomechanical factors explain everything? PLoS One. 2013;8(4):e60491.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ranavolo A, Donini LM, Mari S, Serrao M, Silvetti A, Iavicoli S, et al. Lower-limb joint coordination pattern in obese subjects. Biomed Res Int. 2013;2013:142323.CrossRefPubMedGoogle Scholar
  19. 19.
    Mitchell RJ, Lord SR, Harvey LA, Close JC. Obesity and falls in older people: mediating effects of disease, sedentary behavior, mood, pain and medication use. Arch Gerontol Geriatr. 2015;60(1):52–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Mitchell RJ, Lord SR, Harvey LA, Close JC. Associations between obesity and overweight and fall risk, health status and quality of life in older people. Aust N Z J Public Health. 2014;38(1):13–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Corbeil P, Simoneau M, Rancourt D, Tremblay A, Teasdale N. Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural Syst Rehabil Eng. 2001;9(2):126–36.CrossRefPubMedGoogle Scholar
  22. 22.
    Himes CL, Reynolds SL. Effect of obesity on falls, injury, and disability. J Am Geriatr Soc. 2012;60(1):124–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Allin LJ, Wu X, Nussbaum MA, Madigan ML. Falls resulting from a laboratory-induced slip occur at a higher rate among individuals who are obese. J Biomech. 2016;49(5):678–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim SY, Kim MS, Sim S, Park B, Choi HG. Association between obesity and falls among Korean adults: a population-based cross-sectional study. Medicine (Baltimore). 2016;95(12):e3130.CrossRefGoogle Scholar
  25. 25.
    • Handrigan GA, Maltais N, Gagne M, Lamontagne P, Hamel D, Teasdale N, et al. Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65 years and older. Osteoporos Int. 2017;28(2):483–94. This large cross-sectional study demonstrated that the effect of BMI on increased risk of falls may be more pronounced in men than in women. CrossRefPubMedGoogle Scholar
  26. 26.
    • Zhang N, Lu SF, Zhou Y, Zhang B, Copeland L, Gurwitz JH. Body mass index, falls, and hip fractures among nursing home residents. J Gerontol A Biol Sci Med Sci. 2018;73(10):1403–9. Demonstrated that newly-admitted nursing home residents with obesity were less likely to fall than non-obese residents, contrary to evidence from older adults in the community. CrossRefPubMedGoogle Scholar
  27. 27.
    Cheung YM, Joham A, Marks S, Teede H. The obesity paradox: an endocrine perspective. Intern Med J. 2017;47(7):727–33.CrossRefPubMedGoogle Scholar
  28. 28.
    De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16(11):1330–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Ishii S, Cauley JA, Greendale GA, Nielsen C, Karvonen-Gutierrez C, Ruppert K, et al. Pleiotropic effects of obesity on fracture risk: the study of women's health across the nation. J Bone Miner Res. 2014;29(12):2561–70.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Xu W, Ni C, Yu R, Gu G, Wang Z, Zheng G. Risk factors for distal radius fracture in postmenopausal women. Orthopade. 2017;46(5):447–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, et al. Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med. 2011;124(11):1043–50.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ebinger T, Koehler DM, Dolan LA, McDonald K, Shah AS. Obesity increases complexity of distal radius fracture in fall from standing height. J Orthop Trauma. 2016;30(8):450–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Mpalaris V, Anagnostis P, Goulis DG, Iakovou I. Complex association between body weight and fracture risk in postmenopausal women. Obes Rev. 2015;16(3):225–33.CrossRefPubMedGoogle Scholar
  34. 34.
    Scott D, Duque G, Ebeling P. Does obesity reduce risk for osteoporosis and fractures in older adults? Intern Med J. 2018;48:104–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Leslie WD, Orwoll ES, Nielson CM, Morin SN, Majumdar SR, Johansson H, et al. Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture. J Bone Miner Res. 2014;29(11):2511–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Bredella MA, Lin E, Gerweck AV, Landa MG, Thomas BJ, Torriani M, et al. Determinants of bone microarchitecture and mechanical properties in obese men. J Clin Endocrinol Metab. 2012;97(11):4115–22.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    •• Li X, Gong X, Jiang W. Abdominal obesity and risk of hip fracture: a meta-analysis of prospective studies. Osteoporos Int. 2017;28(10):2747–57. The largest and most recent meta-analysis to demonstrate that abdominal obesity significantly increases the risk of hip fracture. CrossRefPubMedGoogle Scholar
  38. 38.
