Sarcopenia after hip fracture among elderly- An unsolved problem

Jung Wee Park et al found in a study that - after hip fracture, osteoporosis seemed to be well managed and the prevalence of osteoporosis did not increase. However, Skeletal muscle mass index (SMI) decreased and the prevalence of sarcopenia increased.

Sarcopenia is characterized by accelerated loss of muscle strength, function, and mass. It is associated with functional deterioration, falls, fractures, and death. Since October 2016, sarcopenia has been classified as a disease entity and was given an associated International Classification of Diseases (ICD) code, presenting a diagnostic challenge.

Among 1159 patients, who underwent surgery for low-energy hip fractures, 224 patients (38 men and 186 women with a mean age of 76.8±8.7 years) were studied with preoperative and follow-up dual-energy X-ray absorptiometry (DXA). Bone mineral density (BMD) and skeletal muscle mass were measured on DXA scans. The postoperative changes in the prevalence of osteoporosis and that of the sarcopenia were evaluated as well as Koval grade of the hip fracture patients.

The ambulatory function of patients was classified into two categories:

(1) outdoor ambulator: Koval grade I to III and

(2) housebound: Koval grade IV to VII (grade I: independent outdoor ambulator, grade II: outdoor ambulator with cane, grade III: outdoor ambulator with walker/crutches, grade IV: housebound independent ambulatory, grade V: housebound ambulator with cane, grade VI: housebound ambulatory with walker/crutches, grade VII: nonfunctional ambulatory).

The observations of the study were:

• While there was no significant change in BMD, SMI significantly decreased postoperatively.

• Mean decrease of the SMI was 0.53 kg/m2 in men and 0.38 kg/m2 in women.

• Prevalence of sarcopenia increased from 63 to 89% (p=0.014) in men and from 45 to 57% (p=0.006) in women.

• Lower BMI (Odds ratio (OR) 0.85 (95% confidence interval (CI) 0.76–0.96), p=0.008) and prior sarcopenia (OR 14.47 (95% CI 5.29–35.39), p< 0.001) were the risk factors for the decrease of SMI after hip fracture.

The authors concluded that - appendicular SMI decreased 8.2% in men and 6.7% in women 1 year after hip fracture. Prevalence of sarcopenia increased from 63 to 89% in men and 45–57% in women unlike the osteoporosis prevalence, which decreased after the hip fracture surgery. Previous diagnosis of sarcopenia was related to the aggravation of sarcopenia after hip fracture. More active measures should be considered to prevent sarcopenia in hip fracture patients.

Further reading:

Sarcopenia: an unsolved problem after hip fracture

Jung Wee Park, Hong Seok Kim et al

Journal of Bone and Mineral Metabolism (2022) 40:688–695

https://doi.org/10.1007/s00774-022-01334-6