Age-related loss of muscle and bone (sarcopenia and osteoporosis), increases the risk of falls and fractures and consequently leads to a substantial economic burden for the society. The combined condition, osteosarcopenia, may identify patients at a higher risk of those outcomes and could be relevant for assessment and treatment in clinical practice.
To evaluate the current knowledge of the prevalence of osteosarcopenia and the fracture risk in older people.
A systematic literature review was conducted until 10th March 2018. A total of 1105 papers were detected, whereof 1049 and 29 were excluded by title/abstracts and full-text assessment, respectively. Twenty-seven original papers were included in the systematic review, whereof 17 were suitable for meta-analysis.
The prevalence of osteosarcopenia varied (5–37%) depending on the classification of sarcopenia and whether participants were classified initially according to sarcopenia or osteoporosis. In patients with low-energy osteoporotic fractures, sarcopenia was present in 7.8–58% and 1.3–96.3% of the cases, women and men, respectively. The meta-analysis of prevalence of sarcopenia in patients with low-energy fracture (n = 9) was 46% (95% CI 44, 48; p < 0.001). The relative risk of fracture (sarcopenic versus non-sarcopenic) in meta-analysis of four studies was 1.37 (95% CI 1.18, 1.59; p < 0.001). Mean bone mineral density (n = 5) and T-score (n = 3) of femoral neck was significantly lower in sarcopenic participants [− 0.07 g/cm2 (95% CI 0.08, 0.06) and − 0.34 (95% CI − 0.46, − 0.23), respectively].
Osteosarcopenia is frequent and the relative risk of fracture is higher among sarcopenic patients. A standard and strict classification of sarcopenia is needed to assess its true relationship and consequences.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Frisoli A Jr, Chaves PH, Ingham SJ, Fried LP (2011) Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: results from the Women’s Health and Aging Study (WHAS) II. Bone 48(4):952–957
Di Monaco M, Vallero F, Di Monaco R, Tappero R (2011) Prevalence of sarcopenia and its association with osteoporosis in 313 older women following a hip fracture. Arch Gerontol Geriatr 52(1):71–74
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res Off J Am Soc Bone Miner Res 22(3):465–475
Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med 3:1–17
Binkley N, Buehring B (2009) Beyond FRAX: it’s time to consider “sarco-osteopenia”. J Clin Densitometry Off J Int Soc Clin Densitometry 12(4):413–416
Rosenberg I (1989) Summary comments: epidemiological and methodological problems in determining nutritional status in older persons. Am J Clin Nutr 50:1231–1233
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(8):755–763
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM et al (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on sarcopenia in older people. Age Ageing 39(4):412–423
Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12(4):249–256
Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Fragala MS, Kenny AM et al (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol Ser A Biol Sci Med Sci 69(5):547–558
Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB (2003) Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 51(11):1602–1609
Reijnierse EM, Trappenburg MC, Blauw GJ, Verlaan S, de van der Schueren MA, Meskers CG, Maier AB (2016) Common ground? The concordance of sarcopenia and frailty definitions. J Am Med Dir Assoc 17(4):371.e377
Masanes F, Rojano ILX, Salva A, Serra-Rexach JA, Artaza I, Formiga F, Cuesta F, Lopez Soto A, Ruiz D, Cruz-Jentoft AJ (2017) Cut-off points for muscle mass—not grip strength or gait speed—determine variations in sarcopenia prevalence. J Nutr Health Aging 21(7):825–829
WHO (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser 843:1–129
Binkley N, Krueger D, Buehring B (2013) What’s in a name revisited: should osteoporosis and sarcopenia be considered components of “dysmobility syndrome?”. Osteoporos Int J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 24(12):2955–2959
Hill KD, Farrier K, Russell M, Burton E (2017) Dysmobility syndrome: current perspectives. Clin Interv Aging 12:145–152
Cruz-Jentoft AJ, Landi F, Schneider SM, Zuniga C, Arai H, Boirie Y, Chen LK, Fielding RA, Martin FC, Michel JP et al (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 43(6):748–759
Smoliner C, Sieber CC, Wirth R (2014) Prevalence of sarcopenia in geriatric hospitalized patients. J Am Med Dir Assoc 15(4):267–272
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1–2):136
