Skip to main content
SpringerLink
Log in

Identifying low muscle mass in patients with hip fracture: Validation of bioelectrical impedance analysis and anthropometry compared to dual energy X-ray absorptiometry

  • Published:
The journal of nutrition, health & aging

Abstract

Background

Older hip fracture patients often have reduced muscle mass, which is associated with adverse outcomes. Dual energy X-ray absorptiometry (DXA) can determine muscle mass, but is not practical in the acute phase. We investigated bioelectrical impedance analysis (BIA) and anthropometry compared against DXA for detecting low muscle mass in hip fracture patients.

Methods

This was a cross-sectional validation study at two Norwegian hospitals on 162 hip fracture patients aged ≥ 65 years. Appendicular lean mass (ALM) was determined by DXA, BIA and anthropometry 3 months after hip fracture. ALM by BIA was calculated by the Kyle, Janssen, Tengvall and Sergi equations, and ALM by anthropometry by the Heymsfield and Villani equations. The area under the receiver operating characteristic curve (AUC) was used to compare BIA and anthropometry for determining low ALM (≤5.67 kg/m2 for women and ≤7.25kg/m2 for men).

Results

Mean age was 79 years (SD 7.9), 74% were female. Mean ALM by DXA was 14.8 kg (SD 2.3) for women and 20.8 kg (SD 4.2) for men and 45% of women and 60% of men had low ALM. BIA (Kyle) in women (AUC 0.81, 95% confidence interval 0.72–0.89) and BIA (Sergi) in men (AUC 0.89, 95% CI 0.80–0.98) were best able to discriminate between low and normal ALM. Anthropometry (Heymsfield) was less accurate than BIA in women (AUC 0.64, 95% CI 0.54–0.75), and equal to BIA in men (AUC 0.72, 95% CI 0.72 0.56–0.87).

Conclusion

BIA (Sergi, Kyle and Tengvall) and anthropometry (Heymsfield) can identify low muscle mass in hip fracture patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Table 1
Figure 1
Table 2

Similar content being viewed by others

References

  1. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Annals of internal medicine. 2010;152(6):380–90.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Omsland TK, Holvik K, Meyer HE, Center JR, Emaus N, Tell GS, Schei B, Tverdal A, Gjesdal CG, Grimnes G, Forsmo S, Eisman JA, Sogaard AJ. Hip fractures in Norway 1999-2008: time trends in total incidence and second hip fracture rates: a NOREPOS study. European journal of epidemiology. 2012;27(10):807–14.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older P. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A. Muscle mass and functional recovery in men with hip fracture. Am J Phys Med Rehabil. 2007;86(10):818–25.

    Article  PubMed  Google Scholar 

  6. Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014;127(6):547–53.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, Simonsick EM, Harris TB. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. 2005;60(3):324–33.

    Article  PubMed  Google Scholar 

  8. Janssen I. Influence of sarcopenia on the development of physical disability: the Cardiovascular Health Study. J Am Geriatr Soc. 2006;54(1):56–62.

    Article  PubMed  Google Scholar 

  9. Wang Z, Heo M, Lee RC, Kotler DP, Withers RT, Heymsfield SB. Muscularity in adult humans: proportion of adipose tissue-free body mass as skeletal muscle. American journal of human biology: the official journal of the Human Biology Council. 2001;13(5):612–9.

    Article  CAS  Google Scholar 

  10. Kim J, Heshka S, Gallagher D, Kotler DP, Mayer L, Albu J, Shen W, Freda PU, Heymsfield SB. Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol. 2004;97(2):655–60.

    Article  PubMed  Google Scholar 

  11. Kyle UG, Bosaeus I, de Lorenzo AD, Deurenberg P, Elia M, Gomez JM, Heitmann BL, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AM, Pichard C, Composition of the ESPEN Working group. Bioelectrical impedance analysis—part I: review of principles and methods. Clinical nutrition. 2004;23(5):1226–43.

    Article  PubMed  Google Scholar 

  12. Kyle UG, Genton L, Hans D, Pichard C. Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM). Clinical nutrition. 2003;22(6):537–43.

