madman
Super Moderator
Abstract:
Background: Osteosarcopenia is a geriatric syndrome defined by the concomitant presence of osteopenia/osteoporosis (loss of bone mineral density (BMD)) and sarcopenia (loss of muscle mass and/or function), which increases the risk of falls, fractures, and premature mortality.
Objective: To examine the efficacy of non-pharmacological (exercise and/or nutritional) interventions on musculoskeletal measures and outcomes in osteosarcopenic adults by reviewing findings from randomized controlled trials (RCTs).
Methods: This review was registered at PROSPERO (registration number: CRD42020179292) and conducted in accordance with the PRISMA guidelines. Electronic databases were searched for RCTs assessing the effect of at least one non-pharmacological intervention (any form of exercise and/or supplementation with protein, vitamin D, calcium, or creatine) on any musculoskeletal measure/outcome of interest (BMD, bone strength/turnover, muscle mass, and strength, physical performance, falls/fractures) in adults with osteosarcopenia as defined by any proposed criteria.
Results: Two RCTs (of n=106 older osteosarcopenic adults (≥65 years)) assessing the effects of progressive resistance training (RT) (via resistance bands or machines; 2-3 times/week; ~60 minutes in duration) were eligible for inclusion. The two RCTs demonstrated moderate-quality evidence that RT increases muscle mass, strength, and quality, with changes in strength and quality occurring before muscle mass (12 vs 28 weeks). There was low-quality evidence that RT increases lumbar spine BMD and maintains total hip BMD when performed for 12 and 18 months, respectively, and moderate-quality evidence that RT has no effect on markers of bone turnover or physical performance. No major adverse effects were recorded in either of the RCTs. There were no eligible RCTs examining the impact of nutritional interventions.
Conclusion: Chronic RT is safe and effective at potentiating gains in muscle mass, strength, and quality, and increasing or maintaining BMD in older osteosarcopenic adults. No RCT has examined the effects of protein, vitamin D, calcium, or creatine against a control/placebo in this high-risk population.
Osteosarcopenia, defined as the age-related concomitant loss of BMD and muscle mass and/or function, is a strong predictor of functional impairments, falls, fractures, and earlier death in older adults (1). As the older section of society continues to grow, so too will the prevalence of osteosarcopenia and the socioeconomic burden associated with this geriatric syndrome.
Two major risk factors for osteosarcopenia are reductions in physical activity and poor nutritional status, particularly low intake of protein, vitamin D, and calcium (2-4). Declines in physical activity result in a loss of BMD and muscle mass (5) due to reduced stimulation of muscle fibers and a decrease in the mechanical forces that promote osteogenesis (6). Multimodal exercise, incorporating resistance, weight-bearing impact, and/or balance training has been suggested as a dual therapy (4, 7, 8) to improve aspects of osteosarcopenia such as BMD and muscle mass, strength, or physical performance (9, 10).
In addition to physical activity, a number of nutrients play a fundamental role in the structure and function of muscle and bone(11). Vitamin D and calcium supplementation have been shown to improve BMD and muscle strength and reduce falls and fractures in community-dwelling adults deficient in these nutrients (12, 13). Observational studies have demonstrated a relationship between a higher intake of protein (above the recommended dietary guidelines) and greater retention of lean (muscle) mass and BMD in older adults (14-16). Lastly, in healthy older adults, creatine supplementation has consistently shown to augment the benefits of RT (17), although the effect in clinical populations with compromised muscle and bone health is yet to be determined.
Several systematic reviews and meta-analyses have been carried out to evaluate the effects of exercise and nutritional interventions in osteopenic/osteoporotic and sarcopenic populations (18-22), however, at present, there is a lack of studies evaluating the efficacy of these non-pharmacological interventions separately in osteosarcopenic individuals using proposed criteria.
Therefore, this systematic review aims to examine the effects of exercise and/or nutritional interventions with protein, calcium, vitamin D, and creatine on measures and outcomes relating to musculoskeletal health in older adults with osteosarcopenia.
Conclusion
In conclusion, progressive RT is safe and effective in improving several aspects of osteosarcopenia including lumbar spine and total hip BMD and muscle mass, strength, and quality, but not physical performance or bone turnover. There is currently no evidence for other non-pharmacological interventions such as protein, vitamin D, calcium, or creatine in osteosarcopenic individuals. Future research should utilize an RCT design, lasting at least 6 months, and examine the impact of these nutrients (with or without RT) in older osteosarcopenic adults, and include clinically relevant outcomes on activities of daily living falls and fractures.