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 17(12):1726–1733
Hamrick M (2010) JMNI special issue: basic science and mechanisms of muscle–bone interactions. J Musculoskelet Neuronal Interact 10(1):1–2
Chien KR, Karsenty G (2005) Longevity and lineages: toward the integrative biology of degenerative diseases in heart, muscle, and bone. Cell 120(4):533–544
Sharir A, Stern T, Rot C, Shahar R, Zelzer E (2011) Muscle force regulates bone shaping for optimal load-bearing capacity during embryogenesis. Development 138(15):3247–3259
Kaji H (2014) Interaction between muscle and bone. J Bone Metab 21(1):29–40
Kaji H (2013) Linkage between muscle and bone: common catabolic signals resulting in osteoporosis and sarcopenia. Curr Opin Clin Nutr Metab Care 16(3):272–277
Kawao N, Kaji H (2015) Interactions between muscle tissues and bone metabolism. J Cell Biochem 116(5):687–695
Edwards MH, Dennison EM, Sayer AA, Fielding R, Cooper C (2015) Osteoporosis and sarcopenia in older age. Bone 80:126–130
Schafer MJ, Atkinson EJ, Vanderboom PM, Kotajarvi B, White TA, Moore MM, Bruce CJ, Greason KL, Suri RM, Khosla S et al (2016) Quantification of GDF11 and myostatin in human aging and cardiovascular disease. Cell Metab 23(6):1207–1215
Bonewald LF (2011) The amazing osteocyte. J Bone Miner Res Off J Am Soc Bone Miner Res 26(2):229–238
Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G (2013) Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing 42(2):203–209
Landi F, Liperoti R, Fusco D, Mastropaolo S, Quattrociocchi D, Proia A, Tosato M, Bernabei R, Onder G (2012) Sarcopenia and mortality among older nursing home residents. J Am Med Dir Assoc 13(2):121–126
Cawthon PM, Blackwell TL, Cauley J, Kado DM, Barrett-Connor E, Lee CG, Hoffman AR, Nevitt M, Stefanick ML, Lane NE et al (2015) Evaluation of the usefulness of consensus definitions of sarcopenia in older men: results from the observational osteoporotic fractures in men cohort study. J Am Geriatr Soc 63(11):2247–2259
Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G (2012) Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr (Edinburgh, Scotland) 31(5):652–658
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 J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 25(1):187–193
Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103(2A):20S–25S (discussion 25S-26S)
Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M (1999) Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 353(9155):802–805
van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29(6):517–522
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097
Locquet M, Beaudart C, Bruyere O, Kanis JA, Delandsheere L, Reginster JY (2018) Bone health assessment in older people with or without muscle health impairment. Osteoporos Int 29(5):1057–1067. https://doi.org/10.1007/s00198-018-4384-1
Drey M, Sieber CC, Bertsch T, Bauer JM, Schmidmaier R (2016) Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clin Exp Res 28(5):895–899
Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Muir SW, Montero-Odasso M, Gunawardene P, Demontiero O, Duque G (2015) Phenotype of osteosarcopenia in older individuals with a history of falling. J Am Med Dir Assoc 16(4):290–295
Buehring B, Krueger D, Binkley N (2013) Effect of including historical height and radius BMD measurement on sarco-osteoporosis prevalence. J Cachexia Sarcopenia Muscle 4(1):47–54
Waters DL, Hale L, Grant AM, Herbison P, Goulding A (2010) Osteoporosis and gait and balance disturbances in older sarcopenic obese New Zealanders. Osteoporos Int J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 21(2):351–357
Gentil P, Lima RM, de Oliveira RJ, Pereira RW, Reis VM (2007) Association between femoral neck bone mineral density and lower limb fat-free mass in postmenopausal women. J Clin Densitometry Off J Int Soc Clin Densitometry 10(2):174–178
Patil R, Uusi-Rasi K, Pasanen M, Kannus P, Karinkanta S, Sievanen H (2013) Sarcopenia and osteopenia among 70-80-year-old home-dwelling Finnish women: prevalence and association with functional performance. Osteoporos Int J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 24(3):787–796
Kirchengast S, Huber J (2012) Sex-specific associations between soft tissue body composition and bone mineral density among older adults. Ann Hum Biol 39(3):206–213
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(3):295–298
Gillette-Guyonnet S, Nourhashemi F, Lauque S, Grandjean H, Vellas B (2000) Body composition and osteoporosis in elderly women. Gerontology 46(4):189–193
