Sarcopenia and Osteoporosis: Two Factors Affecting Hip Fracture Mortality in the Elderly

Abstract

OBJECTIVE: Sarcopenia and osteoporosis the leading causes of hip fractures in elderly patients. This study aimed to evaluate the effects of sarcopenia related to psoas muscle index and osteoporosis obtained by T score on mortality in hip fracture patients. MATERIALS AND METHODS: This retrospective cross-sectional study examined 236 patients after a hip fracture. The patients were sarcopenic and nonsarcopenic according to the psoas muscular index; According to the femoral neck T score in Dual Energy X-ray Absorptiometry, patients were grouped as low (<-2.5) and high (≥-2.5) and compared. Statistically significant variables associated with 30 days and one-year mortality were analyzed using logistic regression analysis. RESULTS: Eighty-four (35.6%) patients were in the sarcopenia group, and 152 (64.4%) were in the non-sarcopenia group. Ninety-two (38.9%) patients were in the low group, and 152 (61.1%) were in the high group. In the sarcopenia and the low T score groups, the frequency of females, ≥65 years, comorbid disease, intensive care unit requirement, and complications rates were significantly higher. The survival rate was significantly lower (p<0.05). Female gender [odss ratio (OR): 2.97, 95% confidence interval (CI): 1.17-7.54], sarcopenia (OR: 3.65, 95% CI: 1.68-7.91), low T score (OR: 2.62, 95% CI: 1.23-5.62), intensive care unit requirement (OR: 2.32, 95% CI: 1.09-4.92) and presence of postoperative complications (OR: 2.89, 95% CI: 1.32-6.36) are significant risk factors for 1-month mortality; female gender (OR: 2.04, 95% CI: 1.06-3.94) and presence of sarcopenia (OR: 2.24, 95% CI: 1.22-4.09) are risk factors for 1-year mortality (p<0.05). CONCLUSION: Detection of sarcopenia and osteoporosis in elderly patients at the early stage and correction of modifiable factors are of great importance in improving postoperative outcomes and reducing mortality.

Keywords

• Hip fractures
• sarcopenia
• osteoporosis
• postoperative outcomes
• mortality

Sarkopeni ve Osteoporoz: Yaşlılarda Kalça Kırığı Mortalitesini Etkileyen İki Faktör

Abstract

AMAÇ: Sarkopeni ve osteoporoz yaşlı hastalarda kalça kırıklarının önde gelen nedenleri arasındadır. Bu çalışmada kalça kırığı hastalarında, psoas kas indeksine bağlı sarkopeni ve T skoru ile elde edilen osteoporozun mortalite üzerine etkisinin değerlendirilmesi amaçlandı. GEREÇ ve YÖNTEM: Bu retrospektif kesitsel çalışmada kalça kırığı sonrası 236 hasta incelendi. Hastalar psoas kas indeksine göre sarkopenik olan ve sarkopenik olmayan şeklinde; Dual-Energy X-ray Absorptiometry femur boynu T skoruna göre düşük (<-2,5) veya yüksek (≥-2,5) T skoru olarak gruplandırıldı ve karşılaştırıldı. Otuz günlük ve bir yıllık mortalite ile ilişkili istatistiksel olarak anlamlı değişkenler belirlendi ve lojistik regresyon analizi kullanılarak analiz edildi. BULGULAR: Sarkopeni grubunda 84 (%35,6), sarkopeni olmayan grupta 152 (%64,4) hasta vardı. T skoru düşük grupta 92 (%38,9), yüksek grupta 152 (%61,1) hasta mevcuttu. Sarkopeni ve düşük T skor gruplarında ≥65 yaş, kadın cinsiyet, ek hastalık varlığı, cerrahi sonrası yoğun bakım ünitesi takibi ihtiyacı ve cerrahi sonrası cerrahi komplikasyon oranları anlamlı olarak daha yüksekti. Hem sarkopeni hem de T skoru düşük grupta sağkalım oranı anlamlı olarak daha düşüktü (p<0,05). Kadın cinsiyet [olasılık oranı (OO): 2,97, %95 güven aralığı (GA): 1,17-7,54), sarkopeni (OO: 3,65, %95 GA: 1,68-7,91], düşük T skoru (OR: 2,62, %95 GA: 1,23-5,62) ve cerrahi sonrası komplikasyon varlığı (OO: 2,89, %95 GA: 1,32-6,36) 30 günlük mortalite için bağımsız risk faktörleriyken; 1 yıllık mortalitede sadece kadın cinsiyet (OO: 2,04, %95 GA: 1,06-3,94) ve sarkopeni varlığı (OO: 2,24, %95 GA: 1,22-4,09) bağımsız risk faktörleri (p<0,05) olarak gözlendi. SONUÇ: İleri yaş hastalarda sarkopeni ve osteoporozun en erken dönemde saptanması ve değiştirilebilir faktörlerin düzeltilmesinin cerrahi sonrası sonuçların iyileştirilmesi ve mortalitenin azaltılmasında büyük önem taşmaktadır.

