title: The role of sarcopenia with and without fracture.
abstract: BACKGROUND
  Bone and muscle tissues are in a close relationship. They are linked from a biological and functional point of view and both are related to an increased fracture risk in the elderly. The aging process is involved in the loss of functionality of both bones and muscles. In particular, aging-induced decline in muscle size and quality accompanies catabolic alterations in bone tissue; furthermore, age-related changes in bone alter its response to muscle-derived stimulation. The increased fracture risk in individuals with sarcopenia and osteoporosis is due to the decline of muscle mass and strength, the decrease in bone mineral density (BMD) and limited mobility. In this study, we investigated the role of sarcopenia and the main age-related bone diseases, osteoporosis (OP) and osteoarthritis (OA).
  
  
  METHODS
  Muscular performance status was evaluated using the Physical Activity Scale for the Elderly (PASE) test in 27 female patients with OP who underwent total hip arthroplasty for hip fracture, and in 27 age-matched female patients with OA who underwent total hip arthroplasty. Dual-energy X-ray absorptiometry (DEXA) was performed and the T-score values were used to discriminate between OP and OA patients. Body Mass Index (BMI) was calculated. As part of a multiparametric model of evaluation, biopsies of vastus lateralis muscle were analysed by immunohistochemical reaction to find a correlation with the above mentioned functional index.
  
  
  RESULTS
  The PASE test showed that the OP patients had a low or moderate level of physical activity before fracture occurred, whereas the OA patients had more intensive pre-fracture physical performances. Histological analysis showed that osteoporosis is characterised by a preferential type II fibre atrophy; in particular, data correlation showed that lower PASE test scores were related to lower diameter of type II fibres. No correlation was found between bone mineral density (BMD) and PASE test results.
  
  
  CONCLUSIONS
  Osteoporosis is closely related to sarcopenia before and after fracture. Bone remodelling is influenced by muscle morphological and functional impairment and sarcopenia is considered one of the major factors for functional limitation and motor dependency in elderly osteoporotic individuals. Therefore, physical activity should be strongly recommended for OP patients at diagnosis.
authors: Department of Orthopaedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133 Rome, Italy. Electronic address: tarantin@uniroma2.it.
authors: Umberto
authors: U
authors: Tarantino
authors: Department of Orthopaedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133 Rome, Italy; School of Specialisation in Orthopaedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133 Rome, Italy.
authors: Jacopo
authors: J
authors: Baldi
authors: Anatomic Pathology Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy; "Multidisciplinary Study of the Effects of Microgravity on Bone Cells" Project, Italian Space Agency (ASI), Spatial Biomedicine Center, Via del Politecnico snc, 00133 Rome, Italy.
authors: Manuel
authors: M
authors: Scimeca
authors: Department of Orthopaedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133 Rome, Italy; School of Specialisation in Orthopaedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133 Rome, Italy.
authors: Eleonora
authors: E
authors: Piccirilli
authors: Oncologic Centre, "Palazzo Baleani", Azienda Policlinico Umberto I, Corso Vittorio Emanuele II 244, Rome, Italy.
authors: Andrea
authors: A
authors: Piccioli
authors: Anatomic Pathology Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy.
authors: Elena
authors: E
authors: Bonanno
authors: Department of Orthopaedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Viale Oxford 1, 00133 Rome, Italy.
authors: Elena
authors: E
authors: Gasbarra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019644:Arthroplasty, Replacement, Hip; D015519:Bone Density; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007558:Italy / Q000453:epidemiology; D010003:Osteoarthritis / Q000453:epidemiology / Q000503:physiopathology*; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D055948:Sarcopenia / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery
keywords: Aging; BMP2; Hip fracture; Muscle fibre atrophy; Myostatin; Osteoarthritis; Osteoporosis; Risk of falling; Sarcopenia; Satellite cells