Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community dwelling seniors age 65 and older

Authors: BISCHOFF-FERRARI, HEIKE - University Hospital Zurich; ORAV, JOHN ENDEL - Harvard School Of Public Health; KANIS, J. - University Of Sheffield; RIZZOLI, RENE - Geneva University Hospital; SCHLOEGL, MATHIAS - University Hospital Zurich; STAEHELIN, HANNES - University Of Basel; WILLETT, WALTER - Harvard School Of Public Health; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/27/2015
Publication Date: 12/1/2015
Citation: Bischoff-Ferrari, H.A., Orav, J., Kanis, J.A., Rizzoli, R., Schloegl, M., Staehelin, H.B., Willett, W.C., Dawson-Hughes, B. 2015. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community dwelling seniors age 65 and older. Osteoporosis International. 26:2793–2802.

Interpretive Summary: This study sought to compare the extent to which 7 available definitions of sarcopenia and 2 related definitions predict the prospective rate of falling. We studied a cohort of 445 seniors (mean age 71 years, 45% men) living in the community who were followed with a detailed fall assessment for 3 years. We compared the rate of falls in sarcopenic versus non-sarcopenic individuals using regression analyses adjusting for gender and treatment (original intervention tested vitamin D plus calcium against placebo). Of the 7 available definitions, 3 were based on low muscle mass alone (Baumgartner, Delmonico1 and 2) and 4 required both low muscle mass and decreased performance in a functional test (Fielding, Cruz-Jentoft, Morley, Muscaritoli). Among 445 participants, 231 fell, sustaining 514 falls over the 3-year follow-up. The prospective rate of falls in sarcopenic versus non -sarcopenic individuals was best predicted by the Baumgartner definition based on low lean mass alone and the Cruz-Jentoft definition based on low lean mass plus decreased functional performance. Consistently, fall rate was non-significantly higher in sarcopenic versus non-sarcopenic individuals based on the definitions of Delmonico1, Fielding and Morley. Among the definitions investigated, the Baumgartner definition and the Cruz- Jentoft definition had the highest validity for predicting the rate of falls.

Technical Abstract: Purpose: To compare the extent to which 7 available definitions of sarcopenia and 2 related definitions predict the prospective rate of falling. Methods: We studied a cohort of 445 seniors (mean age 71 years, 45% men) living in the community who were followed with a detailed fall assessment for 3 years. For comparing the rate of falls in sarcopenic versus non-sarcopenic individuals, we used multivariate Poisson regression analyses adjusting for gender and treatment (original intervention tested vitamin D plus calcium against placebo). Of the 7 available definitions, 3 were based on low lean mass alone (Baumgartner, Delmonico1 and 2) and 4 required both low muscle mass and decreased performance in a functional test (Fielding, Cruz- Jentoft, Morley, Muscaritoli). The 2 related definitions were based on low lean mass alone (Studenski1) and low lean mass contributing to weakness (Studenski2). Results: Among 445 participants, 231 fell, sustaining 514 falls over the 3-year follow-up. The prospective rate of falls in sarcopenic versus non -sarcopenic individuals was best predicted by the Baumgartner definition based on low lean mass alone (RR = 1.54; 95% CI: 1.09 -2.18) with 11% prevalence of sarcopenia and the Cruz-Jentoft definition based on low lean mass plus decreased functional performance (RR = 1.82; 95% CI: 1.24-2.69) with 7.1% prevalence of sarcopenia. Consistently, fall rate was non-significantly higher in sarcopenic versus non-sarcopenic individuals based on the definitions of Delmonico1, Fielding and Morley. Conclusion: Among the definitions investigated, the Baumgartner definition and the Cruz-Jentoft definition had the highest validity for predicting the rate of falls.