Global epidemiological features and impact of osteosarcopenia: A comprehensive meta-analysis and systematic review.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational studies
PubMed 38086772 · doi:10.1002/jcsm.13392
What was done
A systematic review and meta-analysis (PROSPERO CRD42022351229) searched PubMed, Cochrane, Medline, and Embase from inception to February 2023 for observational population-based studies reporting on the prevalence, risk factors, and clinical outcomes of osteosarcopenia (co-existing sarcopenia and osteopenia/osteoporosis). Study quality was appraised using validated design-specific tools. In total, 66 studies (48 cross-sectional, 17 cohort, 1 case-control) including 64,404 participants (mean age 46.6 to 93 years) were analyzed.
What was found
The pooled global prevalence of osteosarcopenia was 18.5% (95% CI: 16.7–20.3, I² = 98.7%), with 15.3% (95% CI: 13.2–17.4, I² = 97.6%) in men and 19.4% (95% CI: 16.9–21.9, I² = 98.5%) in women. Prevalence was 20.7% (95% CI: 17.1–24.4) using a sarcopenia plus osteopenia/osteoporosis definition and 16.1% (95% CI: 13.3–18.9) using sarcopenia plus osteoporosis. Prevalence was higher in hospital settings (24.7%) than community settings (12.9%, P = 0.001) and varied across regions (Oceania: 22.9%, Asia: 21.6%, South America: 20.8%, North America: 15.7%, Europe: 10.9%). Female sex (OR = 5.07, 95% CI: 2.96–8.69), frailty (OR = 4.72, 95% CI: 2.71–8.23), malnutrition (OR = 2.35, 95% CI: 1.62–3.40), and higher age (OR = 1.10, 95% CI: 1.06–1.15) were associated with increased risk. Longitudinal cohort meta-analyses showed osteosarcopenia significantly increased risks of falls (HR = 1.54, 95% CI: 1.20–1.97; I² = 1.0%, 3 studies), fractures (HR = 2.13, 95% CI: 1.61–2.81; I² = 67.8%, 7 studies), and mortality (HR = 1.75, 95% CI: 1.34–2.28; I² = 0.0%, 5 studies).
Why it matters
This review establishes a global benchmark for osteosarcopenia prevalence (~18.5%) and confirms that the combined loss of bone and muscle mass confers elevated prospective risks of fracture and mortality.
Limits
Extreme statistical heterogeneity (I² > 97% for prevalence) was observed due to varying diagnostic definitions and operational criteria. The majority of included studies were cross-sectional (48 of 66), and prospective outcome analyses relied on a small subset of cohort studies (3 to 7 studies per outcome).
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