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Cited by 83Nutrition and Health in AgingBone health and osteoporosis researchBody Composition Measurement Techniques

Is There Enough Evidence for Osteosarcopenic Obesity as a Distinct Entity? A Critical Literature Review

Open access
Bauer, Jürgen M., Cruz-Jentoft, Alfonso J., Fielding, Roger A., Kanis, John A., Reginster, Jean-Yves, Bruyère, Olivier, Cesari, Matteo, Chapurlat, Roland +16 more·2019·Calcified Tissue International
DOI 10.1007/s00223-019-00561-w
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Abstract

The co-existence of impaired bone health (osteopenia/osteoporosis), reduced muscle mass and strength (sarcopenia), and increased adiposity (obesity) in middle-aged and older people has been identified in recent studies, leading to a proposal for the existence of "osteosarcopenic obesity" as a distinct entity. Evidence for the pathophysiological overlap of these conditions is mounting, although a causal relationship is yet to be established. Each component condition occurs frequently with increasing age, and with shared risk factors in many instances, thus, an overlap of these three conditions is not surprising. However, whether the concurrent existence of sarcopenia, osteoporosis and obesity leads to an increased risk of adverse musculoskeletal outcomes and mortality above and beyond the risks associated with the sum of the component parts remains to be proven and is a question of research interest. In this article, we review evidence for the existence of osteosarcopenic obesity including the current operational definition of osteosarcopenic obesity, prevalence, pathophysiology, outcomes and exploratory approaches to the management of components. We conclude that, there is insufficient evidence to support a discrete clinical entity of osteosarcopenic obesity at this time. To expand knowledge and understanding in this area, there is a need for consensus on a definition of osteosarcopenic obesity which will allow for identification, further epidemiological studies and comparisons between studies. Additionally, studies should assess whether the clinical outcomes associated with osteosarcopenic obesity are worse than the mere addition of those linked with its components. This will help to determine whether defining a person as having this triad will eventually result in a more effective treatment than addressing each of the three conditions separately.

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Written from the paper’s full text.

TL;DR

This critical literature review concludes there is insufficient evidence to support osteosarcopenic obesity as a discrete clinical entity at this time. It argues that a consensus definition is needed and that future studies must test whether the triad confers outcomes worse than the sum of osteoporosis, sarcopenia, and obesity.

Key findings

  • The authors conclude that osteosarcopenic obesity cannot yet be considered a distinct clinical entity, because a causal relationship among its components is not established and it remains unproven whether the concurrent triad increases adverse outcomes beyond the sum of its parts.
  • Reported osteosarcopenic obesity prevalence was 12–19% in women aged over 50 years; a Mexican study of women aged ≥50 years (N = 434) found 19%, and another study of postmenopausal women (mean age 63 years) found 12.1%.
  • In the Korean National Health and Nutrition Examination Survey (N = 3385 men and N = 4064 women aged >50 years), the reported incidence of sarcopenia, sarcopenic obesity, and osteosarcopenic obesity was 31.5%, 5.1%, and 4.1%, respectively.
  • Among older people (N = 801), osteosarcopenic obesity prevalence was 6.8%; visceral/subcutaneous adipose tissue ratio >1 was classified as visceral obesity and was closely linked to higher risk of fractures and inflammation.
  • No clinical studies were currently available that tested therapeutic approaches in individuals with osteosarcopenic obesity; management discussion therefore addressed exercise, nutrition, and pharmacotherapy for the component conditions.

Methods

  • Narrative, critical literature review using searches of PubMed, Scopus, and Embase until January 15, 2018, with MeSH/free words including “osteoporosis,” “sarcopenia,” “obesity,” “osteosarcopenia,” and “osteosarcopenic obesity,” plus terms such as definition, epidemiology, pathophysiology, hormones, exercise, nutrition, non-pharmacological, and pharmacological.
  • Search was limited to human studies, English-language publications, and full-length articles; reference lists and methodological sections of relevant articles were also scrutinized, yielding a final 129 references.
  • The paper synthesizes evidence on definitions, prevalence, pathophysiology, outcomes, and management; it reports no primary data collection or new empirical analysis.

Limitations

  • Stated: there is no standardized definition of osteosarcopenic obesity, and multiple definitions for its components make prevalence comparisons and conclusions difficult.
  • Stated: a causal relationship between the components is yet to be established, and biologically plausible pathophysiological hypotheses have not yet established clinical relevance for prevention or treatment.
  • Stated: very few studies specifically address nutritional intake in osteosarcopenic obesity, and most information comes from studies focused separately on sarcopenia, osteoporosis, or obesity; no clinical studies have tested therapeutic approaches in osteosarcopenic obesity. Evident from the text: as a narrative critical review, evidence selection relied on expert working-group judgment rather than a systematic quantitative synthesis.

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Integrity signals

Registry

Crossref · 10.1007/s00223-019-00561-w

Cites

130 of 130 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 121 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Recent evidence suggests a potential interconnection between osteoporosis, sarcopenia, and obesity with shared pathophysiology.

    “Recent evidence suggests a potential interconnection between osteoporosis, sarcopenia, and obesity with shared pathophysiology [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L (2014) Osteosarcopenic obesity: the role of bone, muscle, and fat on health. J Cachexia Sarcopenia Muscle 5(3):183–192. https://doi.org/10.1007/s13539-014-0146-x source

      Not checked in the free run.

  • Premisecitation

    In a sample of hospital referees aged 65 years or older, the prevalence of sarcopenia varied two-fold from 9% to 18% depending on the cut-offs applied.

    “In a sample of hospital referees aged ≥ 65 years the prevalence of sarcopenia varied two-fold from 9% to 18% depending on the cut-offs applied [35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Beaudart C, Reginster JY, Slomian J, Buckinx F, Locquet M, Bruyere O (2014) Prevalence of sarcopenia: the impact of different diagnostic cut-off limits. J Musculoskelet Neuronal Interact 14(4):425–431

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  • Premisecitation

    In a study of 445 community-dwelling seniors, the prevalence of sarcopenia varied between 2.5 and 27.2% among women and 3.1 and 20.4% among men when seven available definitions plus two related definitions were used.

    “The prevalence of sarcopenia varied between 2.5 and 27.2% among women, and 3.1 and 20.4% among men [33].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Bischoff-Ferrari HA, Orav JE, Kanis JA, Rizzoli R, Schlogl M, Staehelin HB, Willett WC, Dawson-Hughes B (2015) Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 26(12):2793–2802. https://doi.org/10.1007/s00198-015-3194-y source

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  • Premisecitation

    Overweight/obese but otherwise healthy young adults aged 18-21 years exhibit osteosarcopenic elements including increased fat mass and decreased muscle and bone mass compared with lean controls.

