Rebekah Harris1, Yuefang Chang1, Kristen Beavers2, Deepika Laddu-Patel3, Jennifer Bea4, Karen Johnson5, Meryl LeBoff6, Catherine Womack2, Robert Wallace7, Wenjun Li8, Carolyn Crandall9, Jane Cauley1. 1. University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania. 2. University of Wake Forest, Department of Health and Exercise Science, Winston-Salem, North Carolina. 3. Stanford University, Stanford Prevention Research Center, Stanford, California. 4. University of Arizona Cancer Center, Tucson, Arizona. 5. University of Tennessee Health Science Center, Memphis, Tennessee. 6. Brigham & Women's Hospital, Department of Medicine, Boston, Massachusetts. 7. University of Iowa, College of Public Health, Iowa City, Iowa. 8. University of Massachusetts Medical School, Worcester, Massachusetts. 9. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Abstract
OBJECTIVES: To determine whether women with sarcopenia and low bone mineral density (BMD) are at greater risk of clinical fractures than those with sarcopenia or low BMD alone. DESIGN: Women's Health Initiative (WHI) Observational and Clinical trials. SETTING: Three U.S. clinical centers (Pittsburgh, PA; Birmingham, AL; Phoenix/Tucson, AZ). PARTICIPANTS: Women (mean age 63.3 ± 0.07) with BMD measurements (N = 10,937). MEASUREMENTS: Sarcopenia was defined as appendicular lean mass values corrected for height and fat mass. Low BMD was defined as a femoral neck T-score less than -1.0 based on the Third National Health and Nutrition Examination Survey reference database for white women. Cox proportional hazards analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). We followed women for incident fractures over a median of 15.9 years. RESULTS: Participants were classified into mutually exclusive groups based on BMD and sarcopenia status: normal BMD and no sarcopenia (n = 3,857, 35%), sarcopenia alone (n = 774, 7%), low BMD alone (n = 4,907, 45%), and low BMD and sarcopenia (n = 1,399, 13%). Women with low BMD, with (HR = 1.72, 95% CI = 1.44-2.06) or without sarcopenia (HR = 1.58, 95% CI = 1.37-1.83), had greater risk of fracture than women with normal BMD; the difference remained statistically significant after adjustment for important covariates. Women with low BMD, with (HR = 2.78, 95% CI = 1.78-4.30 and without (HR = 2.42, 95% CI = 1.63-3.59) sarcopenia had higher risk of hip fractures. Women with sarcopenia alone had similar HRs to women with normal BMD. CONCLUSION: Compared to women with normal BMD.
OBJECTIVES: To determine whether women with sarcopenia and low bone mineral density (BMD) are at greater risk of clinical fractures than those with sarcopenia or low BMD alone. DESIGN:Women's Health Initiative (WHI) Observational and Clinical trials. SETTING: Three U.S. clinical centers (Pittsburgh, PA; Birmingham, AL; Phoenix/Tucson, AZ). PARTICIPANTS: Women (mean age 63.3 ± 0.07) with BMD measurements (N = 10,937). MEASUREMENTS: Sarcopenia was defined as appendicular lean mass values corrected for height and fat mass. Low BMD was defined as a femoral neck T-score less than -1.0 based on the Third National Health and Nutrition Examination Survey reference database for white women. Cox proportional hazards analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). We followed women for incident fractures over a median of 15.9 years. RESULTS:Participants were classified into mutually exclusive groups based on BMD and sarcopenia status: normal BMD and no sarcopenia (n = 3,857, 35%), sarcopenia alone (n = 774, 7%), low BMD alone (n = 4,907, 45%), and low BMD and sarcopenia (n = 1,399, 13%). Women with low BMD, with (HR = 1.72, 95% CI = 1.44-2.06) or without sarcopenia (HR = 1.58, 95% CI = 1.37-1.83), had greater risk of fracture than women with normal BMD; the difference remained statistically significant after adjustment for important covariates. Women with low BMD, with (HR = 2.78, 95% CI = 1.78-4.30 and without (HR = 2.42, 95% CI = 1.63-3.59) sarcopenia had higher risk of hip fractures. Women with sarcopenia alone had similar HRs to women with normal BMD. CONCLUSION: Compared to women with normal BMD.
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