    Bani Hassan E, Demontiero O, Vogrin S, Ng A, Duque G. Marrow adipose tissue in older men: association with visceral and subcutaneous fat, bone volume, metabolism, and inflammation. Calcif Tissue Int. 2018;103(2):164–74.CrossRefPubMedGoogle Scholar
  39. 39.
    Patsch JM, Li X, Baum T, Yap SP, Karampinos DC, Schwartz AV, et al. Bone marrow fat composition as a novel imaging biomarker in postmenopausal women with prevalent fragility fractures. J Bone Miner Res. 2013;28(8):1721–8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rosenberg IH. Summary comments. Am J Clin Nutr. 1989;50(5):1231–3.CrossRefGoogle Scholar
  41. 41.
    Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in new Mexico. Am J Epidemiol. 1998;147(8):755–63.CrossRefPubMedGoogle Scholar
  42. 42.
    Szulc P, Beck TJ, Marchand F, Delmas PD. Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men—the MINOS study. J Bone Miner Res. 2005;20(5):721–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R. Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients. Arch Gerontol Geriatr. 2012;55(2):e48–52.CrossRefPubMedGoogle Scholar
  44. 44.
    Scott D, Hayes A, Sanders KM, Aitken D, Ebeling PR, Jones G. Operational definitions of sarcopenia and their associations with 5-year changes in falls risk in community-dwelling middle-aged and older adults. Osteoporos Int. 2014;25(1):187–93.CrossRefPubMedGoogle Scholar
  45. 45.
    Woo N, Kim SH. Sarcopenia influences fall-related injuries in community-dwelling older adults. Geriatr Nurs. 2014;35(4):279–82.CrossRefPubMedGoogle Scholar
  46. 46.
    Sornay-Rendu E, Duboeuf F, Boutroy S, Chapurlat RD. Muscle mass is associated with incident fracture in postmenopausal women: the OFELY study. Bone. 2017;94:108–13.CrossRefPubMedGoogle Scholar
  47. 47.
    Chi AS, Long SS, Zoga AC, Parker L, Morrison WB. Association of gluteus medius and minimus muscle atrophy and fall-related hip fracture in older individuals using computed tomography. J Comput Assist Tomogr. 2016;40(2):238–42.CrossRefPubMedGoogle Scholar
  48. 48.
    Marcell TJ, Hawkins SA, Wiswell RA. Leg strength declines with advancing age despite habitual endurance exercise in active older adults. J Strength Cond Res. 2014;28(2):504–13.CrossRefPubMedGoogle Scholar
  49. 49.
    Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90(6):1579–85.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Visser M, Schaap LA. Consequences of sarcopenia. Clin Geriatr Med. 2011;27(3):387–99.CrossRefPubMedGoogle Scholar
  51. 51.
    Balogun S, Winzenberg T, Wills K, Scott D, Jones G, Aitken D, et al. Prospective associations of low muscle mass and function with 10-year falls risk, incident fracture and mortality in community-dwelling older adults. J Nutr Health Aging. 2017;21(7):843–8.CrossRefPubMedGoogle Scholar
  52. 52.
    • Sim M, Prince RL, Scott D, Daly RM, Duque G, Inderjeeth CA, et al. Utility of four sarcopenia criteria for the prediction of falls-related hospitalization in older Australian women. Osteoporos Int. 2019;30(1):167–76 Prospective study that demonstrated that sarcopenia definitions are not associated with increased falls-related hospitalization in older community-dwelling women.CrossRefPubMedGoogle Scholar
  53. 53.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–56.CrossRefPubMedGoogle Scholar
  54. 54.
    Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol Ser A Biol Sci Med Sci. 2014;69(5):547–58.CrossRefGoogle Scholar
  55. 55.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    •• Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. The most recent consensus definition of sarcopenia, in which there is increased emphasis on muscle function and quality rather than muscle mass alone. CrossRefPubMedGoogle Scholar
  57. 57.