    “Overweight/ obese but otherwise healthy young adults (aged 18-21 years) exhibit 'osteosarcopenic elements' including: increased fat mass, and decreased muscle and bone mass compared with lean controls [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Stefanaki C, Peppa M, Boschiero D, Chrousos GP (2016) Healthy overweight/obese youth: early osteosarcopenic obesity features. Eur J Clin Invest 46(9):767–778. https://doi.org/10.1111/eci.12659 source

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  • Interpretationcitation

    Without a standardised definition of osteosarcopenic obesity, it is difficult to make comparisons and draw conclusions on prevalence because published studies use multiple definitions for the osteosarcopenic obesity components.

    “However, without a standardised definition of osteosarcopenic obesity it is difficult to make comparisons and draw conclusions on prevalence of as the published studies use multiple definitions for the osteosarcopenic obesity components (Table 1) [24][25][26].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [24] Szlejf C, Parra-Rodriguez L, Rosas-Carrasco O (2017) Osteosarcopenic obesity: prevalence and relation with frailty and physical performance in middle-aged and older women. J Am Med Dir Assoc 18(8):733 e731–733 e735. https://doi.org/10.1016/j.jamda.2017.02.023 source

      Not checked in the free run.

    • cites [25] Chung JH, Hwang HJ, Shin HY, Han CH (2016) Association between sarcopenic obesity and bone mineral density in middle-aged and elderly Korean. Ann Nutr Metab 68(2):77–84. https://doi.org/10.1159/000442004 source

      Not checked in the free run.

    • cites [26] Ilich JZ, Inglis JE, Kelly OJ, McGee DL (2015) Osteosarcopenic obesity is associated with reduced handgrip strength, walking abilities, and balance in postmenopausal women. Osteoporos Int 26(11):2587–2595. https://doi.org/10.1007/s00198-015-3186-y source

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  • Classified as probably not a substantial claim. 25
  • May combine two claims. 46

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    No clinical studies are currently available that have tested therapeutic approaches in individuals with osteosarcopenic obesity.

    “No clinical studies are currently available that have tested therapeutic approaches in individuals with osteosarcopenic obesity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    An increase in total and/or abdominal adipose tissue causes an increase in proinflammatory cytokines, as well as hormonal disturbances leading to losses of both muscle and bone tissues through a variety of mechanisms which ultimately affect clinical outcomes, such as an increase in risk for falls and fractures.

    “An increase in total and/or abdominal adipose tissue causes an increase in proinflammatory cytokines, as well as hormonal disturbances leading to losses of both muscle and bone tissues through a variety of mechanisms which ultimately affect clinical outcomes, such as an increase in risk for falls and fractures [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L (2014) Osteosarcopenic obesity: the role of bone, muscle, and fat on health. J Cachexia Sarcopenia Muscle 5(3):183–192. https://doi.org/10.1007/s13539-014-0146-x source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent studies identifying the co-existence of impaired bone health, reduced muscle mass or strength, and increased obesity in middle-aged and older women have led to the proposal of osteosarcopenic obesity as a distinct entity.

    “Recent studies identifying the co-existence of impaired bone health (osteopenia/osteoporosis), reduced muscle mass or strength (sarcopenia), and increased obesity in middleaged and older women, have led to the proposal of “osteosarcopenic obesity” as a distinct entity [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Ilich JZ (2017) Another impairment in older age: what does osteosarcopenic obesity syndrome mean for middle-aged and older women? J Am Med Dir Assoc 18(8):648–650. https://doi.org/10.1016/j.jamda.2017.05.001 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Each component of osteosarcopenic obesity occurs frequently with increasing age and with shared risk factors, so an overlap in prevalence is not surprising.

    “Each component of osteosarcopenic obesity occurs frequently with increasing age, and with shared risk factors; thus, an overlap in prevalence is not surprising.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The reductions in muscle and bone tissues are associated with decreases in physical activity; once losses hit a threshold, physical activity becomes even more limited leading to a vicious cycle of progressive loss of muscle and bone as well as gain in fat.

    “The reductions in muscle and bone tissues are associated with decreases in physical activity; once losses hit a threshold, physical activity becomes even more limited leading to a vicious cycle of progressive loss of muscle and bone as well as gain in fat [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L (2014) Osteosarcopenic obesity: the role of bone, muscle, and fat on health. J Cachexia Sarcopenia Muscle 5(3):183–192. https://doi.org/10.1007/s13539-014-0146-x source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is no international consensus on the operational definition of sarcopenia, and several definitions are used with consequent impact on the prevalence of sarcopenia.

    “Currently, there is no international consensus on the operational definition of sarcopenia, and several definitions of sarcopenia are used with consequent impact on the prevalence of sarcopenia [6,[31][32][33][34].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older P (2010) Sarcopenia: European consensus on definition and diagnosis: report of the european working group on sarcopenia in older people. Age Ageing 39(4):412–423. https://doi.org/10.1093/ageing/afq034 source

      Not checked in the free run.

    • cites [31] Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Fragala MS, Kenny AM, Kiel DP, Kritchevsky SB, Shardell MD, Dam TT, Vassileva MT (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69(5):547–558. https://doi.org/10.1093/gerona/glu010 source

      Not checked in the free run.

    • cites [32] Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50(5):889–896 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The definitions employed for the bone component of osteosarcopenic obesity have included both osteopenia and osteoporosis, and consequently may capture a very large proportion of the population of women aged over 50 years.

    “Notably, the definitions employed for the bone component of osteosarcopenic obesity have included both osteopenia and osteoporosis, and consequently may capture a very large proportion of the population of women aged over 50 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11(8):669–674 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    While age-related changes may be considered of primary importance, other important factors may include endocrine disorders, inadequate nutrition, inflammation, neurodegenerative disorders, physical inactivity, and other chronic and lifestyle factors.

    “While age-related changes may be considered of primary importance, other important factors may include endocrine disorders, inadequate nutrition, inflammation, neurodegenerative disorders, physical inactivity, and other chronic and lifestyle factors [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Ilich JZ, Kelly OJ, Inglis JE, Panton LB, Duque G, Ormsbee MJ (2014) Interrelationship among muscle, fat, and bone: connecting the dots on cellular, hormonal, and whole body levels. Ageing Res Rev 15:51–60. https://doi.org/10.1016/j.arr.2014.02.007 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Sweden, the prevalence of osteopenia is approximately 70% of women aged 50 years or older, whereas the prevalence of osteoporosis is 21%.

    “In Sweden, for example, the prevalence of osteopenia is approximately 70% of women aged ≥ 50 years, whereas the prevalence of osteoporosis is 21% [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11(8):669–674 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sarcopenic obesity was associated with increased odds for the development of osteoporosis among the middle-aged and older-aged Korean population.

    “Sarcopenic obesity was associated with increased odds for the development of osteoporosis among the middle-aged and older-aged Korean population [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Chung JH, Hwang HJ, Shin HY, Han CH (2016) Association between sarcopenic obesity and bone mineral density in middle-aged and elderly Korean. Ann Nutr Metab 68(2):77–84. https://doi.org/10.1159/000442004 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    IGF-I, myostatin, and cytokines such as IL-6, collectively referred to as myokines, are released from skeletal myocytes and exert actions on muscle and bone; osteokines including osteocalcin, osteoprotegerin and bone matrix proteins are released from bone cells and participate in regulation of musculoskeletal homeostasis.

