Publications by authors named "Yasumoto Matsui"

35 Publications

Association between osteosarcopenia and cognitive frailty in older outpatients visiting a frailty clinic.

Arch Gerontol Geriatr 2021 Sep 17;98:104530. Epub 2021 Sep 17.

Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan. Electronic address:

Purpose: Osteosarcopenia and cognitive frailty are both risk factors for falls and fractures. The purpose of this study was to determine the association between osteosarcopenia and cognitive frailty.

Materials And Methods: This was a cross-sectional secondary data analysis of the Frailty Registry Study with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. Osteoporosis was defined as a bone mineral density < 70% of the young adult mean. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Cognitive frailty was defined as the coexistence of physical frailty and mild cognitive impairment. Physical frailty was evaluated according to Japanese Cardiovascular Health Study criteria, whereas mild cognitive impairment was defined as a Mini-Mental State Examination score ≥ 24 points and a score ≤ 25 points on the Japanese version of the Montreal Cognitive Assessment. We performed multivariable logistic regression analysis to investigate the association between osteosarcopenia and cognitive frailty.

Results: The data of 432 patients were analysed. The prevalence of osteosarcopenia and cognitive frailty was 10.2% and 20.8%, respectively. Logistic regression analysis revealed that osteosarcopenia was independently associated with cognitive frailty with a higher odds ratio than osteoporosis or sarcopenia alone. Lost points in visuospatial abilities/executive functions and orientation were significantly associated with osteosarcopenia.

Conclusions: Combination of osteoporosis and sarcopenia is more likely to be associated with physical and cognitive decline than osteoporosis and sarcopenia alone. The mechanism by which osteosarcopenia is associated with decreased visuospatial abilities/executive functions and orientation needs to be addressed.
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http://dx.doi.org/10.1016/j.archger.2021.104530DOI Listing
September 2021

Osteosarcopenia, the co-existence of osteoporosis and sarcopenia, is associated with social frailty in older adults.

Aging Clin Exp Res 2021 Sep 7. Epub 2021 Sep 7.

National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan.

Background: Osteosarcopenia is a newly described, aging-associated condition. Social frailty is an important condition whose prevalence may have risen by physical distancing during the coronavirus disease 2019 pandemic. However, the relationship between these two remains unclear.

Aims: To examine the association between osteosarcopenia and social frailty.

Methods: This cross-sectional study was conducted using data from outpatients visiting general geriatric hospital frailty clinics. Bone mineral density (BMD) and muscle mass were measured using dual X-ray absorptiometry. Osteoporosis was defined as a BMD of < 70% of the young adult mean, according to the Japan Osteoporosis Society. Sarcopenia was diagnosed as per the Asian Working Group for Sarcopenia 2019 recommendation. Osteosarcopenia was defined as the co-existence of osteoporosis and sarcopenia. We defined social frailty using a questionnaire comprising four items: general resources, social resources, social behavior, and basic social needs. Ordinal logistic regression analysis was performed with social frailty status and osteosarcopenia as the dependent and independent variables, respectively.

Results: We included 495 patients (mean age = 76.5 ± 7.2 years) in the analysis; of these, 58.2% were robust and 17.2%, 13.5%, and 11.1% had osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively. Social frailty prevalence increased stepwise from 8.0% in robust patients to 11.8%, 17.9%, and 29.1% among those with osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively (P < 0.001). Logistic regression analysis revealed that only osteosarcopenia was significantly associated with social frailty (pooled odds ratio: 2.117; 95% confidence interval: 1.104-4.213).

Discussion: Comprehensive assessment of osteosarcopenia and social frailty is needed for disability prevention in older adults.
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http://dx.doi.org/10.1007/s40520-021-01968-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421463PMC
September 2021

Walking speed and short physical performance battery are associated with conversion to long-term care need: A study in outpatients of a locomotive syndrome-frailty clinic.

Geriatr Gerontol Int 2021 Oct 12;21(10):919-925. Epub 2021 Aug 12.

National Center for Geriatrics and Gerontology, Obu, Japan.

Aim: As the number of frail and disabled older people increases in Japan, systems are needed to detect efficiently the populations at high risk in need of care and to allow early intervention. We investigated cut-off values for those physical functioning assessments adopted by AWGS 2019 associated with new or worsening long-term care insurance (LTCI) certification.

Methods: We recruited 497 outpatients from our locomotive syndrome-frailty clinic. After excluding patients who had undergone orthopedic surgery right after assessment or ≤65 years old, 233 patients (mean age, 78 ± 6 years) were included. Logistic regression analysis was performed using new certification for LTCI services need or deterioration of care status in 1 year as the dependent variable and physical function and other assessments as independent variables. Next, we constructed receiver operating characteristic curves and calculated areas under the curve and optimal cut-off values.

Results: During 1-year follow-up, 37 patients (16%) obtained new certification for LTCI services need or deterioration of status. After adjusting, usual walking speed and Short Physical Performance Battery score were significantly associated with outcomes. With receiver operating characteristic curves, usual walking speed as the test variable showed an area under the curve of 0.740 with a cut-off of 0.92 m/s, whereas the Short Physical Performance Battery score showed an area under the curve of 0.737 with a cut-off score of 9.

Conclusions: Slower walking speed and lower Short Physical Performance Battery score may predict new or worsening LTCI for older people. Geriatr Gerontol Int 2021; 21: 919-925.
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http://dx.doi.org/10.1111/ggi.14258DOI Listing
October 2021

Diagnostic accuracy of sarcopenia by "possible sarcopenia" premiered by the Asian Working Group for Sarcopenia 2019 definition.

Arch Gerontol Geriatr 2021 Nov-Dec;97:104484. Epub 2021 Jul 14.