Iolascon G, Moretti A, Giamattei MT, Migliaccio S, Gimigliano F (2015) Prevalent fragility fractures as risk factor for skeletal muscle function deficit and dysmobility syndrome in post-menopausal women. Aging Clin Exp Res 27(Suppl 1):S11–S16
Di Monaco M, Castiglioni C, De Toma E, Gardin L, Giordano S, Di Monaco R, Tappero R (2015) Presarcopenia and sarcopenia in hip-fracture women: prevalence and association with ability to function in activities of daily living. Aging Clin Exp Res 27(4):465–472
Di Monaco M, Castiglioni C, Di Carlo S (2018) Lean mass and functional recovery in men with hip fracture: a short-term prospective pilot study. Am J Phys Med Rehabil 97(6):401–406. https://doi.org/10.1097/PHM.0000000000000875
Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A (2007) Muscle mass and functional recovery in men with hip fracture. Am J Phys Med Rehabil 86(10):818–825
Clynes MA, Edwards MH, Buehring B, Dennison EM, Binkley N, Cooper C (2015) Definitions of sarcopenia: associations with previous falls and fracture in a population sample. Calcif Tissue Int 97(5):445–452
Gonzalez-Montalvo JI, Alarcon T, Gotor P, Queipo R, Velasco R, Hoyos R, Pardo A, Otero A (2016) Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int 16(9):1021–1027
Fiatarone Singh MA, Singh NA, Hansen RD, Finnegan TP, Allen BJ, Diamond TH, Diwan AD, Lloyd BD, Williamson DA, Smith EU et al (2009) Methodology and baseline characteristics for the sarcopenia and hip fracture study: a 5-year prospective study. J Gerontol Ser A Biol Sci Med Sci 64(5):568–574
Steihaug OM, Gjesdal CG, Bogen B, Kristoffersen MH, Lien G, Ranhoff AH (2017) Sarcopenia in patients with hip fracture: a multicenter cross-sectional study. PLoS One 12(9):e0184780
Landi F, Calvani R, Ortolani E, Salini S, Martone AM, Santoro L, Santoliquido A, Sisto A, Picca A, Marzetti E (2017) The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 28(5):1569–1576
Hars M, Biver E, Chevalley T, Herrmann F, Rizzoli R, Ferrari S, Trombetti A (2016) Low lean mass predicts incident fractures independently from FRAX: a prospective cohort study of recent retirees. J Bone Miner Res Off J Am Soc Bone Miner Res 31(11):2048–2056
Sjoblom S, Suuronen J, Rikkonen T, Honkanen R, Kroger H, Sirola J (2013) Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas 75(2):175–180
Schaap LA, van Schoor NM, Lips P, Visser M (2017) Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures; the Longitudinal Aging Study Amsterdam. J Gerontol A Biol Sci Med Sci. https://doi.org/10.1093/gerona/glx245
Gonnelli S, Caffarelli C, Cappelli S, Rossi S, Giordano N, Nuti R (2014) Gender-specific associations of appendicular muscle mass with BMD in elderly Italian subjects. Calcif Tissue Int 95(4):340–348
Lima RM, Bezerra LM, Rabelo HT, Silva MA, Silva AJ, Bottaro M, de Oliveira RJ (2009) Fat-free mass, strength, and sarcopenia are related to bone mineral density in older women. J Clin Densitometry Off J Int Soc Clin Densitometry 12(1):35–41
Pereira FB, Leite AF, de Paula AP (2015) Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men. Arch Endocrinol Metab 59(1):59–65
Wannenes F, Papa V, Greco EA, Fornari R, Marocco C, Baldari C, Di Luigi L, Emerenziani GP, Poggiogalle E, Guidetti L et al (2014) Abdominal fat and sarcopenia in women significantly alter osteoblasts homeostasis in vitro by a WNT/beta-catenin dependent mechanism. Int J Endocrinol 2014:278316
Bijlsma AY, Meskers MC, Molendijk M, Westendorp RG, Sipila S, Stenroth L, Sillanpaa E, McPhee JS, Jones DA, Narici M et al (2013) Diagnostic measures for sarcopenia and bone mineral density. Osteoporos Int J Establ Result Coop Between Eur Found Osteoporos Natl Osteoporos Found USA 24(10):2681–2691
Morley JE, Abbatecola AM, Argiles JM, Baracos V, Bauer J, Bhasin S, Cederholm T, Coats AJ, Cummings SR, Evans WJ et al (2011) Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 12(6):403–409
Conflict of interest
Barbara Rubek Nielsen (BRN), Jawdat Abdulla (JA), Hanne Elkjær Andersen (HEA), Peters Schwarz (PS) and Charlotte Suetta (CS) declare that they have no conflict of interest, that the study was not founded.
This article does not contain any studies with human participants or animals performed by any of the authors. All the authors certify that they comply with the standard ethical guidelines for authorship and publishing.
For this type of study formal consent is not required.
About this article
Cite this article
Nielsen, B.R., Abdulla, J., Andersen, H.E. et al. Sarcopenia and osteoporosis in older people: a systematic review and meta-analysis. Eur Geriatr Med 9, 419–434 (2018). https://doi.org/10.1007/s41999-018-0079-6