Osteosarcopenic Obesity

Abstract

The term “osteosarcopenic obesity” describes the presence of osteosarcopenia in obese older adults, and also highlights the important contribution of adipose tissue to processes which lead to skeletal muscle and bone losses during ageing. Obesity is associated with increased rates of falls and disability but is commonly perceived to protect against fractures in older adults. However, beneficial effects of obesity for bone health are likely attributable to increased absolute muscle mass and those with sarcopenia and/or osteopenia/osteoporosis may have significantly higher fracture risk. Few studies to date have explored whether the combination of osteopenia/osteoporosis, sarcopenia and obesity is associated with poorer musculoskeletal health than observed in the presence of only one or two of these conditions. While prospective cohort studies are required to determine the clinical value of osteosarcopenic obesity for disability, falls and fracture prediction, it is clear that health professionals need to consistently diagnose and treat poor bone and muscle health in obese older patients. The most effective interventions for reducing risk of disability, falls and fracture in osteosarcopenic obesity are likely to involve lifestyle modification. This may include caloric restriction to induce fat loss, but with the addition of progressive resistance training and weight-bearing impact exercises, as well as maintenance of adequate protein, vitamin D and calcium intakes, in order to minimize weight loss-associated declines in bone and muscle mass. Nevertheless, randomized controlled trials are required to identify effective treatment strategies for the prevention of disability, falls and fractures in osteosarcopenic obese older adults.