National Center for Geriatrics and Gerontology, Obu, Japan. Electronic address:

Purpose: The Asian Working Group for Sarcopenia 2019 (AWGS 2019) proposed a simple assessment of sarcopenia called "possible sarcopenia" for the purpose of early detection and intervention of sarcopenia. The purpose of this study was to report the accuracy of possible sarcopenia against definitive sarcopenia and the characteristics of false-negative cases.

Materials And Methods: This was a cross-sectional study using a research registry with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. The diagnosis of possible sarcopenia and sarcopenia was performed according to the AWGS 2019 criteria, using calf circumference (CC) for case-finding. The accuracy of the diagnosis of sarcopenia in participants with possible sarcopenia was evaluated by calculating sensitivity, specificity, and F-value.

Results: Of the 349 patients (mean age, 78.0±6.0 years; 63% women) analyzed, 86 (24.6%) revealed possible sarcopenia. Possible sarcopenia predicted sarcopenia with a sensitivity of 0.893 and 0.921, specificity of 0.990 and 0.870, and F-values of 0.926 and 0.714 for men and women, respectively. When either the grip strength test or 5-time chair stand test result was examined, the sensitivity of possible sarcopenia to predict sarcopenia decreased, whereas the specificity remained at 0.990-1.000 in men and 0.890-0.940 in women. An extremely decreased CC was identified as a significant characteristic of patients with sarcopenia not detected in the simplified assessment.

Conclusions: The diagnostic accuracy of possible sarcopenia for definitive sarcopenia is excellent. Sarcopenia should be actively examined in patients with extremely decreased CC.
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http://dx.doi.org/10.1016/j.archger.2021.104484DOI Listing
July 2021

Differences in the mass and quality of the quadriceps with age and sex and their relationships with knee extension strength.

J Cachexia Sarcopenia Muscle 2021 08 19;12(4):900-912. Epub 2021 May 19.

National Center for Geriatrics and Gerontology, Obu, Japan.

Background: Although muscle quality evaluations are currently considered important for diagnosing sarcopenia, data from the general population are lacking. This study used mid-thigh computed tomography measurements to evaluate age-related and sex-related differences in quadriceps femoris muscle quality and mass and their relationships with knee extension strength (KES).

Methods: Cross-sectional data from 520 Japanese individuals (273 men and 247 women, mean age: 63.1 ± 10.6 years) were analysed. Mass and quality were assessed using quadriceps cross-sectional areas (CSAs) and computed tomography values (CTVs), respectively. The four constituent muscles, intermuscular adipose tissue, and entire quadriceps area (total quadriceps muscles + intermuscular adipose tissue) were assessed, and the data were stratified by five age groups and sex. To evaluate age-related decline, linear and quadratic equations were tested for fit according to the constituent muscles and sex. KES could be measured in 472 of the 520 participants (254 men and 218 women, mean age: 62.3 ± 10.3). Multiple linear regression analyses with age-adjusted models were then used for evaluating the relationships between KES and quadriceps measurements.

Results: All muscle CSAs and CTVs showed downward trends with age (men: P < 0.001 for all; women: vastus medialis CTV, P = 0.004; others, P < 0.001); the intermuscular adipose tissue CSA did not show any trend (men: P = 0.938; women: P = 0.139), although its percentage of the entire quadriceps area showed an upward trend in both sexes (P < 0.001). Men exhibited a quadratic decline in the CSAs for the entire quadriceps area (P = 0.016), total quadriceps muscles (P = 0.021), the vastus medialis (P = 0.010) and vastus lateralis (P = 0.038), and all CTVs (rectus femoris, P = 0.044; others, P < 0.001). Women exhibited a quadratic equation in the CTV for rectus femoris (P = 0.031), but a linear decline in the other variables (P < 0.001 for all). Both the total quadriceps muscles CSA and CTV were significantly associated with KES in both sexes (P < 0.001). For each muscle, the CSAs of the vastus medialis (P < 0.001) and vastus intermedius (P = 0.001) were significantly associated with KES in men, whereas the vastus medialis CSA (P < 0.001), vastus lateralis CSA (P = 0.006), rectus femoris CSA (P = 0.020), and vastus intermedius CTV (P = 0.025) were significantly associated with KES in women CONCLUSIONS: Age-related quadriceps femoris changes in mass and quality differed by sex and the constituent muscles. The constituent muscles contributing to KES differed between men and women. Quadriceps CSA and CTV measurements are useful for objectively assessing age-related and sex-related muscle deterioration and KES.
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http://dx.doi.org/10.1002/jcsm.12715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350198PMC
August 2021

Evaluation of muscle quality and quantity for the assessment of sarcopenia using mid-thigh computed tomography: a cohort study.

BMC Geriatr 2021 04 13;21(1):239. Epub 2021 Apr 13.

Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan.

Background: For the diagnosis of Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP) revised the algorisms in 2019, where they added computed tomography (CT) as an assessment tool not only for quantity but also for quality in research purpose. However, the evidence for clinical appreciation of CT has been lacking. Therefore, we investigated the correlation between CT and various motor function tests to assess the utility of CT as a potential diagnostic tool for sarcopenia.

Methods: In total, 214 patients who were examined at our center during the study period (2016-2017) were included in the study. Single-slice CT scan of the mid-thigh region was performed, from which cross-sectional area (CSA) and CT attenuation value (CTV) of quadriceps femoris were evaluated for each subject. Other assessments included skeletal muscle mass index by DXA and BIA, muscle strength and physical performance. Furthermore, subjects were classified into four groups as per the Asia Working Group of Sarcopenia (AWGS) 2019 criteria as those with: normal, poor muscle function/strength (poor function), sarcopenia and severe sarcopenia.

Results: Knee muscle strength correlated with CSA (r = 0.60) and the correlation was significantly greater than that with DXA and BIA. For physical performance, standing-up test correlated with CSA (r = - 0.20) and CTV (r = - 0.40) and walking speed with CTV (r = 0.43), which was significantly greater than that with DXA and BIA. The CSA was significantly lower in women with sarcopenia group and in both men and women with severe sarcopenia (all p < 0.01). Furthermore, CTV was significantly lower in women with poor-function and in both men and women with severe sarcopenia group (all p < 0.01).