    “Insulin-like growth factor-I (IGF-I), myostatin, and cytokines (e.g., interleukin-6 [IL-6]), collectively referred to as myokines, are released from skeletal myocytes and exert actions on the muscle and the bone.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Picca A, Calvani R, Manes-Gravina E, Spaziani L, Landi F, Bernabei R, Marzetti E (2017) Bone-muscle crosstalk: unraveling new therapeutic targets for osteoporosis. Curr Pharm Des 23(41):6256–6263. https://doi.org/10.2174/1381612823666170526112300 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a Mexican study of women aged 50 years or older (N=434), the prevalence of osteosarcopenic obesity was 19%, and osteosarcopenic obesity was associated with frailty and poor physical performance.

    “A Mexican study of women aged ≥ 50 years (N = 434) found a prevalence of 19% and osteosarcopenic obesity was associated with frailty and poor physical performance [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Szlejf C, Parra-Rodriguez L, Rosas-Carrasco O (2017) Osteosarcopenic obesity: prevalence and relation with frailty and physical performance in middle-aged and older women. J Am Med Dir Assoc 18(8):733 e731–733 e735. https://doi.org/10.1016/j.jamda.2017.02.023 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the Korean National Health and Nutrition Examination Survey (N=3385 men and N=4064 women aged over 50 years), the incidence of sarcopenia, sarcopenic obesity, and osteosarcopenic obesity was 31.5%, 5.1%, and 4.1%, respectively.

    “Investigation of the Korean National Health and Nutrition Examination Survey (including N = 3385 men and N = 4064 women aged > 50 years) found the incidence of sarcopenia, sarcopenic obesity, and osteosarcopenic obesity as 31.5%,5.1%, and 4.1%, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Chung JH, Hwang HJ, Shin HY, Han CH (2016) Association between sarcopenic obesity and bone mineral density in middle-aged and elderly Korean. Ann Nutr Metab 68(2):77–84. https://doi.org/10.1159/000442004 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bone and muscle are physically and functionally coupled.

    “Bone and muscle are physically and functionally coupled.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Picca A, Calvani R, Manes-Gravina E, Spaziani L, Landi F, Bernabei R, Marzetti E (2017) Bone-muscle crosstalk: unraveling new therapeutic targets for osteoporosis. Curr Pharm Des 23(41):6256–6263. https://doi.org/10.2174/1381612823666170526112300 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Evidence for the pathophysiological overlap of osteoporosis, sarcopenia, and obesity is mounting, although a causal relationship is yet to be established.

    “Evidence for the pathophysiological overlap of these conditions is mounting, although a causal relationship is yet to be established.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a study among postmenopausal women of mean age 63 years, the prevalence of osteosarcopenic obesity was 12.1%, and it was associated with poorer functionality, particularly compared to obese women.

    “Another study among postmenopausal women of mean age 63 years found a prevalence of osteosarcopenic obesity of 12.1% and an association with poorer functionality in women presenting with osteosarcopenic obesity, particularly compared to obese women, increasing the risk for bone fractures and immobility due to the combined decline in bone and muscle mass, and increased fat mass [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Ilich JZ, Inglis JE, Kelly OJ, McGee DL (2015) Osteosarcopenic obesity is associated with reduced handgrip strength, walking abilities, and balance in postmenopausal women. Osteoporos Int 26(11):2587–2595. https://doi.org/10.1007/s00198-015-3186-y source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    While many potential and biologically plausible contributing mechanisms are postulated, indicating a likely multifactorial pathogenesis, biologically plausible hypotheses have not yet established a clinical relevance for pathophysiology, prevention, or treatment.

    “While many potential and biologically plausible contributing mechanisms are postulated, indicating a likely multifactorial pathogenesis, biologically plausible hypotheses have not yet established a clinical relevance for pathophysiology, prevention, or treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The typical Western diet and lifestyle promotes several chronic diseases including the components of osteosarcopenic obesity, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 PUFA ratio and low-fibre and high-processed food consumption, which is linked to a higher risk of frailty and fractures.

    “The typical Western diet and lifestyle promotes several chronic diseases including the components of osteosarcopenic obesity, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 polyunsaturated fatty acid (PUFA) ratio and low-fibre and high-processed food consumption [57], which is linked to a higher risk of frailty and fractures [58,59].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [57] JafariNasabian P, Inglis JE, Kelly OJ, Ilich JZ (2017) Osteosarcopenic obesity in women: impact, prevalence, and management challenges. Int J Womens Health 9:33–42. https://doi.org/10.2147/IJWH.S106107 source

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    • cites [58] Veronese N, Stubbs B, Koyanagi A, Hebert JR, Cooper C, Caruso MG, Guglielmi G, Reginster JY, Rizzoli R, Maggi S, Shivappa N (2018) Pro-inflammatory dietary pattern is associated with fractures in women: an eight-year longitudinal cohort study. Osteoporos Int 29(1):143–151. https://doi.org/10.1007/s00198-017-4251-5 source

      Not checked in the free run.

    • cites [59] Shivappa N, Stubbs B, Hebert JR, Cesari M, Schofield P, Soysal P, Maggi S, Veronese N (2018) The relationship between the dietary inflammatory index and incident frailty: a longitudinal cohort study. J Am Med Dir Assoc 19(1):77–82. https://doi.org/10.1016/j.jamda.2017.08.006 source

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  • May combine two claims.

    Premisecitation

    Clinical outcomes associated with osteosarcopenic obesity components include increased risk of fractures, impaired functional status, physical disability, insulin resistance, increased risk of infections, increased length of hospital stay, and reduced survival.

    “Clinical outcomes associated with osteosarcopenic obesity components include: increased risk of fractures, impaired functional status (including activities of daily living) [70,71], physical disability, insulin resistance, increased risk of infections, increased length of hospital stay, and reduced survival [40].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [70] Curtis E, Litwic A, Cooper C, Dennison E (2015) Determinants of muscle and bone aging. J Cell Physiol 230(11):2618–2625. https://doi.org/10.1002/jcp.25001 source

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    • cites [71] Wang YJ, Wang Y, Zhan JK, Tang ZY, He JY, Tan P, Deng HQ, Huang W, Liu YS (2015) Sarco-osteoporosis: prevalence and association with frailty in Chinese community-dwelling older adults. Int J Endocrinol 2015:482940. https://doi.org/10.1155/2015/482940 source

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    • cites [40] Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L (2014) Osteosarcopenic obesity: the role of bone, muscle, and fat on health. J Cachexia Sarcopenia Muscle 5(3):183–192. https://doi.org/10.1007/s13539-014-0146-x source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Moderate-intensity physical activity programmes significantly improve physical functioning in mobility-limited older adults, attenuate intermuscular fat accumulation and improve muscle quality.

