Muscle Strength may Predict Fracture Risks for Older Men

New study results suggest low muscle mass is associated with an increased risk of hip fractures in older men, even after accounting for other factors.

Older men with lower amounts of muscle mass have significantly increased the risk of hip and potentially other fractures, according to new research led by investigators at Sutter Health’s San Francisco Coordinating Center (SFCC) in San Francisco.

The results were published in the Journal of Bone and Mineral Research, the official journal of the American Society for Bone and Mineral Research.

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‘The relationship between D3CR muscle mass and fracture risk in older men might be mediated by poor physical performance.’

About 36 million falls are reported among older adults each year, resulting in more than 32,000 deaths. One out of every five falls causes an injury, such as broken bones or a head injury. Each year at least 300,000 older people are hospitalized for hip fractures.

Previous studies have shown that low DXA lean mass, a commonly used but inaccurate approximation of muscle is unrelated to a higher risk of fracture. This has led some researchers to erroneously conclude that muscle is relatively unimportant for fracture risk.

Dr. Cawthon and colleagues at leading academic medical centers across the U.S. prospectively studied 1,363 men (mean age, 84.2 years). The risk of fracture by quartile of D3Cr muscle mass was determined, and the study authors also investigated the mediating influence of physical performance (walking speed, chair stands, and grip strength) on the relationship between muscle mass and fracture.

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Results showed D3Cr muscle mass weakly correlated with femoral BMD (r=0.10, p<.001). However, D3Cr muscle mass correlated strongly with fractures, especially hip fracture.

Compared with men in the highest quartile, those in the lowest quartile of D3Cr muscle mass/weight were about twice as likely to have a clinical fracture, any non-spine fracture, and were about six times more likely to have a hip fracture after approximately four years of follow-up.

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D3Cr dilution assessment of muscle mass—currently available only in research settings and being tested by the MrOS Study and other researchers for clinical use—relies on several aspects of creatine biology to estimate muscle mass that does not rely on the same assumptions of compartment models (such as DXA), and may therefore represent a more accurate assessment of muscle mass.

“The clear association between muscle mass and hip fracture was striking. For example, men in the lowest quartile of muscle mass were almost six times more likely to have a fracture than men highest quartile,” says Steve Cummings, M.D., director of the SFCC and a principal investigator of MrOS at Sutter’s California Pacific Medical Center.

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Resistance exercise and even simple activities like climbing stairs may be important for maintaining muscle strength and preventing fractures, however more information from the best evidence is needed to confirm these findings and help guide clinical decision making.

The limitation of the study is its sole cohort was male, as the measure of muscle mass was added to an ongoing study about osteoporosis in men (MrOS). It is important to determine if these associations are also true in women.

If so, then it will be critical to test whether interventions that improve muscle mass also lower fracture risk and how the D3Cr dilution assessment of muscle mass may potentially be used in the clinic to measure health outcomes.

Source-Medindia