閉経後の骨粗鬆症とサルコペニア

閉経後の骨粗鬆症とサルコペニアの関係をみた論文を紹介します。

Sjöblom Samu, et al. Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas, doi:10.1016/j.maturitas.2013.03.016

対象は590人の閉経後のフィンランド女性です。平均年齢68歳で骨密度と筋肉量はDEXAで評価しています。骨密度で正常、骨質減少、骨粗鬆症、筋肉量で非サルコペニア、前サルコペニア、サルコペニアに分類しました。握力や歩行速度も評価しています。

結果ですがサルコペニアの女性は非サルコペニアの女性と比べて、骨粗鬆症が12.9倍多かったです。握力が下位1/4の女性は上位1/4の女性と比較して、骨粗鬆症が11.7倍多い結果でした。サルコペニアの女性は非サルコペニアの女性と比べて骨折が2.7倍多く、転倒が2.1倍多かったです。

以上より、サルコペニアは骨粗鬆症と強く関連し、握力が最もサルコペニア、骨粗鬆症、転倒、骨折の関連を明らかにする有意な測定項目でした。

握力は栄養指標にも含まれるようになり、サルコペニアの診断基準にも含まれることがあります。在宅でも測定できる項目ですので、リハだけでなく、NST、栄養指導、日常診療でもできるだけ握力は評価しておいたほうがよいですね。

Abstract 

Purpose

The aim of the study was to determine the relationship between the components of clinical sarcopenia and osteoporosis in postmenopausal women.

Methods

A population-based cohort of 590 Finnish postmenopausal women (mean age 67.9; range 65–72) was selected from the Osteoporosis Fracture Prevention (OSTPRE-FPS) study in 2002. Bone mineral density (BMD) and lean tissue mass were assessed by dual X-ray absorptiometry (DXA). The study sample was divided into three categories according to the WHO BMD classification: normal, osteopenia and osteoporosis. The study sample was divided into non-sarcopenic, presarcopenic, sarcopenic and non-classified groups according to quartiles of RSMI i.e. relative skeletal muscle index (appendicular muscle mass (kg)/square of height (m)), hand grip strength (kPa) and walking speed.

Results

In logistic regression analysis sarcopenic women had 12.9 times higher odds of having osteoporosis (p≤0.001, OR=12.9; 95% CI=3.1–53.5) in comparison to non-sarcopenic women. In comparison to women in the highest grip strength quartile, women within the lowest quartile had 11.7 times higher odds of having osteoporosis (p=0.001, OR=11.7; 2.6–53.4). Sarcopenic women had 2.7 times higher odds of having fractures than their non-sarcopenic counterparts (p=0.005, OR=2.732; 1.4–5.5). Sarcopenic women had also 2.1 times higher risk of falls during the preceding 12 months compared to non-sarcopenic women (p=0.021, OR=2.1; 1.1–3.9). Adjustment for age, body mass index (BMI), physical activity and hormone therapy (HT) did not significantly alter these results.

Conclusions

The components of clinical sarcopenia are strongly associated with osteoporosis. Grip strength is the most significant measurement to reveal the association between sarcopenia and osteoporosis, falls and fractures.