Conclusions: CSA mostly correlated with muscle strength, whereas CTV mostly correlated with physical performance. CT with measurements of CSA and CTV enables the evaluation of muscle mass and quality simultaneously. CT is believed to be useful in inferring evaluation of motor function and assessment of sarcopenia.
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http://dx.doi.org/10.1186/s12877-021-02187-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045267PMC
April 2021

Physical domain of the Kihon Checklist: A possible surrogate for physical function tests.

Geriatr Gerontol Int 2020 Jun;20(6):644-646

National Center for Geriatrics and Gerontology, Obu, Japan.

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http://dx.doi.org/10.1111/ggi.13916DOI Listing
June 2020

Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20-89 years: A cross-sectional nationwide study in Japan.

J Orthop Sci 2020 Nov 12;25(6):1084-1092. Epub 2020 Mar 12.

Kanai Hospital, Kyoto, Japan. Electronic address:

Background: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex.

Methods: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan.

Results: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score.

Conclusion: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.
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http://dx.doi.org/10.1016/j.jos.2020.01.011DOI Listing
November 2020

Chapter 2 Frailty concepts.

Geriatr Gerontol Int 2020 Feb;20 Suppl 1:14-19

Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.

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http://dx.doi.org/10.1111/ggi.13831DOI Listing
February 2020

Sarcopenia affects conservative treatment of osteoporotic vertebral fracture.

Osteoporos Sarcopenia 2018 Sep 26;4(3):114-117. Epub 2018 Sep 26.

Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan.

Objectives: Sarcopenia and osteoporosis affects activities of daily living and quality of elderly people. However, little is known about its impact on elderly locomotor diseases, such as osteoporotic vertebral fracture (OVF). There is no report investigating the influence of both sarcopenia and osteoporosis on outcomes of OVF. This study aimed to evaluate the clinical outcomes of OVF in elderly patients from sarcopenic perspectives.

Methods: This prospective study was conducted with 396 patients, aged 65 years or more, hospitalized for the treatment of OVF (mean age, 81.9 ± 7.1 years; 111 males, 285 females). The primary outcome was the Japanese Orthopaedic Association (JOA) score for lumbar disease (at first visit, hospital discharge, and 1 year after treatment) and Barthel index (at the same time and before hospitalization). The second outcome was living place after discharge. Susceptibility to sarcopenia and osteoporosis were evaluated and clinical results of conservative treatment were compared.

Results: Sarcopenia significantly affected Barthel index at first visit and discharge. Sarcopenia patients had significantly higher rate for discharge to nursing home and living in nursing home after 1 year than patients without sarcopenia. Osteoporosis significantly affected the JOA score at the first visit and the Barthel index before hospitalization, at the first visit, discharge, and after 1 year. Osteoporosis did not affect the living place at discharge and after 1 year.

Conclusions: Sarcopenia and osteoporosis affected outcomes of conservative treatment for OVF; moreover, sarcopenia affected the living place of OVF patients at discharge and after 1 year.
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http://dx.doi.org/10.1016/j.afos.2018.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362953PMC
September 2018

[Aging-related frailty and sarcopenia. Efficacy of osteoporosis treatment drugs for frailty and sarcopenia.]

Clin Calcium 2018;28(9):1263-1267

Center of Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, Obu, Japan.

Many of the adverse outcomes of frailty are probably mediated by sarcopenia. Unfortunately, there are currently no approved drug treatments for sarcopenia. Osteoporosis and sarcopenia are common in older age. A study on activated vitamin D revealed that muscle mass could be maintained by administering alfacalcidol to patients with osteoporosis. Bisphosphonate therapy, which is a gold standard for osteoporosis treatment, may help to maintain muscle mass.
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http://dx.doi.org/CliCa180912631267DOI Listing
May 2019

What is the best adjustment of appendicular lean mass for predicting mortality or disability among Japanese community dwellers?

BMC Geriatr 2018 01 5;18(1). Epub 2018 Jan 5.

Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan.

Background: Age-related declines in skeletal muscle mass and strength, representing "sarcopenia," are a growing concern in aging societies. However, the prevalence of low muscle mass based on the height-adjustment has been shown to be extremely low, and a more appropriate definition of low muscle mass is needed, particularly for Asian women. The aim of this study was to explore the most appropriate adjustment of appendicular lean mass (ALM) for predicting mortality or disability risk using ALM or any of 5 adjustments of ALM among community-dwelling Japanese.

Methods: Subjects comprised 1026 men and 952 women between 40 and 79 years old at baseline (1997-2000) who participated in the National Institute for Longevity Sciences - Longitudinal Study of Aging, Japan. ALM (kg) and 5 adjusted indices of ALM (ALM/leg length, ALM/height, ALM/height, ALM/weight, and ALM/body mass index [BMI]) were assessed at baseline. Disability was defined by long-term care insurance certification based on responses to a survey mailed in 2013, and death records were obtained as vital statistics until December 2014. Crude and adjusted Cox proportional hazard models were used to estimate hazard ratios for mortality or disability by sex-stratified quintiles of each ALM index (ALM and adjusted ALM) or sarcopenia-related indices. The area under the curve (AUC) was calculated with the multivariate-adjusted logistic regression model. Additionally, mixed-effects analyses were used to clarify the age-related ALM indices decline over 12 years (n = 1838).

Results: Crude Cox proportional hazard models and multivariate-adjusted logistic model (AUC) indicated that higher ALM and ALM/BMI in women, and higher ALM, ALM/leg length, ALM/height, and ALM/BMI in men were associated with lower risks for mortality or disability than ALM/height. The mixed effect model indicated all ALM indices in men, and ALM, ALM/leg length, and ALM/height in women could better predict age-related lean muscle mass decline.