    “Moderate-intensity physical activity programmes significantly improve physical functioning in mobility-limited older adults, attenuate intermuscular fat accumulation and improve muscle quality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Dietary protein intake contributes to maintenance of lean muscle mass and may be a modifiable risk factor for sarcopenia in older adults.

    “Dietary protein intake contributes to maintenance of lean muscle mass and may be a modifiable risk factor for sarcopenia in older adults [65].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, Lee JS, Sahyoun NR, Visser M, Kritchevsky SB, Health ABCS (2008) Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the health, aging, and body composition (Health ABC) study. Am J Clin Nutr 87(1):150–155. https://doi.org/10.1093/ajcn/87.1.150 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Protein intakes of at least 1.0 g/kg body weight/day may be optimal for maintaining lean mass and physical function in older adults.

    “Protein intakes of ≥ 1.0 g/kg body weight/day may be optimal for maintaining lean mass and physical function in older adults [66].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, Newman AB, Kritchevsky SB, Health ABCS (2017) Protein intake and mobility limitation in community-dwelling older adults: the Health ABC study. J Am Geriatr Soc 65(8):1705–1711. https://doi.org/10.1111/jgs.14856 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Very few studies have specifically addressed nutritional intake in the context of osteosarcopenic obesity; most of the presented information has been derived from studies that focused separately on sarcopenia, osteoporosis or obesity.

    “Summarizing the above, it has to be acknowledged that very few studies have specifically addressed nutritional intake in the context of osteosarcopenic obesity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Visceral obesity was closely linked to a higher risk of fractures and inflammation.

    “Visceral obesity was closely linked to a higher risk of fractures and inflammation [77].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Perna S, Spadaccini D, Nichetti M, Avanzato I, Faliva MA, Rondanelli M (2018) Osteosarcopenic visceral obesity and osteosarcopenic subcutaneous obesity, two new phenotypes of sarcopenia: prevalence, metabolic profile, and risk factors. J Aging Res 2018:6147426. https://doi.org/10.1155/2018/6147426 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The methodological sections and reference lists of relevant articles were scrutinised by multiple named experts for potentially interesting articles.

    “Finally, the methodological sections and reference lists of relevant articles (particularly review articles) were scrutinised (by JB, EMD, RF, JMK, FL, SM, SP, JYR, PS) for potentially interesting articles.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Obese adults are shown to have lower micronutrient intake and higher prevalence of micronutrient inadequacy as compared with normal weight adults.

    “Obese adults are shown to have lower micronutrient intake and higher prevalence of micronutrient inadequacy as compared with normal weight adults [68].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Agarwal S, Reider C, Brooks JR, Fulgoni VL 3rd (2015) Comparison of prevalence of inadequate nutrient intake based on body weight status of adults in the united states: an analysis of NHANES 2001-2008. J Am Coll Nutr 34(2):126–134. https://doi.org/10.1080/07315724.2014.901196 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Osteosarcopenic obesity components occur frequently in middle-aged and older women and are independently associated with frailty and poor physical performance; women with osteosarcopenic obesity have lower functional abilities and higher frailty scores compared with their counterparts without osteosarcopenic obesity.

    “Osteosarcopenic obesity components occur frequently in middle-aged and older women and are independently associated with frailty and poor physical performance; women with osteosarcopenic obesity have lower functional abilities and higher frailty scores compared with their counterparts without osteosarcopenic obesity [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Szlejf C, Parra-Rodriguez L, Rosas-Carrasco O (2017) Osteosarcopenic obesity: prevalence and relation with frailty and physical performance in middle-aged and older women. J Am Med Dir Assoc 18(8):733 e731–733 e735. https://doi.org/10.1016/j.jamda.2017.02.023 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The rise in intermuscular fat found in sarcopenia may be suppressed by physical activity; mobility-limited older people have a greater change in intermuscular adipose tissue over time.

    “The rise in intermuscular fat found in sarcopenia may be suppressed by physical activity [78]; mobility-limited older people have a greater change in intermuscular adipose tissue over time [8].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [78] Fielding RA, Travison TG, Kirn DR, Koochek A, Reid KF, von Berens A, Zhu H, Folta SC, Sacheck JM, Nelson ME, Liu CK, Aberg AC, Nydahl M, Lilja M, Gustafsson T, Cederholm T (2017) Effect of structured physical activity and nutritional supplementation on physical function in mobility-limited older adults: results from the VIVE2 randomized trial. J Nutr Health Aging 21(9):936–942. https://doi.org/10.1007/s12603-017-0936-x source

      Not checked in the free run.

    • cites [8] Reid KF, Doros G, Clark DJ, Patten C, Carabello RJ, Cloutier GJ, Phillips EM, Krivickas LS, Frontera WR, Fielding RA (2012) Muscle power failure in mobility-limited older adults: preserved single fiber function despite lower whole muscle size, quality and rate of neuromuscular activation. Eur J Appl Physiol 112(6):2289–2301. https://doi.org/10.1007/s00421-011-2200-0 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Greater adherence to a Mediterranean pattern diet is associated with less loss of skeletal muscle mass and lean body mass, better physical performance, a significant reduction in waist circumference, and a lower incidence of frailty.

    “Greater adherence to a Mediterranean pattern diet is associated with less loss of skeletal muscle mass and lean body mass, better physical performance [61], a significant reduction in waist circumference [62], and a lower incidence of frailty [63].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [61] Isanejad M, Sirola J, Mursu J, Rikkonen T, Kroger H, Tuppurainen M, Erkkila AT (2018) Association of the Baltic sea and mediterranean diets with indices of sarcopenia in elderly women. OSPTRE-FPS study. Eur J Nutr 57(4):1435–1448. https://doi.org/10.1007/s00394-017-1422-2 source

      Not checked in the free run.

    • cites [62] Alvarez-Perez J, Sanchez-Villegas A, Diaz-Benitez EM, Ruano-Rodriguez C, Corella D, Martinez-Gonzalez MA, Estruch R, Salas-Salvado J, Serra-Majem L (2016) Influence of a mediterranean dietary pattern on body fat distribution: results of the predimed-canarias intervention randomized trial. J Am Coll Nutr 35(6):568–580. https://doi.org/10.1080/07315724.2015.1102102 source

      Not checked in the free run.

    • cites [63] Veronese N, Stubbs B, Noale M, Solmi M, Rizzoli R, Vaona A, Demurtas J, Crepaldi G, Maggi S (2017) Adherence to a mediterranean diet is associated with lower incidence of frailty: a longitudinal cohort study. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.08.028 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among a sample population of older people (N=801), the prevalence of osteosarcopenic obesity was 6.8%; subjects with a visceral/subcutaneous adipose tissue ratio greater than 1 were classified as having visceral obesity, and subjects with values under 1 were classified as having subcutaneous obesity.

