Osteoporosis and gait and balance disturbances in older sarcopenic obese New Zealanders.
Bone, muscle, and fat may affect gait and balance in older adults. Osteoporosis was prevalent in low muscle mass participants and related to gait and balance deficits. Low muscle combined with high fat mass had more functional deficits and poorer bone health, which has implications for falls risk and fractures.


BACKGROUND
Decreasing bone density and muscle mass and increasing fat mass may act synergistically to affect gait and balance in older adults.


METHODS
One hundred eighty-three older adults (age 72.7 +/- 6 years, range 56-93; body mass index 28.2 +/- 4.9, range 16.6-46.0) were recruited from a New Zealand falls prevention intervention trial. Total and appendicular skeletal muscle mass (ASM), percent fat, and bone mineralization were assessed by dual energy X-ray absorptiometry and used to characterize normal lean (NL, n = 51), sarcopenic (SS, n = 18), sarcopenic obese (SO, n = 29), and obese (OO, n = 85) phenotypes. Functional performance was assessed using timed up and go, chair stand, single leg stand, and step test. Regression models were adjusted for age, sex, medications, and physical activity.


RESULTS
Femoral neck osteoporosis was present in 22% SS, 17% SO, 12% NL, and 7% OO. Femoral neck osteoporosis with low ASM predicted poor chair stand performance (beta -3.3, standard error 1.6, p = 0.04). SO scored lowest on the chair stand (p = 0.03) and step test (p = 0.03). Higher ASM predicted faster timed up and go performance (p = 0.001).


CONCLUSIONS
Osteoporosis was prevalent in low ASM groups (SS and SO) and related to gait and balance deficits, particularly in the SO. This has implications for falls risk, fractures, and interventions.
Waters
D L
DL
Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, P. O. Box 913, Dunedin 9054, New Zealand. debra.waters@otago.ac.nz
Hale
L
L
Grant
A M
AM
Herbison
P
P
Goulding
A
A
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015992:Body Mass Index; D015519:Bone Density; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000150:complications*; D010024:Osteoporosis / Q000150:complications* / Q000503:physiopathology; D004856:Postural Balance; D055948:Sarcopenia / Q000150:complications; D012678:Sensation Disorders / Q000209:etiology*; D026302:Tai Ji