Conclusions: Unadjusted ALM in women, and ALM/leg length, ALM/height, ALM/BMI, and ALM in men may be more appropriate for predicting future mortality or disability than ALM/height. Considering the age-related muscle mass decline, unadjusted ALM would be the first variable to assess, regardless of sex, in this Japanese cohort study.
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http://dx.doi.org/10.1186/s12877-017-0699-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756439PMC
January 2018

Disuse Atrophy Accompanied by Intramuscular Ectopic Adipogenesis in Vastus Medialis Muscle of Advanced Osteoarthritis Patients.

Am J Pathol 2017 Dec 15;187(12):2674-2685. Epub 2017 Sep 15.

Department of Regenerative Medicine, Institute, National Center for Geriatrics and Gerontology, Oobu, Japan. Electronic address:

Muscle dysfunction is the most important modifiable mediating factor in primary osteoarthritis (OA) because properly contracting muscles are a key absorber of forces acting on a joint. However, the pathological features of disuse muscle atrophy in OA patients have been rarely studied. Vastus medialis muscles of 14 female patients with OA (age range, 69 to 86 years), largely immobile for 1 or more years, were obtained during arthroplastic surgery and analyzed histologically. These were compared with female patients without arthritis, two with patellar fracture and two with patellar subluxation. Areas occupied by myofibers and adipose tissue were quantified. Large numbers of myofibers were lost in the vastus medialis of OA patients. The loss of myofibers was a possible cause of the reduction in muscle strength of the operated on knee. These changes were significantly correlated with an increase in intramuscular ectopic adipose tissue, and not observed in knees of nonarthritic patients. Resident platelet-derived growth factor receptor α-positive mesenchymal progenitor cells contributed to ectopic adipogenesis in vastus medialis muscles of OA patients. The present study suggests that significant loss of myofibers and ectopic adipogenesis in vastus medialis muscles are common pathological features of advanced knee OA patients with long-term loss of mobility. These changes may be related to the loss of joint function in patients with knee OA.
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http://dx.doi.org/10.1016/j.ajpath.2017.08.009DOI Listing
December 2017

Does the Q - H index show a stronger relationship than the H:Q ratio in regard to knee pain during daily activities in patients with knee osteoarthritis?

J Phys Ther Sci 2016 Dec 27;28(12):3320-3324. Epub 2016 Dec 27.

Department of Rehabilitation and Care, Seijoh University, Japan.

[Purpose] The purpose of this study was to elucidate the relationship between knee muscle strength and knee pain in activities of daily living, based on consideration of the difference between extension and flexion strength (Q - H) and the hamstring:quadriceps (H:Q) ratio in patients with knee osteoarthritis. [Subjects and Methods] The participants were 78 females with knee osteoarthritis, and a total of 133 knees that had not been treated surgically were the targets of this research. The legs were divided according to dominance. Isometric knee extension and flexion muscle strength and knee pain during activities of daily living were measured. The H:Q ratio (flexion/extension muscle strength) and the difference between extension and flexion strength, (extension muscle strength/weight) minus (flexion muscle strength/weight), that is, Q - H, were calculated. The correlation between these indices and the knee pain score during activities of daily living was investigated. [Results] Greater knee pain during activities of daily living was related to lower knee extension muscle strength and Q - H in both the dominant and nondominant legs. Knee flexion muscle strength and the H:Q ratio were not significantly correlated with knee pain during any activities of daily living. [Conclusion] Knee extension muscle strength and Q - H were found to be significantly correlated with knee pain during activities of daily living, whereas the H:Q ratio was not.
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http://dx.doi.org/10.1589/jpts.28.3320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5276753PMC
December 2016

[Pathological state or cause of sarcopenia.]

Authors:
Yasumoto Matsui

Clin Calcium 2017;27(1):45-52

National Center for Geriatrics and Gerontology, Japan.

Skeletal muscle atrophy by aging(Sarcopenia)is more likely to occur in lower limbs rather than upper ones, and in the thigh rather than in the lower leg, and in the anterior side of thigh rather than posterior, faster in men than in women. It differs from disuse muscle atrophy in that it occurs slowly and gradually, hard to be recovered, or fast twitch fibers are mainly involved. Many factors or phenomena are known to contribute to proceed sarcopenia. In the aged skeletal muscle tissue, the number of satellite cells or motor neurons decrease and the function of the neuro-muscular junction declines. Oxidative stress and chronic inflammation increase as aging which relate with sarcopenia. Inflammatory cytokines, such IL-6, TNF-α, IL-5 play the roles Muscle protein breakdown is up regulated through ubiquitin-dependent proteolysis. Oxidative stress influences mitochondrial dysfunction or induces apoptosis. Also as aging, anabolic factors which are preferable to protein synthesis, such as IGF-1, sex hormones, vitamin D, or branched chain amino acid.
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http://dx.doi.org/CliCa17014552DOI Listing
March 2017

Sarcopenia is Associated With Impairment of Activities of Daily Living in Japanese Patients With Early-Stage Alzheimer Disease.

Alzheimer Dis Assoc Disord 2017 Jul-Sep;31(3):256-258

*Center for Comprehensive Care and Research on Memory Disorders †Medical Genome Center §Department of Advanced Medicine (Orthopedic Surgery), National Center for Geriatrics and Gerontology, Obu ‡Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences, Kobe, Japan.

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http://dx.doi.org/10.1097/WAD.0000000000000175DOI Listing
June 2018

Sarcopenia and sarcopenic leg as potential risk factors for acute osteoporotic vertebral fracture among older women.

Eur Spine J 2016 11 18;25(11):3424-3431. Epub 2015 Feb 18.

Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan.

Purpose: Sarcopenia-related falls and fractures among women with osteoporosis are becoming an emerging problem because of rapid aging worldwide. We aimed to investigate the association between sarcopenia, given by the muscle mass of the arms and legs, and osteoporotic vertebral fracture (OVF) among female patients.