    Lemieux S, Prud'homme D, Bouchard C, Tremblay A, Despres JP. A single threshold value of waist girth identifies normal-weight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr. 1996;64(5):685–93.CrossRefPubMedGoogle Scholar
  58. 58.
    Okorodudu DO, Jumean MF, Montori VM, Romero-Corral A, Somers VK, Erwin PJ, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. Int J Obes. 2010;34:791.CrossRefGoogle Scholar
  59. 59.
    WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser. 1994;843:1–129.Google Scholar
  60. 60.
    Tan LF, Lim ZY, Choe R, Seetharaman S, Merchant R. Screening for frailty and sarcopenia among older persons in medical outpatient clinics and its associations with healthcare burden. J Am Med Dir Assoc. 2017;18(7):583–7.CrossRefPubMedGoogle Scholar
  61. 61.
    • Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG, et al. 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. 2017;32(3):575–83. This prospective study found that sarcopenic obese older men may have increased risk of incident falls compared with non-sarcopenic non-obese men, but not compared with men with obesity or sarcopenia alone. CrossRefPubMedGoogle Scholar
  62. 62.
    Tanimoto Y, Watanabe M, Sun W, Sugiura Y, Hayashida I, Kusabiraki T, et al. Sarcopenia and falls in community-dwelling elderly subjects in Japan: defining sarcopenia according to criteria of the European Working Group on Sarcopenia in Older People. Arch Gerontol Geriatr. 2014;59(2):295–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Yamada M, Nishiguchi S, Fukutani N, Tanigawa T, Yukutake T, Kayama H, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc. 2013;14(12):911–5.CrossRefPubMedGoogle Scholar
  64. 64.
    Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012;31(5):652–8.CrossRefPubMedGoogle Scholar
  65. 65.
    • Zhang X, Huang P, Dou Q, Wang C, Zhang W, Yang Y, et al. Falls among older adults with sarcopenia dwelling in nursing home or community: a meta-analysis. Clin Nutr. 2019. Meta-analysis demonstrating that sarcopenia is a risk factor for falls among community-dwelling older people, but not among nursing home older persons. Google Scholar
  66. 66.
    Landi F, Calvani R, Ortolani E, Salini S, Martone AM, Santoro L, et al. The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int. 2017;28(5):1569–76.CrossRefPubMedGoogle Scholar
  67. 67.
    Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease. Circulation. 2011;124:e837–41.CrossRefPubMedGoogle Scholar
  68. 68.
    Choi SJ, Files DC, Zhang T, Wang ZM, Messi ML, Gregory H, et al. Intramyocellular lipid and impaired myofiber contraction in normal weight and obese older adults. J Gerontol A Biol Sci Med Sci. 2016;71(4):557–64.CrossRefPubMedGoogle Scholar
  69. 69.
    Takegahara Y, Yamanouchi K, Nakamura K, Nakano S, Nishihara M. Myotube formation is affected by adipogenic lineage cells in a cell-to-cell contact-independent manner. Exp Cell Res. 2014;324(1):105–14.CrossRefPubMedGoogle Scholar
  70. 70.
    Tuttle LJ, Sinacore DR, Mueller MJ. Intermuscular adipose tissue is muscle specific and associated with poor functional performance. J Aging Res. 2012;2012:172957.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Hughes VA, Frontera WR, Wood M, Evans WJ, Dallal GE, Roubenoff R, et al. Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health. J Gerontol A Biol Sci Med Sci. 2001;56(5):B209–17.CrossRefPubMedGoogle Scholar
  72. 72.
    Scott D, Trbojevic T, Skinner E, Clark RA, Levinger P, Haines TP, et al. Associations of calf inter- and intra-muscular adipose tissue with cardiometabolic health and physical function in community-dwelling older adults. J Musculoskelet Neuronal Interact. 2015;15(4):350–7.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Anderson DE, Quinn E, Parker E, Allaire BT, Muir JW, Rubin CT, et al. Associations of computed tomography-based trunk muscle size and density with balance and falls in older adults. J Gerontol A Biol Sci Med Sci. 2016;71(6):811–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Marcus RL, Addison O, LaStayo PC. Intramuscular adipose tissue attenuates gains in muscle quality in older adults at high risk for falling. A brief report. J Nutr Health Aging. 2013;17(3):215–8.CrossRefPubMedGoogle Scholar
  75. 75.
