大腿骨近位部骨折後サルコペニアは男性に多い

大腿骨近位部骨折後のサルコペニアは女性より男性に多いという横断研究を紹介します。

Marco Di Monaco, et al. Sarcopenia is more prevalent in men than in women after hip fracture: A cross-sectional study of 591 inpatients. Archives of Gerontology and Geriatrics, doi:10.1016/j.archger.2012.05.002

サルコペニアの評価はDEXAで行い、四肢筋肉量÷身長÷身長が若年の2標準偏差以下で判断しています。

結果ですが、ニューメキシコの若年標準値を用いた場合、女性の64％（531人中340人）、男性の95％（60人中57人）にサルコペニアを認めました。ロチェスターの若年標準値を用いた場合、女性の21.8％、男性の86.7％にサルコペニアを認めました。

多変量解析後も性別はサルコペニアの独立した要因でした（男性のほうがオッズ比で10.54倍～23.64倍多い）。以上より、大腿骨近位部骨折後のサルコペニアは女性より男性に多く、特に男性でのサルコペニア予防と治療が重要という結論です。

サルコペニアの有病割合を男性で評価した英語論文は、私が知る限りこれが初めてです。ただ、男性のほうが四肢筋肉量÷身長÷身長のカットオフ値が高い影響はありますが、ここまで極端な差は出ないのではと推測します。日本での臨床研究に期待したいです。

Abstract
Our aim was to compare the prevalence of sarcopenia in men and women with hip fracture. We studied 591 of 630 hip fracture inpatients consecutively admitted to our Rehabilitation ward. All the patients underwent a Dual-Energy X-Ray Absorptiometry (DXA) scan 18.4±8.7 (mean±SD) days after hip fracture occurrence. Sarcopenia was defined when appendicular lean mass divided by height squared was less than two standard deviations below the mean of the young reference group obtained from population based studies. Using normative data from the New Mexico Elder Health Study, 340 of the 531 women (64.0%), and 57 of the 60 men (95.0%) had sarcopenia. Using normative data from the survey performed in Rochester, Minnesota, 116 of the 531 women (21.8%), and 52 of the 60 men (86.7%) had sarcopenia. After adjustment for age, time between fracture occurrence and DXA scan, number of medications in use, and number of concomitant diseases, men had a significantly higher prevalence of sarcopenia than women (p<0.001). The adjusted odds ratio was either 10.54 (95% CI from 3.25 to 34.16) or 23.64 (from 10.8 to 51.6) depending on the reference population adopted. Our data shows a high proportion of sarcopenic subjects after hip-fracture. Sarcopenia was significantly more prevalent in men than in women. Relevancy of prevention and treatment of muscle loss is emphasized, particularly in men.