Comprehensive nutritional status in sarco-osteoporotic older fallers

In older persons, the combination of osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of falls and fractures. However, the particular nutritional status of the sarco-osteoporotic (SOP) patients remains unknown. The goal of this study was to obtain a comprehensive picture of nutritional status in SOP patients. Cross-sectional study. Falls & Fractures Clinic, Nepean Hospital (Penrith, Australia). 680 subjects (mean age=79, 65% female) assessed between 2008-2013. Assessment included medical history, mini-nutritional assessment, physical examination, bone densitometry and body composition by DXA, and blood tests for nutritional status (albumin, creatinine, hemoglobin, vitamin D, vitamin B-12, calcium, phosphate and folate). Patients were divided in 4 groups: 1) osteopenia/osteoporosis (BMD <-1.0 SD); 2) sarcopenia; 3) SOP; and 4) normal (no sarcopenia/no osteoporosis). Difference between groups was assessed with one-way ANOVA and chi square analysis. Multivariable linear regression evaluated the association between the groups and measures of nutritional parameters. Sarcopenia was present in 47.4% of those with osteopenia (167/352) and 62.7% in those with osteoporosis (91/145). Mean age of the SOP was 80.4 +/- 7 years. SOP patients showed significantly higher prevalence of falls and fractures. Univariate analyses showed that SOP were more likely than normal to have a BMI < 25 (OR 2.42 95%CI 1.45-4.041, p < 0.001), a MNA score < 12 (OR 2.0, 95%CI 1.15-3.49, p < 0.05), serum folate < 20 nmol/L (OR 4.0 95%CI 1.35-11.87, p < 0.01) and hemoglobin < 120g/L (OR 2.0 95%CI 1.28-3.30, p < 0.01). Multivariate analysis showed that a MNA score < 12 was independently associated with SOP compared to normal when adjusted for age and gender. Hemoglobin < 120g/L, BMI < 25, and GDS > 6 remained independently associated with SOP after adjustment for all variables including inflammatory conditions. Hypoalbuminemia (< 35 g/L) was associated with just osteopenia/osteoporosis (OR: 2.03, 95%CI 1.08-3.81, p < 0.01) and just sarcopenia (OR: 1.77, 95%CI 1.0-3.0, p < 0.01) compared to normal. No differences in vitamin D, glomerular filtration rate, albumin, corrected calcium, phosphate, red blood cells folate or vitamin B12 levels were found between the subgroups. In approaching SOP patients, early prevention protocols directed to optimize their nutritional status would be a key strategy to prevent poor outcomes such as falls and fractures in this high risk population. Therefore, nutritional assessment and early nutritional supplementation should be essential domains in this strategy.