    • Scott D, Johansson J, McMillan L, Ebeling PR, Nordstrom A, Nordstrom P. Mid-calf skeletal muscle density and its associations with physical activity, bone health and incident 12-month falls in older adults: the Healthy Ageing Initiative. Bone. 2019;120:446–51. This study reported that higher levels of inter- and intramuscular fat in the lower-limbs are associated with incident falls, and poorer bone health.CrossRefPubMedGoogle Scholar
  76. 76.
    Lang T, Cauley JA, Tylavsky F, Bauer D, Cummings S, Harris TB. Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: the Health, Aging, And Body Composition Study. J Bone Miner Res. 2010;25(3):513–9.CrossRefPubMedGoogle Scholar
  77. 77.
    Inacio M, Ryan AS, Bair WN, Prettyman M, Beamer BA, Rogers MW. Gluteal muscle composition differentiates fallers from non-fallers in community dwelling older adults. BMC Geriatr. 2014;14:1471–2318.CrossRefGoogle Scholar
  78. 78.
    Ilich-Ernst J, Brownbill RA, Ludemann MA, Fu R. Critical factors for bone health in women across the age span: how important is muscle mass? Medscape Womens Health. 2002;7(3):2.PubMedGoogle Scholar
  79. 79.
    Rosen CJ, Bouxsein ML. Mechanisms of disease: is osteoporosis the obesity of bone? Nat Clin Pract Rheumatol. 2006;2(1):35–43.CrossRefGoogle Scholar
  80. 80.
    Ilich JZ, Kelly OJ, Inglis JE, Panton LB, Duque G, Ormsbee MJ. Interrelationship among muscle, fat, and bone: connecting the dots on cellular, hormonal, and whole body levels. Ageing Res Rev. 2014;15:51–60.CrossRefPubMedGoogle Scholar
  81. 81.
    Batsis JA, Barre LK, Mackenzie TA, Pratt SI, Lopez-Jimenez F, Bartels SJ. Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy x-ray absorptiometry data from the national health and nutrition examination survey 1999-2004. J Am Geriatr Soc. 2013;61(6):974–80.CrossRefPubMedGoogle Scholar
  82. 82.
    Aibar-Almazan A, Martinez-Amat A, Cruz-Diaz D, Jimenez-Garcia JD, Achalandabaso A, Sanchez-Montesinos I, et al. Sarcopenia and sarcopenic obesity in Spanish community-dwelling middle-aged and older women: association with balance confidence, fear of falling and fall risk. Maturitas. 2018;107:26–32.CrossRefPubMedGoogle Scholar
  83. 83.
    Meng NH, Li CI, Liu CS, Lin CH, Lin WY, Chang CK, et al. Comparison of height- and weight-adjusted sarcopenia in a Taiwanese metropolitan older population. Geriatr Gerontol Int. 2015;15(1):45–53.CrossRefPubMedGoogle Scholar
  84. 84.
    Waters DL, Hale L, Grant AM, Herbison P, Goulding A. Osteoporosis and gait and balance disturbances in older sarcopenic obese New Zealanders. Osteoporos Int. 2010;21(2):351–7.CrossRefPubMedGoogle Scholar
  85. 85.
    Shin H, Liu PY, Panton LB, Ilich JZ. Physical performance in relation to body composition and bone mineral density in healthy, overweight, and obese postmenopausal women. J Geriatr Phys Ther. 2014;37(1):7–16.CrossRefPubMedGoogle Scholar
  86. 86.
    Pasco J, Sui S, Tembo M, Holloway-Kew K, Rufus P, Kotowicz M. Sarcopenic obesity and falls in the elderly. J Gerontol Geriatr Res. 2018;7(2):465.CrossRefGoogle Scholar
  87. 87.
    Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci. 2000;904:437–48.CrossRefPubMedGoogle Scholar
  88. 88.
    Scott D, Sanders KM, Aitken D, Hayes A, Ebeling PR, Jones G. Sarcopenic obesity and dynapenic obesity: 5-year associations with falls risk in middle-aged and older adults. Obesity (Silver Spring). 2014;22(6):1568–74.CrossRefGoogle Scholar
  89. 89.
