Does Sarcopenia Increase the Risk for Fresh Vertebral Fragility Fractures?: A Case-Control Study

Abstract

Study design: Case-control study.

Purpose: Sarcopenia is an age associated condition characterized by decrease in muscle mass, strength, and physical performance. We aimed to investigate whether sarcopenia increased the risk of vertebral fragility fractures among the elderly.

Overview of literature: Initial reports on sarcopenia suggest its contribution to the development of vertebral fragility fractures. However, recent studies showed contradictory findings.

Methods: Fifty-one consecutive patients with vertebral fragility fractures and matched controls without fractures were evaluated for sarcopenia, T-score, body mass index, and presence of preexisting vertebral fractures. Sarcopenia was diagnosed as total psoas cross-sectional area (TPA) 2 standard deviations below normative value from normal young adults and decreased handgrip strength (26 kg for men and 18 kg for women). Univariate and multivariate analyses were performed using the fresh fracture occurrence as the dependent variable.

Results: Sarcopenia was confirmed in 29.4% and 7.8% of cases and controls (p=0.005), respectively; 56.8% and 13.7% of cases and controls had previous vertebral fractures. Sarcopenia prevalence was greater among those with previous fractures (38% vs. 7.6%; odds ratio, 7.76; p<0.001). TPA was lower among the cases (1,278 mm2 vs. 1,569 mm2 , p=0.001) and those with previous fractures (1,168 mm2 vs. 1,563 mm2 , p<0.001). Handgrip strength was greater among those without previous fractures (19.6 kg vs. 16.3 kg, p=0.05). In multivariate analysis, sarcopenia was not identified as a significant predictor of fresh fractures whereas previous fractures and lower T-score were found to be significant.

Conclusions: Sarcopenia is not an independent risk factor for fresh vertebral fragility fractures in the elderly.

Keywords: Muscle strength; Osteoporosis; Osteoporotic fractures; Sarcopenia; Skeletal muscle.

Fig. 1.

Axial T2-weighted images at L4 level of control patients showing the total psoas cross-sectional area. SD, standard deviation; Peri, perimeter length in mm.

Fig. 2.

Axial T2-weighted image at L4 level of a patient with sarcopenia showing decreased muscle area with fat infiltration. SD, standard deviation; Peri, perimeter length in mm.