The Journal of Clinical Endocrinology and Metabolism Journal Article

Physical Function and Bone Structure Decline

December 21, 2021
 

Philippe Paul Wagner, Danielle E Whittier, Dominique Foesser, Steven K Boyd, Roland Chapurlat, Pawel Szulc
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 12, December 2021, Pages e5180–e5194
https://doi.org/10.1210/clinem/dgab506

Abstract

Context

High fracture risk in individuals with low muscle strength is attributed to high risk of falls.

Objective

This work aims to study the association of muscle mass and physical performance with bone microarchitecture decline and risk of fall and nonvertebral fracture in men.

Methods

A prospective, 8-year follow-up of a cohort was conducted among the general population. A total of 821 volunteer men aged 60 and older participated. Hip areal bone mineral density (aBMD) and appendicular lean mass (ALM) were assessed at baseline by dual x-ray absorptiometry. Lower-limb relative ALM (RALM-LL) is ALM-LL/(leg length)2. The physical performance score reflects the ability to perform chair stands and static and dynamic balance. Bone microarchitecture was assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline and after 4 and 8 years. Statistical analyses were adjusted for shared risk factors. Outcome measurements included the rate of change in the HR-pQCT indices, incident falls, and fractures.

Results

Cortical bone loss and estimated bone strength decline were faster in men with low vs normal RALM-LL (failure load: –0.74 ± 0.09 vs –0.43 ± 0.10%/year; P < .005). Differences were similar between men with poor and those with normal physical performance (failure load: –1.12 ± 0.09 vs –0.40 ± 0.05%/year; P < .001). Differences were similar between men having poor performance and low RALM-LL and men having normal RALM-LL and performance (failure load: –1.40 ± 0.17 vs –0.47 ± 0.03%/year; P < .001). Men with poor physical performance had a higher risk of fall (hazard ratio [HR] = 3.52; 95% CI, 1.57–7.90, P < .05) and fracture (HR = 2.68; 95% CI, 1.08–6.66, P < .05).

Conclusion

Rapid decline of bone microarchitecture and estimated strength in men with poor physical performance and low RALM-LL may contribute to higher fracture risk.

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