Methods: This cross-sectional study examined 216 women with fresh OVF (OVF group) diagnosed by magnetic resonance imaging and 1,608 women from an outpatient clinic who did not have a OVF [non-fracture (NF) group]. We performed whole-body dual-energy X-ray absorptiometry to analyze body composition, including skeletal muscle mass index (SMI; lean mass/height) and bone mineral density (BMD). We used stepwise logistic regression analysis to determine the risk factors associated with OVF.

Results: After controlling for age, the OVF group showed lower appendicular SMI (5.62 vs. 5.97 kg/m, P < 0.001), lower arm SMI (1.36 vs. 1.42 kg/m, P = 0.004), lower leg SMI (4.27 vs. 4.55 kg/m, P < 0.001), and higher prevalence of sarcopenia (42.3 vs. 25.9 %, P < 0.001), compared with the NF group. Reduced leg muscle mass and presence of sarcopenia were independent risk factors for acute OVF in multivariate analysis (odds ratio = 1.4, P = 0.002; odds ratio = 1.96, P < 0.001, respectively).

Conclusions: We found higher prevalence of sarcopenia and lower leg muscle mass among patients with acute OVF compared with patients who did not have an OVF. These results suggest that sarcopenia may be a risk factor for OVF.
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http://dx.doi.org/10.1007/s00586-015-3805-5DOI Listing
November 2016

Prevalence and associated factors of sarcopenia in elderly subjects with amnestic mild cognitive impairment or Alzheimer disease.

Curr Alzheimer Res 2016 ;13(6):718-26

Kobe University, Graduate School of Health Sciences, Department of Community Health Sciences, 7- 10-2 Tomogaoka, Suma, Kobe, Hyogo, Japan 654-0142.

Background: To date, very little is known about the nature of sarcopenia in subjects with cognitive impairment. The aims of this study were firstly to clarify the prevalence of sarcopenia at various stages of cognitive impairment, and secondly to examine factors related to sarcopenia in men and women with cognitive impairment.

Method: The subjects were 418 outpatients (normal cognition; NC: 35, amnestic mild cognitive impairment; aMCI: 40, Alzheimer disease; AD: 343) who attended the Memory Clinic at the National Center for Geriatrics and Gerontology of Japan during the period from October 2010 to July 2014. Cognitive status, vitality, depressive mood, body mass index, hand grip strength, timed up and go test, skeletal muscle mass and serum levels of 25-hydroxyvitamin D, albumin and creatinine were assessed. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass. We performed the univariate and multivariate logistic regression analyses to explore factors associated with sarcopenia.

Results: The overall prevalence of sarcopenia was 21.1% (NC = 8.6%, aMCI = 12.5%, AD = 23.3%). In both sexes, factors associated with sarcopenia were age (P < .01), body mass index (P < .001) and vitality (P < .05). In women, serum level of 25-hydroxyvitamin D was associated with sarcopenia (P < .05).

Conclusion: Low vitality could be a dementia-specific risk factor for sarcopenia. Prevention of sarcopenia in patients with cognitive impairment should be approached from physical and psychologic points of view.
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http://dx.doi.org/10.2174/1567205013666160211124828DOI Listing
January 2017

Effects of a custom-made hinged knee brace with knee flexion support for patients with knee osteoarthritis:a preliminary study.

Nagoya J Med Sci 2015 Feb;77(1-2):95-101

Department of Advanced Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.

A knee brace for medial knee osteoarthritis (OA) is required to restrict knee adduction moment (KAM), but must not restrict knee flexion during swing phase. There is no report of a knee brace with both functions. The purpose of this study is to investigate the effect of the custom-made hinged knee brace for patients with knee OA compared to the hinged knee brace generally used, and to assess the KAM and knee flexion angle during swing phase. Fifteen patients (average age: 71.6 ± 7.8 years old) with medial knee OA participated. Gait analysis was performed using a 3-D motion analysis system to measure two conditions: hinged knee brace (KB), and a custom-made hinged knee brace with knee-flexion support- equipped rubber tubes at the posterior of the lateral and medial side poles (KBF). The peak KAM with KBF was significantly smaller than those with the KB (P=0.004, the difference between these conditions of KAM: 0.06 Nm/kg). The peak knee flexion angles during swing phase with KBF were also significantly larger than those with the KB (P=0.004, the difference between these conditions of knee flexion angle: 1.5 degrees). The custom-made brace with one type of tube actuator in the present study could decrease KAM and make for a small increase of knee flexion angle as opposed to the hinged knee brace.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361511PMC
February 2015

Sex- and age-related differences in mid-thigh composition and muscle quality determined by computed tomography in middle-aged and elderly Japanese.

Geriatr Gerontol Int 2015 Jun 20;15(6):700-6. Epub 2014 Sep 20.

Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan.

Aim: Sex- and age-related differences in mid-thigh composition and muscle quality remain unclear. The present study aimed to clarify these differences using computed tomography in middle-aged and elderly Japanese.

Methods: A total of 2310 participants (age 40-89 years), who were randomly selected from the local residents, underwent computed tomography examination of the right mid-thigh. Thigh circumference and cross-sectional areas of the thigh, muscle, quadriceps, non-quadriceps, fat, and bone were measured. Knee extension strength and muscle quality index (knee extension strength/quadriceps cross-sectional area) were also assessed. Sex- and age-related differences in these indices were analyzed.

Results: The thigh cross-sectional area in men and women decreased by 0.6% and 0.5%/year, respectively, because of a decrease in muscle cross-sectional area (men 75.2%, women 40.6%), fat cross-sectional area (men 24.4%, women 59.6%) and bone cross-sectional area (men 0.5%, women -0.2%). Muscle cross-sectional area in men and women decreased by 0.6% and 0.4%/year, respectively, because of a decrease in quadriceps cross-sectional area (men 65.6%, women 81.6%) and non-quadriceps cross-sectional area (men 34.4%, women 18.4%). Muscle quality in men and women decreased by 0.4% and 0.3%/year, respectively.