    • Follis S, Cook A, Bea J, Going S, Laddu D, Cauley JA, et al. Association between sarcopenic obesity and falls in a multiethnic cohort of postmenopausal women: sarcopenic obesity and falls. J Am Geriatr Soc. 2018;66:106. This study demonstrated that sarcopenic obesity increased the risk of incident falls in postmenopausal women, compared to non-obese, non-sarcopenic postmenopausal women. CrossRefGoogle Scholar
  90. 90.
    Scott D, Chandrasekara SD, Laslett LL, Cicuttini F, Ebeling PR, Jones G. 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. 2016;99(1):30–42.CrossRefPubMedGoogle Scholar
  91. 91.
    Buehring B, Hansen KE, Lewis BL, Cummings SR, Lane NE, Binkley N, et al. Dysmobility syndrome independently increases fracture risk in the osteoporotic fractures in men (MrOS) prospective cohort study. J Bone Miner Res. 2018;33(9):1622–9.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    •• Harris R, Chang Y, Beavers K, Laddu-Patel D, Bea J, Johnson K, et al. Risk of fracture in women with sarcopenia, low bone mass, or both. J Am Geriatr Soc. 2017;65(12):2673–8. Long-term study indicating that sarcopenia does not add additional risk for fracture in women with low BMD. CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Scott D, Seibel M, Cumming R, Blyth F, Waite LM, Naganathan V, et al. Does Combined Osteopenia/Osteoporosis and Sarcopenia Confer Greater Risk of Falls and Fracture Than Either Condition Alone in Older Men? The Concord Health and Ageing in Men Project. J Gerontol: Series A 2019;74:827–834.Google Scholar
  94. 94.
    Chalhoub D, Cawthon PM, Ensrud KE, Stefanick ML, Kado DM, Boudreau R, et al. Risk of nonspine fractures in older adults with sarcopenia, low bone mass, or both. J Am Geriatr Soc. 2015;63(9):1733–40.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Szlejf C, Parra-Rodriguez L, Rosas-Carrasco O. Osteosarcopenic obesity: prevalence and relation with frailty and physical performance in middle-aged and older women. J Am Med Dir Assoc. 2017;18(8):733.e1–5.CrossRefGoogle Scholar
  96. 96.
    Levine JA, Abboud L, Barry M, Reed JE, Sheedy PF, Jensen MD. Measuring leg muscle and fat mass in humans: comparison of CT and dual-energy x-ray absorptiometry. J Appl Physiol (1985). 2000;88(2):452–6.CrossRefGoogle Scholar
  97. 97.
    Reiss J, Iglseder B, Kreutzer M, Weilbuchner I, Treschnitzer W, Kassmann H, et al. Case finding for sarcopenia in geriatric inpatients: performance of bioimpedance analysis in comparison to dual x-ray absorptiometry. BMC Geriatr. 2016;16:52.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Clark RV, Walker AC, Miller RR, O'Connor-Semmes RL, Ravussin E, Cefalu WT. Creatine (methyl-d3) dilution in urine for estimation of total body skeletal muscle mass: accuracy and variability vs. MRI and DXA. J Appl Physiol (1985). 2018;124(1):1–9.CrossRefGoogle Scholar
  99. 99.
    Malmstrom TK, Morley JE. Sarc-f: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013;14(8):531–2.CrossRefPubMedGoogle Scholar
  100. 100.
    Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community screening tool for sarcopenia? J Am Med Dir Assoc. 2014;15(9):630–4.CrossRefPubMedGoogle Scholar
  101. 101.
    Beaudart C, McCloskey E, Bruyère O, Cesari M, Rolland Y, Rizzoli R, et al. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016;16(1):170.CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, O’Loughlin P, et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LIFE study): randomised parallel trial. Br Med J. 2012;345:e4547.CrossRefGoogle Scholar
  103. 103.
    Papa EV, Dong X, Hassan M. Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clin Interv Aging. 2017;12:955–61.CrossRefPubMedPubMedCentralGoogle Scholar
  104. 104.
    Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc. 2011;43(2):249–58.CrossRefPubMedPubMedCentralGoogle Scholar
  105. 105.