    “Among a sample population of older people (N = 801), the prevalence of osteosarcopenic obesity was determined as 6.8%; subjects with a visceral/subcutaneous adipose tissue ratio > 1 were classified as having visceral obesity, and subjects with values under 1 were classified as having subcutaneous obesity [77].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Perna S, Spadaccini D, Nichetti M, Avanzato I, Faliva MA, Rondanelli M (2018) Osteosarcopenic visceral obesity and osteosarcopenic subcutaneous obesity, two new phenotypes of sarcopenia: prevalence, metabolic profile, and risk factors. J Aging Res 2018:6147426. https://doi.org/10.1155/2018/6147426 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Articles included in this narrative critical literature review were identified through literature searches of PubMed, Scopus, and Embase using specified MeSH items or free words, limited to human studies, English language, and full-length articles published from inception until January 15, 2018.

    “Articles included in this narrative, critical literature review were identified through literature searches of PubMed, Scopus, and Embase using the following MeSH items or free words: “osteoporosis”, “sarcopenia”, “obesity” “osteosarcopenia”, “osteosarcopenic obesity”; additional terms searched for in either the title, abstract or keywords included: “definition”, “epidemiology”, “pathophysiology”,”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Testosterone has a dose-dependent impact on fat-free mass in both the young and old, with higher levels associated with reduction in fat mass and increase in skeletal muscle mass and strength.

    “Testosterone has a dose-dependent impact on fat-free mass in both the young and old, with higher levels associated with reduction in fat mass and increase in skeletal muscle mass and strength [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Bhasin S, Woodhouse L, Casaburi R, Singh AB, Mac RP, Lee M, Yarasheski KE, Sinha-Hikim I, Dzekov C, Dzekov J, Magliano L, Storer TW (2005) Older men are as responsive as young men to the anabolic effects of graded doses of testosterone on the skeletal muscle. J Clin Endocrinol Metab 90(2):678–688. https://doi.org/10.1210/jc.2004-1184 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The components of osteosarcopenic obesity occur as a result of sedentary behaviour and a lack of regular physical activity, among other factors.

    “The components of osteosarcopenic obesity occur as a result of sedentary behaviour and a lack of regular physical activity, among other factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A Western pattern diet is linked to a higher risk of sarcopenia in menopausal women as compared with a Mediterranean pattern diet, which is associated with lower risk.

    “A Western pattern diet is linked to a higher risk of sarcopenia in menopausal women as compared with a Mediterranean pattern diet (high in low-fat dairy, vegetable, fish, nut, olive and vegetable oil), which is associated with lower risk [60].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Mohseni R, Aliakbar S, Abdollahi A, Yekaninejad MS, Maghbooli Z, Mirzaei K (2017) Relationship between major dietary patterns and sarcopenia among menopausal women. Aging Clin Exp Res 29(6):1241–1248. https://doi.org/10.1007/s40520-016-0721-4 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low levels of testosterone, but not oestradiol, predict frailty in older men and are associated with incident falls.

    “Low levels of testosterone, but not oestradiol, predict frailty in older men and are associated with incident falls [44][45][46].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [44] Wu FC, Tajar A, Pye SR, Silman AJ, Finn JD, O’Neill TW, Bartfai G, Casanueva F, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Punab M, Boonen S, Vanderschueren D, European Male Aging Study G (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European male aging study. J Clin Endocrinol Metab 93(7):2737–2745. https://doi.org/10.1210/jc.2007-1972 source

      Not checked in the free run.

    • cites [45] Hyde Z, Flicker L, Almeida OP, Hankey GJ, McCaul KA, Chubb SA, Yeap BB (2010) Low free testosterone predicts frailty in older men: the health in men study. J Clin Endocrinol Metab 95(7):3165–3172. https://doi.org/10.1210/jc.2009-2754 source

      Not checked in the free run.

    • cites [46] Vandenput L, Mellstrom D, Laughlin GA, Cawthon PM, Cauley JA, Hoffman AR, Karlsson MK, Rosengren BE, Ljunggren O, Nethander M, Eriksson AL, Lorentzon M, Leung J, Kwok T, Orwoll ES, Ohlsson C (2017) Low testosterone, but not estradiol, is associated with incident falls in older men: the international MrOS study. J Bone Miner Res 32(6):1174–1181. https://doi.org/10.1002/jbmr.3088 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Hyperglycaemia predicts persistently lower muscle strength with aging, and an excessive loss of skeletal muscle mass has been detected in older adults with type 2 diabetes.

    “Hyperglycaemia predicts persistently lower muscle strength with aging [54], and an excessive loss of skeletal muscle mass has been detected in older adults with type 2 diabetes [55].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [54] Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L (2015) Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care 38(1):82–90. https://doi.org/10.2337/dc14-1166 source

      Not checked in the free run.

    • cites [55] Park SW, Goodpaster BH, Lee JS, Kuller LH, Boudreau R, de Rekeneire N, Harris TB, Kritchevsky S, Tylavsky FA, Nevitt M, Cho YW, Newman AB, Health A, Body Composition S (2009) Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care 32(11):1993–1997. https://doi.org/10.2337/dc09-0264 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    The potential clinical consequences of osteosarcopenic obesity are linked to each of the underlying conditions, with the possibility of interaction to increase further the adverse health effects.

    “The potential clinical consequences of osteosarcopenic obesity are linked to each of the underlying conditions, with the possibility of interaction to increase further the adverse health effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Both diabetes and obesity impact on muscle loss, and muscle mass is inversely associated with insulin resistance and prediabetes.

    “Both diabetes and obesity impact on muscle loss [52], and muscle mass is inversely associated with insulin resistance and prediabetes [53].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Sinclair AJ, Abdelhafiz AH, Rodriguez-Manas L (2017) Frailty and sarcopenia - newly emerging and high impact complications of diabetes. J Diabetes Complications 31(9):1465–1473. https://doi.org/10.1016/j.jdiacomp.2017.05.003 source

      Not checked in the free run.

    • cites [53] Srikanthan P, Karlamangla AS (2011) Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab 96(9):2898–2903. https://doi.org/10.1210/jc.2011-0435 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increasing age and obesity both contribute to sarcopenia, for which a postulated mechanism involves disturbed insulin signalling and insulin resistance.

    “Increasing age and obesity both contribute to sarcopenia, for which a postulated mechanism involves disturbed insulin signalling and insulin resistance [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Kalinkovich A, Livshits G (2017) Sarcopenic obesity or obese sarcopenia: a cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev 35:200–221. https://doi.org/10.1016/j.arr.2016.09.008 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Although understanding of the aetiology, prevalence, and consequences of osteosarcopenic obesity components is limited, it is reasonable to infer a negative impact in an aging, and increasingly obese population.