Conclusion: Thigh cross-sectional area decreased with age mainly because of a decrease in muscle cross-sectional area in men and fat cross-sectional area in women. The rate of decrease in muscle cross-sectional area was 1.5-fold higher in men than in women. Muscle cross-sectional area decreased with age mainly because of a decrease in quadriceps cross-sectional area, especially in women. Decrease in muscle quality with age was similar in both sexes.
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http://dx.doi.org/10.1111/ggi.12338DOI Listing
June 2015

Relationship between standing postural alignments and physical function among elderly women using day service centers in Japan.

J Back Musculoskelet Rehabil 2015 ;28(1):111-7

Background: Posture and physical function have been quantified in mature adults, but not in elderly females.

Objective: To quantify standing posture and measures of physical function in community-dwelling women over the age of 65 years, and to examine relationships between these variables.

Methods: Fifty-three women were recruited from day care service users (average age: 83.7 ±6.3 years old). Standing postural alignments were assessed using 2-dimensional analyses with a digital video camera. The time up and go test (TUG) and other physical function tests were conducted.

Results: Decreased lower cervical angle (increased forward head position) was significantly correlated with increased upper cervical angle (increased chin-up, r = −0.45), increased thoracic spine angle (increased kyphosis, r = −0.38), and decreased lumbar spine angle (thoracolumbar segments backward relative to the pelvis, r = 0.48). The decreased lumbar spine angle was significantly correlated with increased thoracic angle (increased kyphosis, r = −0.37), increased pelvic plane angle (increased anterior pelvic tilt, r = −0.49), and decreased knee flexion angle (r = 0.46). Increased TUG time (slower walking speed) was correlated to increased forward head position (r = 0.30) and thoracolumbar segments forward relative to the pelvis (r = 0.34).

Conclusions: Posture and physical function measures were provided for community-dwelling females who were >65 years of age. They did not demonstrate any correlation between measured knee strength, back strength or single leg standing with measures of postural alignment, but TUG showed a moderate correlation with the lower cervical and lumbar spine posture measures.
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http://dx.doi.org/10.3233/BMR-140498DOI Listing
August 2016

Association of grip strength and related indices with independence of activities of daily living in older adults, investigated by a newly-developed grip strength measuring device.

Geriatr Gerontol Int 2014 Apr;14 Suppl 2:77-86

Department of Advanced Medicine (Orthopedic Surgery).

Aim: To investigate the association of grip strength and activities of daily living independence in older adults, using a newly-developed grip strength measuring device.

Methods: Patients who visited the clinic for memory disorders at the National Center for Geriatrics and Gerontology (142 men and 205 women, mean age 74.8 ± 8.8 years) were included in the present study. Their strength during gripping performance is described in detail, and following the indices were calculated: maximum strength (MS), response time (RT), time to MS, time to reach turning point (TP), strength at TP, inclination from start to TP, time from TP to reach MS, inclination from TP to MS and ratio of strength (TP/MS). Barthel Index (BI), total scores and scores of each subclass were used for evaluating activities of daily living independence. MS was compared between the independent and dependent groups. Correlations, using partial Pearson's coefficient adjusted for age, and Mini-Mental State Examination total score were analyzed between indices and BI by sex, side, and age groups.

Results: MS was significantly higher in the independent group. MS and RT were significantly related with BI total and certain subclasses in both hands, TP/MS was significantly related in the right hand of either sex, and strength at TP was significantly related in both hands in women and in the left hand in men. Time to reach TP was particularly correlated in both hands and time from TP to reach MS in the right hand, in men. The correlation of indices varied by sex, hand side and age group, especially in men aged in their 70s, and in women aged less than 70 years and women aged in their 80s.

Conclusion: MS was shown to be useful, but some of the newly defined indices, such as RT, strength at TP, and elements regarding before and after TP until reaching MS, were also suggested to be useful.
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http://dx.doi.org/10.1111/ggi.12262DOI Listing
April 2014

Use of alfacalcidol in osteoporotic patients with low muscle mass might increase muscle mass: an investigation using a patient database.

Geriatr Gerontol Int 2014 Feb;14 Suppl 1:122-8

Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Nagoya, Japan.

Aim: Sarcopenia causes a decline in physical performance and decreased quality of life. However, there is little evidence for effective treatments. Because of the similarities between osteoporosis and sarcopenia, alfacalcidol used for osteoporosis might be beneficial for low muscle mass. Therefore, we investigated the effect of alfacalcidol on muscle mass in patients with low muscle mass.

Methods: In this retrospective cohort analysis, patients from an osteoporosis database were divided into two groups: alfacalcidol-treated patients (vitamin D group; n = 156) and a control group without drug treatment (n = 233). Muscle mass was evaluated in terms of the skeletal muscle index (SMI; kg/m(2)) obtained from dual-energy X-ray absorptiometry measurements that were taken at the start and end of a 1-year period. Low muscle mass was determined using specific SMI cut-offs for Japanese individuals.

Results: Both the vitamin D group (mean age 73.7 ± 9.8 years) and the control group (mean age 72.3 ± 11.9 years) were primarily women (n = 141, 90.4%; n = 189, 81.1%, respectively). Low muscle mass was identified in 32.7% (n = 51) of the vitamin D group and 32.2% (n = 75) of the control group. The mean appendicular SMI in the vitamin D group did not change significantly over the 1-year period. The change was significant among the patients with low muscle mass (5.30 kg/m(2) vs 5.49 kg/m(2)). The mean appendicular SMI in the control group decreased significantly over the 1-year period (6.09 kg/m(2) vs 5.99 kg/m(2)). The change in the patients with low muscle mass was not significant.

