Abstract
Background: Admitted bedridden older patients are at risk of the development of sarcopenia during hospital stay (incident sarcopenia). The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Methods: A multicenter, pragmatic, prospective observational study was designed. Older subjects with hip fracture admitted to two rehabilitation units were included. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. The mortality was evaluated after 7 years of follow-up. Results: A total of 187 subjects (73.8% women) age 85.2 ± 6.3 years were included. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index. During follow-up 114 patients died (60.5% sarcopenic vs. 39.5% non-sarcopenic, p = 0.001). Cox regression analyses showed that factors associated to increased risk of mortality were sarcopenia (HR: 1.67, 95% CI 1.11–2.51) and low hand-grip strength (HR: 1.76, 95% CI 1.08–2.88). Conclusions: Older patients with undernutrition have a higher risk of developing sarcopenia during hospital stay, and sarcopenic patients have almost two times more risk of mortality than non-sarcopenic patients during follow-up after hip fracture.
Highlights
Sarcopenia is a geriatric syndrome [1], characterized by the loss of muscle mass and function, which has been recognized as an independent clinical syndrome by the International Classification of Nutrients 2019, 11, 2243; doi:10.3390/nu11092243 www.mdpi.com/journal/nutrientsDisease, tenth revision, Clinical Modification (ICD-10CM) code (M62.84), strengthening its clinical significance [2,3]
Almost all patients lived at their own home before the fracture (99%), and only two (1%) patients lived in nursing homes
49 patients. * Logistic regression analysis adjusted for age, sex and centre. ‡ Logistic regression analysis adjusted for age, and centre
Summary
Sarcopenia is a geriatric syndrome [1], characterized by the loss of muscle mass and function, which has been recognized as an independent clinical syndrome by the International Classification of Nutrients 2019, 11, 2243; doi:10.3390/nu11092243 www.mdpi.com/journal/nutrientsDisease, tenth revision, Clinical Modification (ICD-10CM) code (M62.84), strengthening its clinical significance [2,3]. Sarcopenia shares physio-pathological mechanisms, and is associated with a high prevalence of osteoporosis [5,6] This situation has brought the introduction of the concept of osteosarcopenia, where sarcopenia and osteoporosis overlap resulting in important functional consequences like falls and hip fractures among others [7,8]. The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index.
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