    “Although understanding of the aetiology, prevalence, and consequences of osteosarcopenic obesity components are, so far, limited, it is reasonable to infer a negative impact in an aging, and increasingly obese population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The multiple pathways involved in muscle loss offer many targets for therapeutic intervention.

    “Multiple pathways are involved in the loss of muscle mass arising from aging, malnutrition, obesity, inflammation and inactivity, which offers many targets for therapeutic intervention [102].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Morley JE (2016) Pharmacologic options for the treatment of sarcopenia. Calcif Tissue Int 98(4):319–333. https://doi.org/10.1007/s00223-015-0022-5 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Antibiotics increase levels of circulating amino acids that would otherwise be degraded by intestinal bacteria.

    “The gut microbiota can modulate amino acid availability; antibiotics have been shown to increase levels of circulating amino acids, which would have been otherwise degraded by intestinal bacteria [97].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97] Puiman P, Stoll B, Molbak L, de Bruijn A, Schierbeek H, Boye M, Boehm G, Renes I, van Goudoever J, Burrin D (2013) Modulation of the gut microbiota with antibiotic treatment suppresses whole body urea production in neonatal pigs. Am J Physiol Gastrointest Liver Physiol 304(3):G300–G310. https://doi.org/10.1152/ajpgi.00229.2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Omega-3 PUFA supplementation increases the rate of muscle protein synthesis in older adults.

    “Omega-3 PUFA supplementation increases the rate of muscle protein synthesis in older adults [91].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie MJ, Mittendorfer B (2011) Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr 93(2):402–412. https://doi.org/10.3945/ajcn.110.005611 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Multiple pathways are involved in the loss of muscle mass arising from aging, malnutrition, obesity, inflammation and inactivity.

    “Multiple pathways are involved in the loss of muscle mass arising from aging, malnutrition, obesity, inflammation and inactivity, which offers many targets for therapeutic intervention [102].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Morley JE (2016) Pharmacologic options for the treatment of sarcopenia. Calcif Tissue Int 98(4):319–333. https://doi.org/10.1007/s00223-015-0022-5 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Supplementation with whey protein, essential amino acids and vitamin D, in conjunction with age-appropriate exercise, increases fat-free mass and strength, and boosts nutritional status, physical function and quality of life in sarcopenic older persons (mean age 80 years) with a 12-week program.

    “Supplementation with whey protein, essential amino acids and vitamin D, in conjunction with age-appropriate exercise, is shown to increase fat-free mass and strength, and boost nutritional status, physical function and quality of life in sarcopenic older persons (mean age 80 years) with only a 12-week program [92].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Rondanelli M, Klersy C, Terracol G, Talluri J, Maugeri R, Guido D, Faliva MA, Solerte BS, Fioravanti M, Lukaski H, Perna S (2016) Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly. Am J Clin Nutr 103(3):830–840. https://doi.org/10.3945/ajcn.115.113357 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several pharmacological agents are currently under investigation to manage sarcopenia, including testosterone, selective androgen receptor modulators (SARMs), AMP-activated protein kinase (AMPK) agonists, activin 11R antagonists, growth hormone, IGF-I analogues, and ghrelin-modulating agents.

    “Several pharmacological agents are currently under investigation to manage sarcopenia e.g., testosterone, selective androgen receptor modulators (SARMs), AMP-activated protein kinase (AMPK) agonists, activin 11R antagonists, growth hormone, IGF-I analogues, and ghrelin-modulating agents [103].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] De Spiegeleer A, Beckwee D, Bautmans I, Petrovic M, Sarcopenia Guidelines Development group of the Belgian Society of Geriatrics (2018) Pharmacological interventions to improve muscle mass, muscle strength and physical performance in older people: an umbrella review of systematic reviews and meta-analyses. Drugs Aging 35(8):719–734. https://doi.org/10.1007/s40266-018-0566-y source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Testosterone supplementation benefits other aspects of health, including sexual function, physical function, vitality, quality of life and improved mood.

    “Testosterone supplementation is also shown to benefit other aspects of health, including sexual function, physical function, vitality, quality of life and improved mood [109, 111].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [109] Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MD, Adams JE, Oldham JA, Wu FC (2010) Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 95(2):639–650. https://doi.org/10.1210/jc.2009-1251 source

      Not checked in the free run.

    • cites [111] Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, Gill TM, Barrett-Connor E, Swerdloff RS, Wang C, Ensrud KE, Lewis CE, Farrar JT, Cella D, Rosen RC, Pahor M, Crandall JP, Molitch ME, Cifelli D, Dougar D, Fluharty L, Resnick SM, Storer TW, Anton S, Basaria S, Diem SJ, Hou X, Mohler ER 3rd, Parsons JK, Wenger NK, Zeldow B, Landis JR, Ellenberg SS, Testosterone Trials I (2016) Effects of testosterone treatment in older men. N Engl J Med 374(7):611–624. https://doi.org/10.1056/NEJMoa1506119 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Targeting pathways that centrally regulate both bone and muscle (e.g., growth hormone, IGF-I, sex steroids) and newly emerging pathways that facilitate communication between these tissues (e.g., activin/myostatin) might allow greater therapeutic benefit in frail older people.

    “Targeting pathways that centrally regulate both bone and muscle (e.g.growth hormone, IGF-I, sex steroids), and newly emerging pathways that facilitate communications between these two tissues (e.g.activin/myostatin) might allow a greater therapeutic benefit in frail older people [104].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Girgis CM, Mokbel N, Digirolamo DJ (2014) Therapies for musculoskeletal disease: can we treat two birds with one stone? Curr Osteoporos Rep 12(2):142–153. https://doi.org/10.1007/s11914-014-0204-5 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The gut microbiota can modulate amino acid availability.

    “The gut microbiota can modulate amino acid availability; antibiotics have been shown to increase levels of circulating amino acids, which would have been otherwise degraded by intestinal bacteria [97].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97] Puiman P, Stoll B, Molbak L, de Bruijn A, Schierbeek H, Boye M, Boehm G, Renes I, van Goudoever J, Burrin D (2013) Modulation of the gut microbiota with antibiotic treatment suppresses whole body urea production in neonatal pigs. Am J Physiol Gastrointest Liver Physiol 304(3):G300–G310. https://doi.org/10.1152/ajpgi.00229.2011 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Several trials conducted with testosterone show a direct effect on muscle mass and, in several cases, on muscle strength and performance, with a slight reduction in body fat, and some effect on bone density.

    “Several trials conducted with testosterone show a direct effect on muscle mass and, in several cases, on muscle strength and performance, with a slight reduction in body fat, and some effect on bone density [107-110].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [107] Isidori AM, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, Lenzi A, Fabbri A (2005) Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf) 63(3):280–293. https://doi.org/10.1111/j.1365-2265.2005.02339.x source

      Not checked in the free run.