Conclusions: The vitamin D group maintained muscle mass, and the SMI increased in patients with low muscle mass. Thus, the use of alfacalcidol might be effective in osteoporotic patients with low muscle mass.
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http://dx.doi.org/10.1111/ggi.12222DOI Listing
February 2014

Effects of knee extensor muscle strength on the incidence of osteopenia and osteoporosis after 6 years.

J Bone Miner Metab 2014 Sep 7;32(5):550-5. Epub 2013 Nov 7.

Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, 35 Gengo, Morioka-cho, Obu, Aichi, 474-8511, Japan,

The association of knee extensor muscle strength with bone mineral density (BMD) has been reported in cross-sectional epidemiological studies, but it remains unclear whether or not this is the case with longitudinal change. Thus, we investigated whether or not the knee extension strength can predict the incidence of osteopenia or osteoporosis after 6 years, then compared the difference between sexes. Subjects were 1255 community-dwelling Japanese men and menopaused women, aged 40-81 years. BMD of lumbar spine and femoral neck was assessed by dual-energy X-ray absorptiometry twice at 6-year intervals. Subjects were divided into three groups, normal, osteopenia, and osteoporosis, depending on their young adult mean BMD % value. In the cross-sectional analysis the correlations between the knee extension strength and BMD of the two regions were examined, using Pearson's correlation coefficient. Longitudinal analyses were then conducted to determine the odds ratio, controlled for age and BMI, given that those who were normal in the initial stage developed osteopenia or osteoporosis after 6 years, for every 1 SD decrease in knee extension strength, as well as those who first had normal or osteopenia and then developed osteoporosis. Cross-sectional analysis showed a statistically significant relation between knee extensor muscle strength and BMD at both the lumbar spine (p = 0.02) and the femoral neck (p < 0.0001) only in men. The longitudinal analysis showed the significant effect of muscle strength on the loss of femoral neck BMD from normal to osteopenia or osteoporosis both in men (OR 1.84, 95 % CI 1.36-2.48, p < 0.0001) and in women (OR 1.29, 95 % CI 1.002-1.65, p < 0.05), as well as on the loss of spinal BMD from normal or osteopenia to osteoporosis only in men (OR 2.97, 95 % CI 1.07-8.23, p < 0.05). The results suggest the importance of knee extension strength to maintain the bone health of the proximal femur and spine in aging particularly in men.
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http://dx.doi.org/10.1007/s00774-013-0528-8DOI Listing
September 2014

[Aging of joint].

Clin Calcium 2013 Jan;23(1):15-22

Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Japan.

Joint disease is one of the most frequent causes of reaching a state requiring care by others. Thus, it is very important to cope with osteoarthritis (OA) in order to maintain the physical independence of elderly people. Xp findings of OA in the knee, which is the most commonly affected joint, do not correlate well with pain ; hence, on the diagnosis, MRI is useful to know the pathology of subchondral bone, cartilage or meniscus. In OA cartilage, increased degradation and decreased production of major matrix components, like type II collagen and aggrecan occur, as well as chondrocyte hypertrophy or apoptosis. In the meantime, general changes in the aging process, such as the changes of autophagy or energy metabolism, have also recently been reported. Since OA treatments at present are just against symptoms, like by NSAIDS or arthroplasty, the development of new treatment methods is expected, based on the clarification of the pathology, including consideration of the relations with aging of bone and muscles, or with metabolic syndrome.
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http://dx.doi.org/CliCa13011522DOI Listing
January 2013

Divergent Significance of Bone Mineral Density Changes in Aging Depending on Sites and Sex Revealed through Separate Analyses of Bone Mineral Content and Area.

J Osteoporos 2012 25;2012:642486. Epub 2012 Nov 25.

Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, 35 Gengo, Morioka-cho, Obu 474-8511, Japan.

Bone mineral density (aBMD) is equivalent to bone mineral content (BMC) divided by area. We rechecked the significance of aBMD changes in aging by examining BMC and area separately. Subjects were 1167 community-dwelling Japanese men and women, aged 40-79 years. ABMDs of femoral neck and lumbar spine were assessed by DXA twice, at 6-year intervals. The change rates of BMC and area, as well as aBMD, were calculated and described separately by the age stratum and by sex. In the femoral neck region, aBMDs were significantly decreased in all age strata by an increase in area as well as BMC loss in the same pattern in both sexes. In the lumbar spine region, aBMDs decreased until the age of 60 in women, caused by the significant BMC decrease accompanying the small area change. Very differently in men, aBMDs increased after their 50s due to BMC increase, accompanied by an area increase. Separate analyses of BMC and area change revealed that the significance of aBMD changes in aging was very divergent among sites and between sexes. This may explain in part the dissociation of aBMD change and bone strength, suggesting that we should be more cautious when interpreting the meaning of aBMD change.
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http://dx.doi.org/10.1155/2012/642486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512306PMC
December 2012

High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture.

Geriatr Gerontol Int 2013 Apr 23;13(2):413-20. Epub 2012 Jul 23.

Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Aim: Sarcopenia-related falls and fractures are becoming an emerging problem as a result of rapid aging worldwide. We aimed to investigate the prevalence of sarcopenia by estimating the muscle mass of the arms and legs of patients with and without hip fracture.

Methods: This cross-sectional study examined 357 patients immediately after a hip fracture (the HF group) and in 2511 patients from an outpatient clinic who did not have a hip fracture (the NF group) at single institution in Japan. We carried out whole-body dual energy X-ray absorptiometry to analyze body composition with skeletal muscle mass index (SMI; lean mass/height(2)) and bone mineral density (BMD). We carried out stepwise logistic regression analysis to determine the factors associated with a hip fracture.

Results: Lower appendicular SMI (P < 0.001), leg SMI (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after controlling for age and sex. The arm SMI was similar in both groups (P > 0.95). In multivariate analysis, the presence of sarcopenia, older age and lower BMD were associated with the occurrence of a hip fracture (OR 1.476, P = 0.002; OR 1.103, P < 0.001; OR 0.082, P < 0.001; respectively).

