Sarcopenia and Its Association with Falls and Fractures in Older Adults: A Systematic Review and Meta-analysis

Overview

Journal J Cachexia Sarcopenia Muscle

Date 2019 Apr 18

PMID 30993881

Citations 371

Authors

Suey S Y Yeung

Esmee M Reijnierse

Vivien K Pham

Marijke C Trappenburg

Wen Kwang Lim

Carel G M Meskers

Andrea B Maier

Affiliations

Soon will be listed here.

Abstract

Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I statistics. The search identified 2771 studies. Thirty-six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non-sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty-three studies (45 926 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (cross-sectional studies: OR 1.60; 95% CI 1.37-1.86, P < 0.001, I = 34%; prospective studies: OR 1.89; 95% CI 1.33-2.68, P < 0.001, I = 37%) and fractures (cross-sectional studies: OR 1.84; 95% CI 1.30-2.62, P = 0.001, I = 91%; prospective studies: OR 1.71; 95% CI 1.44-2.03, P = 0.011, I = 0%) compared with non-sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent, and study quality. The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures.

Citing Articles

Epigenetic factors and inflammaging: FOXO3A as a potential biomarker of sarcopenia and upregulation of DNMT3A and SIRT3 in older adults.

Bogucka D, Wajda A, Stypinska B, Radkowski M, Targowski T, Modzelewska E Front Immunol. 2025; 16:1467308.

PMID: 40034697 PMC: 11872893. DOI: 10.3389/fimmu.2025.1467308.

Risk screening by the emergency medical services identifies older patients at risk of emergency department readmission: a retrospective observational study.

Saario E, Makinen M, Castren M, Jamsen E Aging Clin Exp Res. 2025; 37(1):59.

PMID: 40021579 PMC: 11870983. DOI: 10.1007/s40520-025-02942-8.

Are There Differences in Postural Control and Muscular Activity in Individuals with COPD and with and Without Sarcopenia?.

Sepulveda-Loyola W, Alvarez-Bustos A, Valenzuela-Fuenzalida J, Ordinola Ramirez C, Saldias Solis C, Probst V Adv Respir Med. 2025; 93(1).

PMID: 39996622 PMC: 11851567. DOI: 10.3390/arm93010005.

Sarcopenia as a predictor of poor functional outcome of cervical spine surgery: a systematic review and meta-analysis.

Tayal A, Wahi S, Afsar A, Pahwa B, Garg K Neurosurg Rev. 2025; 48(1):256.

PMID: 39976777 DOI: 10.1007/s10143-025-03398-0.

Prevalence and influencing factors of sarcopenia among older adults in rural coastal areas of Ningbo City.

Huang S, Zhou F, Zhou Y, Zhong J, Hong H, Weng G Sci Rep. 2025; 15(1):6037.

PMID: 39971968 PMC: 11839905. DOI: 10.1038/s41598-025-90017-z.

References

Lera L, Albala C, Sanchez H, Angel B, Hormazabal M, Marquez C . Prevalence of Sarcopenia in Community-Dwelling Chilean Elders According to an Adapted Version of the European Working Group on Sarcopenia in Older People (EWGSOP) Criteria. J Frailty Aging. 2017; 6(1):12-17. DOI: 10.14283/jfa.2016.117. View

Woo N, Kim S . Sarcopenia influences fall-related injuries in community-dwelling older adults. Geriatr Nurs. 2014; 35(4):279-82. DOI: 10.1016/j.gerinurse.2014.03.001. View

Hida T, Shimokata H, Sakai Y, Ito S, Matsui Y, Takemura M . Sarcopenia and sarcopenic leg as potential risk factors for acute osteoporotic vertebral fracture among older women. Eur Spine J. 2015; 25(11):3424-3431. DOI: 10.1007/s00586-015-3805-5. View

Bijlsma A, Meskers C, Ling C, Narici M, Kurrle S, Cameron I . Defining sarcopenia: the impact of different diagnostic criteria on the prevalence of sarcopenia in a large middle aged cohort. Age (Dordr). 2012; 35(3):871-81. PMC: 3636407. DOI: 10.1007/s11357-012-9384-z. View