    • cites [108] Storer TW, Basaria S, Traustadottir T, Harman SM, Pencina K, Li Z, Travison TG, Miciek R, Tsitouras P, Hally K, Huang G, Bhasin S (2017) Effects of testosterone supplementation for 3 years on muscle performance and physical function in older men. J Clin Endocrinol Metab 102(2):583–593. https://doi.org/10.1210/jc.2016-2771 source

      Not checked in the free run.

    • cites [109] Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MD, Adams JE, Oldham JA, Wu FC (2010) Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 95(2):639–650. https://doi.org/10.1210/jc.2009-1251 source

      Not checked in the free run.

    • cites [110] Ottenbacher KJ, Ottenbacher ME, Ottenbacher AJ, Acha AA, Ostir GV (2006) Androgen treatment and muscle strength in elderly men: a meta-analysis. J Am Geriatr Soc 54(11):1666–1673. https://doi.org/10.1111/j.1532-5415.2006.00938.x source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most studies have documented that GH supplementation is ineffective in older subjects, increasing muscle mass but not muscle strength.

    “Most studies have documented that GH supplementation is ineffective in older subjects, by increasing muscle mass but not muscle strength [117][118][119].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [117][118][119]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Drugs available for the prevention and treatment of osteoporosis impact upon bone mineral density and fracture risk.

    “Drugs available for the prevention and treatment of osteoporosis impact upon BMD and fracture risk, although their effect on muscle or fat mass is not well studied [100,101].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [100] Tella SH, Gallagher JC (2014) Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol 142:155–170. https://doi.org/10.1016/j.jsbmb.2013.09.008 source

      Not checked in the free run.

    • cites [101] Reginster JY, Neuprez A, Beaudart C, Lecart MP, Sarlet N, Bernard D, Disteche S, Bruyere O (2014) Antiresorptive drugs beyond bisphosphonates and selective oestrogen receptor modulators for the management of postmenopausal osteoporosis. Drugs Aging 31(6):413–424. https://doi.org/10.1007/s40266-014-0179-z source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A combined intervention of vitamin D with high whey protein, leucine-enriched oral supplement improves muscle mass and lower-extremity function and decreases fat mass among sarcopenic older adults.

    “The combined intervention of a vitamin D with high whey protein, leucine-enriched oral supplement has resulted in improvements in muscle mass and lower-extremity function as well as in a decrease in fat mass among sarcopenic older adults [87,88].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [87] Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, McMurdo ME, Mets T, Seal C, Wijers SL, Ceda GP, De Vito G, Donders G, Drey M, Greig C, Holmback U, Narici M, McPhee J, Poggiogalle E, Power D, Scafoglieri A, Schultz R, Sieber CC, Cederholm T (2015) Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the provide study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 16(9):740–747. https://doi.org/10.1016/j.jamda.2015.05.021 source

      Not checked in the free run.

    • cites [88] Verlaan S, Aspray TJ, Bauer JM, Cederholm T, Hemsworth J, Hill TR, McPhee JS, Piasecki M, Seal C, Sieber CC, Ter Borg S, Wijers SL, Brandt K (2017) Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: a case-control study. Clin Nutr 36(1):267–274. https://doi.org/10.1016/j.clnu.2015.11.013 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Combined diet improvement and physical activity involving aerobic, strength, flexibility and balance training can positively influence intermuscular fat accumulation and improve muscle quality, with equivocal effects on physical functioning in older adults with osteosarcopenic obesity components.

    “Together these can positively influence intermuscular fat accumulation and improve muscle quality with equivocal effects on physical functioning.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] JafariNasabian P, Inglis JE, Kelly OJ, Ilich JZ (2017) Osteosarcopenic obesity in women: impact, prevalence, and management challenges. Int J Womens Health 9:33–42. https://doi.org/10.2147/IJWH.S106107 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The gut microbiota may be a new therapeutic target in muscle wasting.

    “The gut microbiota may be a new therapeutic target in muscle wasting [96].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] Bindels LB, Delzenne NM (2013) Muscle wasting: the gut microbiota as a new therapeutic target? Int J Biochem Cell Biol 45(10):2186–2190. https://doi.org/10.1016/j.biocel.2013.06.021 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Pharmacological treatment effects with anabolic hormones can be demonstrated but are mitigated and of uncertain clinical significance, alongside some safety concerns.

    “Pharmacological treatment effects with anabolic hormones can be demonstrated but are rather mitigated and of uncertain clinical significance alongside some safety concerns.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recommendations for the conduct of clinical trials and a proposal for a core outcome set (activity/independence, quality of life, costs, muscle mass, strength and performance) have been developed to aid future development of new therapeutic targets for sarcopenia.

    “To aid future development of new therapeutic targets for sarcopenia, recommendations for the conduct of clinical trials have been developed, along with the proposal for a core outcome set to include the domains of activity/independence, quality of life, costs, and muscle mass, strength and performance [105,106].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [105] Reginster JY, Cooper C, Rizzoli R, Kanis JA, Appelboom G, Bautmans I, Bischoff-Ferrari HA, Boers M, Brandi ML, Bruyere O, Cherubini A, Flamion B, Fielding RA, Gasparik AI, Van Loon L, McCloskey E, Mitlak BH, Pilotto A, Reiter-Niesert S, Rolland Y, Tsouderos Y, Visser M, Cruz-Jentoft AJ (2016) Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia. Aging Clin Exp Res 28(1):47–58. https://doi.org/10.1007/s40520-015-0517-y source

      Not checked in the free run.

    • cites [106] Bahat G, Tufan A, Tufan F, Karan MA (2016) Suggestions on sarcopenia-related trials. Aging Clin Exp Res 28(5):1029–1030. https://doi.org/10.1007/s40520-016-0601-y source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Omega-3 PUFAs may influence skeletal muscle health and function.

    “Omega-3 PUFAs may influence skeletal muscle health and function [89]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] Jeromson S, Gallagher IJ, Galloway SD, Hamilton DL (2015) Omega-3 fatty acids and skeletal muscle health. Mar Drugs 13(11):6977–7004. https://doi.org/10.3390/md13116977 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    A review of the current literature shows that while data is accumulating for the existence of osteosarcopenic obesity as a distinct entity, a number of questions remain, not least the clinical relevance of identification of such a condition.

    “A review of the current literature shows that while data is accumulating for the existence of osteosarcopenic obesity as a distinct entity a number of questions remain, not least the clinical relevance of identification of such a condition.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The pathophysiological overlap of these conditions may occur through an interplay of inflammatory and hormonal mechanisms.

    “Evidence for the pathophysiological overlap of these conditions is expanding, which may occur through an interplay of inflammatory and hormonal mechanisms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Bimagrumab improved body composition and insulin sensitivity in insulin-resistant individuals.