Keywords

• Kalça kırığı
• sarkopeni
• osteoporoz
• psoas kas indeks
• mortalite

References

1. 1. Araiza-Nava B, Méndez-Sánchez L, Clark P, Peralta-Pedrero ML, Javaid MK, Calo M, et al. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporos Int. 2022; 33: 1429-1444.
2. 2. Bozkurt HH, Tokgöz MA, Yapar A, Atik OŞ. What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures? Eklem Hastalik Cerrahisi. 2019; 30: 296-300.
3. 3. Karadeniz S, Yurtbay A. Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Jt Dis Relat Surg. 2022; 33: 538-546.
4. 4. Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Järvinen M. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet. 1999; 353: 802-805.
5. 5. Ballane G, Cauley JA, Luckey MM, Fuleihan Gel-H. Secular trends in hip fractures worldwide: opposing trends East versus West. J Bone Miner Res. 2014; 29: 1745-1755.
6. 6. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012; 23: 949-955.
7. 7. Lim KK, Matchar DB, Chong JL, Yeo W, Howe TS, Koh JSB. Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review. Osteoporos Int. 2019; 30: 929-938. 8. Shin WC, Jang JH, Seo HE, Suh KT, Moon NH. Prevalence and clinical impact of sarcopenia in osteoporotic hip fracture: Single center retrospective cohort study. Acta Orthop Traumatol Turc. 2020; 54: 27-33.
8. 9. Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, et al. Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing. 2018; 47: 661-670.

9. 10. Yoo JI, Ha YC, Kwon HB, Lee YK, Koo KH, Yoo MJ. High Prevalence of Sarcopenia in Korean Patients after Hip Fracture: a Case-Control Study. J Korean Med Sci. 2016; 31: 1479-1484.
10. 11. Hida T, Ishiguro N, Shimokata H, Sakai Y, Matsui Y, Takemura M, et al. High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture. Geriatr Gerontol Int. 2013; 13: 413-420.
11. 12. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997; 127: 990S-991S.
12. 13. Frisoli A Jr, Chaves PH, Ingham SJ, Fried LP. 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. 2011; 48: 952-957.
13. 14. 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: 412-423.
14. 15. Marra M, Sammarco R, De Lorenzo A, Iellamo F, Siervo M, Pietrobelli A, et al. Assessment of Body Composition in Health and Disease Using Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA): A Critical Overview. Contrast Media Mol Imaging. 2019; 2019: 3548284.
15. 16. Hans D, Šteňová E, Lamy O. The Trabecular Bone Score (TBS) Complements DXA and the FRAX as a Fracture Risk Assessment Tool in Routine Clinical Practice. Curr Osteoporos Rep. 2017; 15: 521-531.
16. 17. Bahat G, Turkmen BO, Aliyev S, Catikkas NM, Bakir B, Karan MA. Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass. Clin Nutr. 2021; 40: 4360-4365.
17. 18. Epidemiologic and methodologic problems in determining nutritional status of older persons. Proceedings of a conference. Albuquerque, New Mexico, October 19-21, 1988. Am J Clin Nutr. 1989; 50: 1121-1235.
18. 19. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48: 16-31.
19. 20. De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JR, Lapauw B, et al. Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men. Age Ageing. 2016; 45: 602-608.
20. 21. Antunes AC, Araújo DA, Veríssimo MT, Amaral TF. Sarcopenia and hospitalisation costs in older adults: a cross-sectional study. Nutr Diet. 2017; 74: 46-50.
21. 22. De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JM, Lapauw B, et al. Low Lean Mass Predicts Incident Fractures Independently From FRAX: a Prospective Cohort Study of Recent Retirees. J Bone Miner Res. 2016; 31: 2048-2056.
22. 23. Schaap LA, van Schoor NM, Lips P, Visser M. 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. 2018; 73: 1199-1204.
23. 24. Steihaug OM, Gjesdal CG, Bogen B, Kristoffersen MH, Lien G, Ranhoff AH. Sarcopenia in patients with hip fracture: A multicenter cross-sectional study. PLoS One. 2017; 12: e0184780.
24. 25. 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: 1569-1576.
25. 26. Hong W, Cheng Q, Zhu X, Zhu H, Li H, Zhang X, et al. Prevalence of Sarcopenia and Its Relationship with Sites of Fragility Fractures in Elderly Chinese Men and Women. PLoS One. 2015; 10: e0138102.
26. 27. Barron RL, Oster G, Grauer A, Crittenden DB, Weycker D. Determinants of imminent fracture risk in postmenopausal women with osteoporosis. Osteoporos Int. 2020; 31: 2103-2111.
27. 28. Edwards MH, Dennison EM, Aihie Sayer A, Fielding R, Cooper C. Osteoporosis and sarcopenia in older age. Bone. 2015; 80: 126-130.
28. 29. Frank AW, Lorbergs AL, Chilibeck PD, Farthing JP, Kontulainen SA. Muscle cross sectional area and grip torque contraction types are similarly related to pQCT derived bone strength indices in the radii of older healthy adults. J Musculoskelet Neuronal Interact. 2010; 10: 136-141.
29. 30. Segal NA, Torner JC, Yang M, Curtis JR, Felson DT, Nevitt MC, et al. Muscle mass is more strongly related to hip bone mineral density than is quadriceps strength or lower activity level in adults over age 50 year. J Clin Densitom. 2008; 11: 503-510.