    Article  CAS  PubMed  Google Scholar 

  13. Tengvall M, Ellegard L, Malmros V, Bosaeus N, Lissner L, Bosaeus I. Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clinical nutrition. 2009;28(1):52–8.

    Article  PubMed  Google Scholar 

  14. Bosaeus I, Wilcox G, Rothenberg E, Strauss BJ. Skeletal muscle mass in hospitalized elderly patients: Comparison of measurements by single-frequency BIA and DXA. Clinical nutrition. 2013.

    Google Scholar 

  15. Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. 2000;72(3):796–803.

    CAS  PubMed  Google Scholar 

  16. Villani AM, Miller M, Cameron ID, Kurrle S, Whitehead C, Crotty M. Body composition in older community-dwelling adults with hip fracture: portable field methods validated by dual-energy X-ray absorptiometry. Br J Nutr. 2012:1–11.

  17. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75(5):797–8.

    CAS  PubMed  Google Scholar 

  18. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. Journal of applied physiology. 2000;89(2):465–71.

    CAS  PubMed  Google Scholar 

  19. Sergi G, de Rui M, Veronese N, Bolzetta F, Berton L, Carraro S, Bano G, Coin A, Manzato E, Perissinotto E. Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clinical nutrition. 2014.

    Google Scholar 

  20. Heymsfield SB, McManus C, Smith J, Stevens V, Nixon DW. Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. Am J Clin Nutr. 1982;36(4):680–90.

    CAS  PubMed  Google Scholar 

  21. Villani AM, Crotty M, Cameron ID, Kurrle SE, Skuza PP, Cleland LG, Cobiac L, Miller MD. Appendicular skeletal muscle in hospitalised hip-fracture patients: development and cross-validation of anthropometric prediction equations against dual-energy X-ray absorptiometry. Age Ageing. 2014;43(6):857–62.

    Article  PubMed  Google Scholar 

  22. Soreide K, Korner H, Soreide JA. Diagnostic accuracy and receiver-operating characteristics curve analysis in surgical research and decision making. Annals of surgery. 2011;253(1):27–34.

    Article  PubMed  Google Scholar 

  23. Šidák Z. Rectangular Confidence Regions for the Means of Multivariate Normal Distributions. Journal of the American Statistical Association. 1967;62(318):626–33.

    Google Scholar 

  24. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  CAS  PubMed  Google Scholar 

  25. Karelis AD, Messier V, Suppere C, Briand P, Rabasa-Lhoret R. Effect of cysteinerich whey protein (immunocal(R)) supplementation in combination with resistance training on muscle strength and lean body mass in non-frail elderly subjects: a randomized, double-blind controlled study. J Nutr Health Aging., 2015;19(5):531–6.

    Article  CAS  PubMed  Google Scholar 

  26. Arnarson A, Gudny Geirsdottir O, Ramel A, Briem K, Jonsson PV, Thorsdottir I. Effects of whey proteins and carbohydrates on the efficacy of resistance training in elderly people: double blind, randomised controlled trial. European journal of clinical nutrition. 2013;67(8):821–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39(2):203–9.

    PubMed  Google Scholar 

  28. Gonzalez-Correa C, Caicedo-Eraso J. Bioelectrical impedance analysis (BIA): a proposal for standardization of the classical method in adults. Journal of Physics: Conference Series; 2012: IOP Publishing.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway

    Ole Martin Steihaug, B. Bogen & A. H. Ranhoff

  2. Department of Clinical Science, University of Bergen, Bergen, Norway

    C. G. Gjesdal & A. H. Ranhoff

  3. Department of Rheumatology, Haukeland University Hospital, Bergen, Norway

    C. G. Gjesdal

  4. Bergen University College, Bergen, Norway

    B. Bogen

Authors
  1. Ole Martin Steihaug
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. G. Gjesdal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Bogen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. H. Ranhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ole Martin Steihaug.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steihaug, O.M., Gjesdal, C.G., Bogen, B. et al. Identifying low muscle mass in patients with hip fracture: Validation of bioelectrical impedance analysis and anthropometry compared to dual energy X-ray absorptiometry. J Nutr Health Aging 20, 685–690 (2016). https://doi.org/10.1007/s12603-016-0686-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-016-0686-1

Keywords

Search

Navigation