    “In addition, bimagrumab improved body composition and insulin sensitivity in insulin-resistant individuals [126].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [126] Garito T, Roubenoff R, Hompesch M, Morrow L, Gomez K, Rooks D, Meyers C, Buchsbaum MS, Neelakantham S, Swan T, Filosa LA, Laurent D, Petricoul O, Zakaria M (2018) Bimagrumab improves body composition and insulin sensitivity in insulin-resistant individuals. Diabetes Obes Metab 20(1):94–102. https://doi.org/10.1111/dom.13042 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Identification of the epidemiological overlap of osteoporosis, sarcopenia, and obesity is perhaps not surprising given the common risk factors and increasing prevalence of these conditions in older age.

    “Thus, identification of the epidemiological overlap of osteoporosis, sarcopenia, and obesity is perhaps not surprising given the common risk factors and increasing prevalence of these conditions in older age.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: A progressive loss of bone and muscle mass and an increase in adipose tissue occur with normal aging.

  • May combine two claims.

    Premisecitation

    In healthy older adults without sarcopenia, 2 years of an oral ghrelin mimetic agent (ibutamoren mesylate; MK-0677) increased GH and IGF-I blood levels and muscle mass but without significant changes in strength or physical function.

    “In healthy older adults, without sarcopenia, 2 years of an oral ghrelin mimetic agent (ibutamoren mesylate; MK-0677) increased the GH and IGF-I blood levels and muscle mass but without significant changes in strength or physical function [120].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [120] Nass R, Pezzoli S, Clancy Oliveri M, Patrie J, Harrell F, Clasey J, Heymsfield S, Bach M, Lee Vance M, Thorner M (2008) Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults a randomized trial. Ann Intern Med 149(9):601–611 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Participants with slower walking speed at baseline receiving bimagrumab had greater improvements in gait speed (mean 0.15 m/s, p = 0.009) and 6-min walk distance (mean 82 m; p = 0.022) than those receiving placebo.

    “Participants with slower walking speed at baseline receiving bimagrumab had greater improvements in gait speed (mean 0.15 m/s, p = 0.009) and 6-min walk distance (mean 82 m; p = 0.022) than those receiving placebo [125].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [125] Rooks D, Praestgaard J, Hariry S, Laurent D, Petricoul O, Perry RG, Lach-Trifilieff E, Roubenoff R (2017) Treatment of sarcopenia with bimagrumab: results from a phase II, randomized, controlled, proof-of-concept study. J Am Geriatr Soc 65(9):1988–1995. https://doi.org/10.1111/jgs.14927 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bimagrumab decreased intermuscular thigh adipose tissue by 9.5% and subcutaneous thigh fat by 3.8% at 24 weeks.

    “In parallel, decreases in intermuscular thigh adipose tissue of 9.5% and 3.8% in subcutaneous thigh fat were measured at 24 weeks [125].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [125] Rooks D, Praestgaard J, Hariry S, Laurent D, Petricoul O, Perry RG, Lach-Trifilieff E, Roubenoff R (2017) Treatment of sarcopenia with bimagrumab: results from a phase II, randomized, controlled, proof-of-concept study. J Am Geriatr Soc 65(9):1988–1995. https://doi.org/10.1111/jgs.14927 source

      Not checked in the free run.

65 of 65

  • The paper relies on this without support.

    A condition qualifies as a distinct clinical entity only if it is associated with adverse outcomes above and beyond the sum of its component conditions.

    “However, whether the concurrent existence of sarcopenia, osteoporosis and obesity leads to an increased risk of adverse outcomes including mortality above and beyond the risks associated with the sum of the component parts remains to be proven and is a question of research interest.”
    “However, there is little evidence to date on an additive or multiplicative health impact of osteoporosis in a distinct overlap with obesity and sarcopenia.”

  • The paper relies on this without support.

    A progressive loss of bone and muscle mass and an increase in adipose tissue occur with normal aging.

    “A progressive loss of bone and muscle mass and increase in adipose tissue occurs with normal aging.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The cross-talk between adipose tissue, skeletal muscle and bone supports the evidence of an increasingly complex picture in which the pathophysiological and clinical alterations of bone structure and osteoporosis may also play a role.

    “Moreover, the cross-talk between adipose tissue, skeletal muscle and bone supports the evidence of an increasingly complex picture in which the pathophysiological and clinical alterations of bone structure and osteoporosis may also play a role [16].”

    From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [16]

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Authors
Bauer, J. M., Cruz-Jentoft, A. J., Fielding, R. A., Kanis, J. A., Reginster, J.-Y., Bruyère, O., Cesari, M., Chapurlat, R., Al-Daghri, N., Dennison, E., Kaufman, J.-M., Landi, F., Laslop, A., Locquet, M., Maggi, S., McCloskey, E., Perna, S., Rizzoli, R., Rolland, Y., Rondanelli, M., Szulc, P., Vellas, B., Vlaskovska, M., & Cooper, C.
Affiliations
  • Heidelberg University (DE)
  • Instituto Ramón y Cajal de Investigación Sanitaria (ES)
  • Tufts University (US)
  • University of Liège (BE)
  • University of Milan (IT)
  • Inserm (FR)
  • Southampton General Hospital (GB)
  • Ghent University Hospital (BE)
  • Università Cattolica del Sacro Cuore (IT)
  • Austrian Agency for Health and Food Safety (AT)
  • National Research Council (IT)
  • University of Sheffield (GB)
  • University of Bahrain (BH)
  • University of Geneva (CH)
  • University of Pavia (IT)
  • Medical University of Sofia (BG)
Corresponding author
Bauer, Jürgen M.
ORCID
Venue
Calcified Tissue International
Publisher
Springer Science and Business Media LLC
Published
2019-05-16
Volume
105
Issue
2
Pages
109-124
ISSN
  • 0171-967X (ISSN-L)
  • 1432-0827
DOI
10.1007/s00223-019-00561-w
OpenAlex
W2946181666
Cited by
83
References
130
Citations by year
2026: 4 · 2025: 6 · 2024: 8 · 2023: 20 · 2022: 10 · 2021: 17 · 2020: 15 · 2019: 2 · 2012: 1
FWCI
1.30
Type
journal article
Language
en
Update notices
correction (2019-07-23)
Open access
Licence
Locations
  • Calcified Tissue International (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
  • Research Bank (Australian Catholic University) (submittedVersion, cc-by)
  • HAL (submittedVersion, cc-by)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • ORBi (University of Liège) (submittedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
  • King Saud University
  • Versus Arthritis (19583)
  • Medical Research Council (MR/P020941/1)
  • Institute of Population and Public Health
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
osteosarcopenic obesity, osteopenia, osteoporosis, sarcopenia, obesity, middle-aged and older adults, pathophysiology, prevalence, musculoskeletal outcomes, mortality, shared risk factors
MeSH terms
Gastrointestinal Microbiome, Adipose Tissue, Angiotensin-Converting Enzyme Inhibitors, Exercise Therapy, Female, Humans, Male, Obesity, Osteoporosis, Receptors, Androgen, Risk Factors, Testosterone, Exercise, Prevalence, Treatment Outcome, Subcutaneous Fat, Adiposity, Ghrelin, Myostatin, Sarcopenia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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