Conclusion: This study showed a higher prevalence of sarcopenia and more reduced leg muscle mass in patients after a hip fracture than in the outclinic patients who did not have hip fractures. The results imply sarcopenia can be a risk factor for a hip fracture.
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http://dx.doi.org/10.1111/j.1447-0594.2012.00918.xDOI Listing
April 2013

Estimation of appendicular muscle mass and fat mass by near infrared spectroscopy in older persons.

Geriatr Gerontol Int 2012 Oct 13;12(4):652-8. Epub 2012 Feb 13.

Section for Health Promotion, Department of Health and Medical Care, Center for Development of Advanced Medicine for Dementia, National Hospital for Geriatric Medicine Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Aim: Near infrared spectroscopy has been reported to have a high reliability and accuracy in assessing the percentage of body fat. However, whether muscle mass can be accurately estimated using this method has not been established. This study examined whether a near infrared spectroscopy method could estimate appendicular muscle mass and fat mass, with dual-energy X-ray absorptiometry as the standard method for comparison.

Methods: A total of 20 orthopedic inpatients (mean age 73.2 ± 6.8 years) were recruited for this study. Their body composition was assessed using near infrared spectroscopy and dual-energy X-ray absorptiometry. Appendicular muscle mass and fat mass were estimated from height, weight and optical densities.

Results: The optical densities for the upper arm (biceps, triceps) and forearm (flexor carpi radialis) were significantly correlated with appendicular muscle mass (r = 0.534 to 0.623) or fat mass (r = -0.483 to -0.827). Estimated appendicular muscle mass and fat mass explained 89% and 80% of the variance in the dual-energy X-ray absorptiometry-derived muscle mass and fat mass estimates using height, weight and optical density values of the proximal flexor carpi radialis.

Conclusions: Near infrared spectroscopy is a useful method to assess not only fat mass, but also muscle mass in older adults.
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http://dx.doi.org/10.1111/j.1447-0594.2011.00834.xDOI Listing
October 2012

Serum 25-hydroxyvitamin D status in hip and spine-fracture patients in Japan.

J Orthop Sci 2011 Jul 19;16(4):418-23. Epub 2011 May 19.

Department of Physical Therapy, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan.

Background: Serum 25-hydroxyvitamin D (25(OH)D) is used as an index that reflects the level of vitamin D. We have previously reported, on the basis of a study in Sado in Niigata, that patients with hip fracture have lower serum 25(OH)D levels than non-hip-fracture cases. In this study, the serum 25(OH)D status in hip-fracture cases was examined in four regions in Japan. Although most hip-fracture patients have experienced past spine-compression fractures, the relationship of these fractures and 25(OH)D is unknown. Therefore, we also examined the 25(OH)D level in spine-compression fracture patients in the same locations and time periods.

Methods: The levels of 25(OH)D, intact parathyroid hormone (intact PTH), undercarboxylated osteocalcin (ucOC), urine N-terminal crosslinking telopeptide of type I collagen (NTX), and bone mineral density were examined in patients with hip and spine fracture due to osteoporosis in several regions in Japan.

Results: There were no significant differences in age, BMI, serum 25(OH)D, serum intact PTH, and serum ucOC among the regions. Levels of serum 25(OH)D were low in patients with hip fracture and spine fracture. The average serum 25(OH)D level was significantly lower in hip-fracture patients than in spine-fracture patients (16.3 vs. 18.1 ng/mL, P < 0.05). High serum ucOC was found in 37% of hip-fracture patients and 44% of spine-fracture patients.

Conclusions: Both hip and spine-fracture patients have vitamin D insufficiency, with similar results found in elderly patients in four areas of Japan. The severity of this condition tends to be more serious in hip-fracture patients than in spine-fracture patients.
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http://dx.doi.org/10.1007/s00776-011-0089-4DOI Listing
July 2011

Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women.

Bone 2010 Feb 6;46(2):453-7. Epub 2009 Sep 6.

Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

Two case-control studies were designed to investigate the contribution of the geometry and bone mineral density (BMD) of the proximal femur to bone strength in Japanese elderly women. We also investigated whether clinical CT is useful to assess the risk of hip fracture. Subjects in the neck fracture study included 20 Japanese women with neck fracture (age: mean+/-SD; 80.1+/-4.5 years old) and 20 age-matched control women (79.2+/-2.6 years old). Subjects in the trochanteric fracture study included 16 Japanese women with trochanteric fracture (82.6+/-5.0 years old) and 16 age-matched control women (80.8+/-3.8 years old). CT examination of the proximal femur was performed between the date of admission and the date of surgery. The CT scanners used were an Aquillion 16 (Toshiba) and Somatom 64 (Siemens); the scanning conditions including spatial resolution and scanning energy were adjusted, and the same type of reference phantom containing hydroxyapatite was used. QCT PRO software (Mindways) was used to analyze data for BMD, geometry, and biomechanical parameters. Both the neck and trochanteric fracture cases had significantly lower total and cortical BMD, a significantly smaller cortical cross-sectional area (CSA), and a larger trabecular CSA. Both had significantly thinner cortex and smaller distance to center of bone mass, and women with trochanteric fracture had a significantly smaller cortical perimeter in the cross-sectional femoral neck. Women with neck fracture had a longer hip axis length (HAL) and women with trochanteric fracture had a significantly larger neck-shaft angle (NSA). Both groups had significantly lower cross-sectional moment of inertia (CSMI), and only women with neck fracture had a significantly higher buckling ratio (BR) compared to their respective controls. According to the multiple logistic regression analysis, women with neck fracture had a significantly longer HAL, lower CSMI, and higher BR, and women with trochanteric fracture had a significantly smaller cortical CSA of the femoral neck. We conclude that clinical CT may be useful for the assessment of the risk of neck and trochanteric fracture.
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http://dx.doi.org/10.1016/j.bone.2009.08.059DOI Listing
February 2010
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