Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: Results from the Women's Health and Aging Study (WHAS) II

Abstract

Objectives

The goal of this study was to examine the associations between severe osteopenia and osteoporosis and/or sarcopenia on frailty status, a major geriatric syndrome in community-dwelling older women.

Design

Cross-sectional analysis.

Setting

Women's Health and Aging Studies II (WHAS-II), Baltimore, Maryland.

Participants and measurements

The analytic sample for this study included 250 women aged 76–86 years old who underwent DXA evaluation at round 4. Frailty was determined using validated screening criteria. Severe osteopenia was defined as BMD between − 2.0 SD and − 2.49 SD and osteoporosis as BMD less than − 2.5 SD (lumbar spine and/or proximal femur). Sarcopenia was determined by the appendicular lean mass by height² (aLM/ht² method) and considered present when the value was less then − 2 SD compared to young women.

Results

Mean age of study subjects was 79.6 (± 2.7) years. Overall prevalence of frailty was 6.8% (n = 17). Severe osteopenia/osteoporosis occurred in 42.1% (n = 7) in the frail group, 28% (n = 33) in the pre frail group and 25.2% in the robust group. Sarcopenia was present in 52.9% (n = 9) in the frail group, 42% (n = 50) in the pre frail and 41.2% (n = 47) in the robust group. Almost sixteen percent (n = 39) had severe osteopenia/osteoporosis concomitant to sarcopenia. In an adjusted logistic regression model, severe osteopenia/osteoporosis (OR: 2.1; 95% CI: 0.68–6.6, p = 0.196) and sarcopenia (OR: 3.1; 95% CI: 0.88–11.1; p = 0.077) were individually associated with frailty, though not statistically significant. On the other hand, the likelihood of being frail was substantially higher in the presence of these two syndromes (OR: 6.4; 95% CI: 1.1–36.8, p = 0.037).

Conclusion

These findings suggest a concomitant impact of severe osteopenia/osteoporosis plus sarcopenia in regard to frailty status in a sample of oldest old women living in the community.

Introduction

Frailty is a major geriatric syndrome characterized by low muscle strength [1], [2], decreased walking speed [3], weight loss [4], low physical activity [5], and falls and fractures [6]. It commonly occurs in older adults, and results in an increased risk of adverse health outcomes including decreased quality of life, disability, recurrent hospitalizations, and death [7], [8], [9]. Consistently, studies have discussed a theoretical link between sarcopenia, an age related decrease in muscle strength and mass, and the complex pathogenesis of frailty and its major outcomes [4], [6], [7], [10]; however, the literature has not been able to establish if this association is only with muscle strength and/or muscle mass. Older women with decreased muscle mass are three times more likely to develop functional impairment [11] and disability [12] and, in the United States, sarcopenia related healthcare expenses have been estimated at $18.5 billion in 2000 ($10.8 billion in men, $7.7 billion in women) [13].

Osteoporosis has also been associated with frailty status in elderly women, but this has not been clearly demonstrated [6], [14], [15], [16], [17], [18]. In the Study of Osteoporosis Fractures (SOF) [14], a prospective cohort study, frail elderly women had lower bone mineral density (BMD) and a 1.7- to 1.8-fold increased risk of hip fracture and a 1.5-fold increased risk of any non-spinal fracture compared to robust women, but the association between osteoporosis and frailty patients with fractures or low BMD was not shown.

The association between sarcopenia and osteoporosis with frailty may be the result of common etiologic factors like mechanical factors [19], vitamin D deficiency [20], low levels of testosterone [21], estrogens, sulfate of dihydroepiandrostenedione (S-DHEA) [22] and insulin growth factor I (IGF-I) [23], inflammation (high levels of IL-6 and TNF α) [23], [24], decreased food intake and malnutrition [25].

The goal of this study was to assess the individual and the joint impact of severe osteopenia/osteoporosis and sarcopenia on the frailty status in community older women using dual energy X-ray absorptiometry (DXA) derived measurements. We hypothesized that the frailty likelihood would be highest in the presence of both sarcopenia and severe osteopenia and osteoporosis, lowest when none of these impairments were prevalent, and intermediate in the presence of one of the two impairments.