Background: Osteosarcopenia is a geriatric syndrome defined by the concomitant presence of osteopenia/osteoporosis (loss of bone mineral density (BMD)) and sarcopenia (loss of muscle mass and/or function), which increases the risk of falls, fractures, and premature mortality.
Objective: To examine the efficacy of non-pharmacological (exercise and/or nutritional) interventions on musculoskeletal measures and outcomes in osteosarcopenic adults by reviewing findings from randomized controlled trials (RCTs).
Methods: This review was registered at PROSPERO (registration number: CRD42020179292) and conducted in accordance with the PRISMA guidelines. Electronic databases were searched for RCTs assessing the effect of at least one non-pharmacological intervention (any form of exercise and/or supplementation with protein, vitamin D, calcium, or creatine) on any musculoskeletal measure/outcome of interest (BMD, bone strength/turnover, muscle mass, and strength, physical performance, falls/fractures) in adults with osteosarcopenia as defined by any proposed criteria.
Results: Two RCTs (of n=106 older osteosarcopenic adults (≥65 years)) assessing the effects of progressive resistance training (RT) (via resistance bands or machines; 2-3 times/week; ~60 minutes in duration) were eligible for inclusion. The two RCTs demonstrated moderate-quality evidence that RT increases muscle mass, strength, and quality, with changes in strength and quality occurring before muscle mass (12 vs 28 weeks). There was low-quality evidence that RT increases lumbar spine BMD and maintains total hip BMD when performed for 12 and 18 months, respectively, and moderate-quality evidence that RT has no effect on markers of bone turnover or physical performance. No major adverse effects were recorded in either of the RCTs. There were no eligible RCTs examining the impact of nutritional interventions.
Conclusion: Chronic RT is safe and effective at potentiating gains in muscle mass, strength, and quality, and increasing or maintaining BMD in older osteosarcopenic adults. No RCT has examined the effects of protein, vitamin D, calcium, or creatine against a control/placebo in this high-risk population.
Osteosarcopenia, defined as the age-related concomitant loss of BMD and muscle mass and/or function, is a strong predictor of functional impairments, falls, fractures, and earlier death in older adults (1). As the older section of society continues to grow, so too will the prevalence of osteosarcopenia and the socioeconomic burden associated with this geriatric syndrome.
Two major risk factors for osteosarcopenia are reductions in physical activity and poor nutritional status, particularly low intake of protein, vitamin D, and calcium (2-4). Declines in physical activity result in a loss of BMD and muscle mass (5) due to reduced stimulation of muscle fibers and a decrease in the mechanical forces that promote osteogenesis (6). Multimodal exercise, incorporating resistance, weight-bearing impact, and/or balance training has been suggested as a dual therapy (4, 7, 8) to improve aspects of osteosarcopenia such as BMD and muscle mass, strength, or physical performance (9, 10).
In addition to physical activity, a number of nutrients play a fundamental role in the structure and function of muscle and bone(11). Vitamin D and calcium supplementation have been shown to improve BMD and muscle strength and reduce falls and fractures in community-dwelling adults deficient in these nutrients (12, 13). Observational studies have demonstrated a relationship between a higher intake of protein (above the recommended dietary guidelines) and greater retention of lean (muscle) mass and BMD in older adults (14-16). Lastly, in healthy older adults, creatine supplementation has consistently shown to augment the benefits of RT (17), although the effect in clinical populations with compromised muscle and bone health is yet to be determined.
Several systematic reviews and meta-analyses have been carried out to evaluate the effects of exercise and nutritional interventions in osteopenic/osteoporotic and sarcopenic populations (18-22), however, at present, there is a lack of studies evaluating the efficacy of these non-pharmacological interventions separately in osteosarcopenic individuals using proposed criteria.
Therefore, this systematic review aims to examine the effects of exercise and/or nutritional interventions with protein, calcium, vitamin D, and creatine on measures and outcomes relating to musculoskeletal health in older adults with osteosarcopenia.
Conclusion
In conclusion, progressive RT is safe and effective in improving several aspects of osteosarcopenia including lumbar spine and total hip BMD and muscle mass, strength, and quality, but not physical performance or bone turnover. There is currently no evidence for other non-pharmacological interventions such as protein, vitamin D, calcium, or creatine in osteosarcopenic individuals. Future research should utilize an RCT design, lasting at least 6 months, and examine the impact of these nutrients (with or without RT) in older osteosarcopenic adults, and include clinically relevant outcomes on activities of daily living falls and fractures.