    •• Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019(1). This recent Cochrane review of exercise for preventing falls in older adults recommended functional and resistance exercises as interventions with good evidence for reducing falls risk. Google Scholar
  106. 106.
    Daly RM. Exercise and nutritional approaches to prevent frail bones, falls and fractures: an update. Climacteric. 2017;20(2):119–24.CrossRefPubMedGoogle Scholar
  107. 107.
    •• Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211–20. A randomised controlled trial that demonstrated that high-velocity resistance training and impact exercise improved both BMD and physical performance in postmenopausal women. CrossRefPubMedGoogle Scholar
  108. 108.
    Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Sanders KM, Hill K, et al. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. J Bone Miner Res. 2014;29:182–91.CrossRefPubMedGoogle Scholar
  109. 109.
    Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Gunawardene P, et al. Comprehensive nutritional status in sarco-osteoporotic older fallers. J Nutr Health Aging. 2015;19(4):474–80.CrossRefPubMedGoogle Scholar
  110. 110.
    Jyvakorpi SK, Pitkala KH, Puranen TM, Bjorkman MP, Kautiainen H, Strandberg TE, et al. Low protein and micronutrient intakes in heterogeneous older population samples. Arch Gerontol Geriatr. 2015;61(3):464–71.CrossRefPubMedGoogle Scholar
  111. 111.
    Anagnostis P, Dimopoulou C, Karras S, Lambrinoudaki I, Goulis DG. Sarcopenia in post-menopausal women: is there any role for vitamin D? Maturitas. 2015;82(1):56–64.CrossRefPubMedGoogle Scholar
  112. 112.
    Rizzoli R. Nutrition and sarcopenia. J Clin Densitom. 2015;18(4):483–7.CrossRefPubMedGoogle Scholar
  113. 113.
    Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, et al. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the health, aging, and body composition (Health ABC) study. Am J Clin Nutr. 2008;87(1):150–5.CrossRefPubMedGoogle Scholar
  114. 114.
    Kobayashi S, Asakura K, Suga H, Sasaki S. High protein intake is associated with low prevalence of frailty among old Japanese women: a multicenter cross-sectional study. Nutr J. 2013;12:164.CrossRefPubMedPubMedCentralGoogle Scholar
  115. 115.
    Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin d: a meta-analysis of randomised controlled trials. Br Med J. 2009;339:b3692.CrossRefGoogle Scholar
  116. 116.
    Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, et al. Annual high-dose oral vitamin d and falls and fractures in older women: a randomized controlled trial. J Am Med Assoc. 2010;303(18):1815–22.CrossRefGoogle Scholar
  117. 117.
    Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: systematic review and meta-analysis. Br Med J. 2015;351:h4183.CrossRefGoogle Scholar
  118. 118.
    Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, et al. Calcium intake and risk of fracture: systematic review. Br Med J. 2015;351:h4580.CrossRefGoogle Scholar
  119. 119.
    Zhao JG, Zeng XT, Wang J, Liu L. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. J Am Med Assoc. 2017;318(24):2466–82.CrossRefGoogle Scholar
  120. 120.
    Smith GI, Julliand S, Reeds DN, Sinacore DR, Klein S, Mittendorfer B. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015;102(1):115–22.CrossRefPubMedPubMedCentralGoogle Scholar
  121. 121.
    Moon A, Heywood L, Rutherford S, Cobbold C. Creatine supplementation: can it improve quality of life in the elderly without associated resistance training? Curr Aging Sci. 2013;6(3):251–7.CrossRefPubMedGoogle Scholar
  122. 122.
    Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LC, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713–9.CrossRefPubMedGoogle Scholar
  123. 123.
    Kim H, Suzuki T, Saito K, Kojima N, Hosoi E, Yoshida H. Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: a 4-year follow-up study. Geriatr Gerontol Int. 2016;16(2):175–81.CrossRefPubMedGoogle Scholar
  124. 124.
    Andrews RD, MacLean DA, Riechman SE. Protein intake for skeletal muscle hypertrophy with resistance training in seniors. Int J Sport Nutr Exerc Metab. 2006;16(4):362–72.CrossRefPubMedGoogle Scholar
  125. 125.
    Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int. 2010;21(7):1121–32.CrossRefPubMedGoogle Scholar
  126. 126.