Sanada K, Miyachi M, Tanimoto M, Yamamoto K, Murakami H, Okumura S . A cross-sectional study of sarcopenia in Japanese men and women: reference values and association with cardiovascular risk factors. Eur J Appl Physiol. 2010; 110(1):57-65. DOI: 10.1007/s00421-010-1473-z. View

Kim T, Choi K . Sarcopenia: definition, epidemiology, and pathophysiology. J Bone Metab. 2014; 20(1):1-10. PMC: 3780834. DOI: 10.11005/jbm.2013.20.1.1. View

Menant J, Weber F, Lo J, Sturnieks D, Close J, Sachdev P . Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia?. Osteoporos Int. 2016; 28(1):59-70. DOI: 10.1007/s00198-016-3691-7. View

Newman A, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M . Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc. 2003; 51(11):1602-9. DOI: 10.1046/j.1532-5415.2003.51534.x. View

Cruz-Jentoft A, Landi F, Schneider S, Zuniga C, Arai H, Boirie Y . Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014; 43(6):748-59. PMC: 4204661. DOI: 10.1093/ageing/afu115. View

10.

Hida T, Ishiguro N, Shimokata H, Sakai Y, Matsui Y, Takemura M . High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture. Geriatr Gerontol Int. 2012; 13(2):413-20. DOI: 10.1111/j.1447-0594.2012.00918.x. View

11.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

12.

Muir S, Berg K, Chesworth B, Klar N, Speechley M . Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. J Clin Epidemiol. 2009; 63(4):389-406. DOI: 10.1016/j.jclinepi.2009.06.010. View

13.

Bergen G, Stevens M, Burns E . Falls and Fall Injuries Among Adults Aged ≥65 Years - United States, 2014. MMWR Morb Mortal Wkly Rep. 2016; 65(37):993-998. DOI: 10.15585/mmwr.mm6537a2. View

14.

Damian J, Pastor-Barriuso R, Valderrama-Gama E, de Pedro-Cuesta J . Factors associated with falls among older adults living in institutions. BMC Geriatr. 2013; 13:6. PMC: 3566955. DOI: 10.1186/1471-2318-13-6. View

15.

Pasma J, Engelhart D, Schouten A, Van Der Kooij H, Maier A, Meskers C . Impaired standing balance: the clinical need for closing the loop. Neuroscience. 2014; 267:157-65. DOI: 10.1016/j.neuroscience.2014.02.030. View

16.

Meng N, Li C, Liu C, Lin C, Lin W, Chang C . Comparison of height- and weight-adjusted sarcopenia in a Taiwanese metropolitan older population. Geriatr Gerontol Int. 2014; 15(1):45-53. DOI: 10.1111/ggi.12227. View

17.

Yoo J, Ha Y, Kwon H, Lee Y, Koo K, Yoo M . High Prevalence of Sarcopenia in Korean Patients after Hip Fracture: a Case-Control Study. J Korean Med Sci. 2016; 31(9):1479-84. PMC: 4974192. DOI: 10.3346/jkms.2016.31.9.1479. View

18.

Bischoff-Ferrari H, Orav J, Kanis J, Rizzoli R, Schlogl M, Staehelin H . Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int. 2015; 26(12):2793-802. DOI: 10.1007/s00198-015-3194-y. View

19.

Bijlsma A, Meskers M, Molendijk M, Westendorp R, Sipila S, Stenroth L . Diagnostic measures for sarcopenia and bone mineral density. Osteoporos Int. 2013; 24(10):2681-91. DOI: 10.1007/s00198-013-2376-8. View

20.

Beenakker K, Ling C, Meskers C, de Craen A, Stijnen T, Westendorp R . Patterns of muscle strength loss with age in the general population and patients with a chronic inflammatory state. Ageing Res Rev. 2010; 9(4):431-6. PMC: 7105185. DOI: 10.1016/j.arr.2010.05.005. View