Osteosarcopenia: a common syndrome in the elderly

November 21, 2023 (DocRed)


Osteosarcopenia is a recently described syndrome of high frequency in the elderly. The coexistence of osteoporosis and sarcopenia leads to frailty, disability, and increased morbidity and mortality. It is recommended to start treatment based on osteoporosis medications and lifestyle changes to identify people at risk and avoid deterioration in quality of life. Changes include adequate protein intake, comprehensive physical rehabilitation with progressive resistance exercise, and supplementation with vitamin D and calcium.


Osteoporosis and sarcopenia are age-related conditions that are becoming more common as the population ages.1 their coexistence is called osteosarcopenia And fragility fractures are associated with greater morbidity and mortality.

Osteoporosis is characterized by decreased bone mass and deterioration in microstructure that results in bone fragility and increased susceptibility to fracture. Sarcopenia is a syndrome of progressive and generalized decline in muscle mass and strength that is associated with disability, poor quality of life, and mortality.

There is no internationally accepted definition for osteosarcopenia, but it is based on definitions of its co-existing conditions:

  • Sarcopenia: Strength was decreased due to reduced muscle quantity and quality (hand grip strength <27 kg in men and <16 kg in women).
  • Osteoporosis: T-score Bone mineral density (BMD) (lumbar spine, femoral neck and total femur) <-1 standard deviation (SD) for osteopenia and <-2.5 SD for osteoporosis.

Its pathophysiology is related to increased bone resorption due to decreased physical activity with age which impairs muscle stimulation on bone for its formation. Similarly, infiltration of musculoskeletal adipose tissue results in dysfunction and lipotoxicity that leads to a state of chronic low-grade inflammation.

Both tissues have hormonal receptors, particularly estrogen, that stimulate their growth, so estrogen supplementation in postmenopausal women may prevent this.


Bone mass decreases by 30% between the third and seventh decade of life, and it is estimated that 33% of women and 20% of men over the age of 50 will have a fragility fracture. Muscle mass begins to decline in the late fourth decade and decreases by 30% in the ninth decade.

Few studies report on the prevalence of osteosarcopenia, but it is known that it can be as high as 50% in postmenopausal women, and those with sarcopenia have 4 times the risk of developing osteoporosis.

Factors associated with osteosarcopenia

  • Genetics: Determines the peak bone mass, muscle strength and vitamin D receptors achieved.
  • Alcohol and cigarettes: They are risk factors established in the Fracture Risk Assessment Tool (FRAX).
    • Liquor: Excessive intake has toxic effects on osteoblasts, gonadal function, protein and calcium metabolism, physical activity, and fall risk.
    • Cigarette: Smokers are more likely to develop early menopause and lose muscle mass due to lower levels of physical activity and body mass index (BMI).
  • physical activity: Prevents bone and muscle loss, especially with progressive resistance exercise that stimulates the periosteum and osteoblasts.
  • Diet: Combined supplementation of calcium and vitamin D is recommended to reduce the risk of fractures, and fasting is advised to be avoided in older people as it reduces muscle synthesis.
  • Age and Gender: Caucasian women over the age of 50 have a higher risk of fragility fractures.

osteosarcopenic obesity

a BMI <20 kg/m2 It is a risk factor for low BMD and fragility fractures. With age, BMI may remain stable, but the percentage of muscle decreases and fat increases, leading to the development of sarcopenic obesity, which is associated with cardiometabolic diseases, disability, and mortality.

However, in post-menopausal women, peripheral adipose tissue may be a protective factor for bone because it produces estrogen from the conversion of androgens.


There is no specific medication for the treatment of osteosarcopenia, only for osteoporosis.

Lifestyle interventions form the basis of treatment and should ensure adequate protein consumption, progressive resistance exercise, and calcium and vitamin D supplementation.


  • Daily consumption of:
    • vitamin D: 800 IU/day to maintain levels above 50 nmol/L in postmenopausal women.
    • Protein: 1-1.2 g/kg/day (if chronic kidney disease (CKD), reduce to 0.6-0.8 g/kg/day) to maintain protein anabolism in older people with acute or chronic diseases.
    • Eat a Mediterranean diet (rich in antioxidants) to reduce oxidative stress and chronic inflammation.
  • Antiresorptive (bisphosphonates), anabolic, and hormonal (hormone replacement therapy and selective estrogen modulators) osteoporosis medications.
  • Individual and group physical therapy (gait and balance), vestibular, occupational and progressive muscle resistance.
  • Referral to specialists to rule out co-morbidities.


The coexistence of osteoporosis and sarcopenia is an elderly syndrome associated with high morbidity, mortality, and costs. Its prevalence increases as the population ages, so it must be prevented through lifestyle interventions. It is recommended to intervene timely by identifying people with risk factors and avoid compromising the quality of life.

As the population ages, chronic non-communicable diseases that greatly impact quality of life will become more prevalent. For a healthy aging population, health care should focus on prevention and promotion of healthy lifestyles from childhood onwards, with special attention to those over 50 years of age.

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