    Kukuljan S, Nowson CA, Sanders K, Daly RM. Effects of resistance exercise and fortified milk on skeletal muscle mass, muscle size, and functional performance in middle-aged and older men: an 18-mo randomized controlled trial. J Appl Physiol (1985). 2009;107(6):1864–73.CrossRefGoogle Scholar
  127. 127.
    Bunout D, Barrera G, Leiva L, Gattas V, de la Maza MP, Avendano M, et al. Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin d deficient elderly subjects. Exp Gerontol. 2006;41(8):746–52.CrossRefPubMedGoogle Scholar
  128. 128.
    Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stahelin HB, Willett WC, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med. 2010;170(9):813–20.CrossRefPubMedGoogle Scholar
  129. 129.
    Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med. 2015;175(5):703–11.CrossRefPubMedGoogle Scholar
  130. 130.
    Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc. 2003;51(12):1740–7.CrossRefPubMedGoogle Scholar
  131. 131.
    • Compston JE, Wyman A, FitzGerald G, Adachi JD, Chapurlat RD, Cooper C, et al. Increase in fracture risk following unintentional weight loss in postmenopausal women: the global longitudinal study of osteoporosis in women. J Bone Miner Res. 2016;31(7):1466–72. This study demonstrated the detrimental effects of weight loss in postmenopausal women on body composition, including decreased bone and muscle mass, and increased fracture risk as early as 1-year following weight loss.CrossRefPubMedPubMedCentralGoogle Scholar
  132. 132.
    •• Soltani S, Hunter GR, Kazemi A, Shab-Bidar S. The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int. 2016;27(9):2655–71. A systematic review and meta-analysis of weight loss approaches and their effect on BMD, which demonstrated that weight loss due to caloric restriction decreased BMD whereas weight loss due to resistance training did not. CrossRefPubMedGoogle Scholar
  133. 133.
    LeBlanc ES, Rizzo JH, Pedula KL, Yaffe K, Ensrud KE, Cauley JA, et al. Long-term weight trajectory and risk of hip fracture, falls, impaired physical function, and death. J Am Geriatr Soc. 2018;66(10):1972–9.CrossRefPubMedGoogle Scholar
  134. 134.
    Carlsson LMS, Sjöholm K, Ahlin S, Jacobson P, Andersson-Assarsson JC, Karlsson Lindahl L, et al. Long-term incidence of serious fall-related injuries after bariatric surgery in Swedish obese subjects. Int J Obes 2018.Google Scholar
  135. 135.
    •• Sardeli AV, Komatsu TR, Mori MA, Gaspari AF, Chacon-Mikahil MPT. Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis. Nutrients. 2018;10(4). The most recent systematic review and meta-analysis on the effect of various weight loss approaches on body composition, which demonstrated that resistance training prevented almost 100% of losses in lean mass associated with caloric restriction. Google Scholar
  136. 136.
    •• Villareal DT, Aguirre L, Gurney B, Waters DL, Sinacore DR, Colombo E, et al. Aerobic or resistance exercise, or both, in dieting obese older adults. N Engl J Med. 2017;376:1943–55. Randomised controlled trial which indicated that a combination of resistance and aerobic training is likely to provide the most benefit for physical function and body composition in obese older adults. CrossRefPubMedPubMedCentralGoogle Scholar
  137. 137.
    Muschitz C, Kocijan R, Haschka J, Zendeli A, Pirker T, Geiger C, et al. The impact of vitamin D, calcium, protein supplementation, and physical exercise on bone metabolism after bariatric surgery: the BABS study. J Bone Miner Res. 2016;31(3):672–82.CrossRefPubMedGoogle Scholar
  138. 138.
    Amamou T, Normandin E, Pouliot J, Dionne IJ, Brochu M, Riesco E. Effect of a high-protein energy-restricted diet combined with resistance training on metabolic profile in older individuals with metabolic impairments. J Nutr Health Aging. 2017;21(1):67–74.CrossRefPubMedGoogle Scholar
  139. 139.
    Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364(13):1218–29.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonAustralia
  2. 2.Austin HealthHeidelbergAustralia
  3. 3.Department of Medicine and Australian Institute for Musculoskeletal Science, Melbourne Medical School – Western CampusThe University of MelbourneSt AlbansAustralia

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