Clinical impact of osteosarcopenia on mortality, physical function and chronic inflammation: a 9-year follow up cohort study.

Osteosarcopenia, mortality and physical function


  • Walter sepulveda loyola aculty of Health and Social Sciences, Universidad de Las Americas, Santiago, Chile
  • Jaqueline de Barros Morselli Program of Masters and Doctoral degree in Rehabilitation Sciences, Londrina State University (UEL) and University of Northern Parana (UNOPAR), Londrina, Brazil.
  • Felipe Araya-Quintanilla Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile.
  • Denilson Teixeira Program of Masters and Doctoral degree in Rehabilitation Sciences, Londrina State University (UEL) and University of Northern Parana (UNOPAR), Londrina, Brazil.
  • Alejandro Alvarez-Bustos Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.
  • Mario Molari Program of Masters and Doctoral degree in Rehabilitation Sciences, Londrina State University (UEL) and University of Northern Parana (UNOPAR), Londrina, Brazil.
  • Juan José Valenzuela- Fuenzalida Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370186, Chile
  • Vanessa Suziane Probst Program of Masters and Doctoral degree in Rehabilitation Sciences, Londrina State University (UEL) and University of Northern Parana (UNOPAR), Londrina, Brazil.


Palabras clave:

osteosarcopenia, sarcopenia, older people, functionality, mortality


Objective: This study aimed to determine the impact of osteosarcopenia on important clinical and functional outcomes in older adults.

Methods: 242 community-dwelling older adults from the study on ageing and longevity (ELLO data from 2009 to 2018). Subjects underwent body composition analysis by dual energy X-ray absorptiometry and bioelectrical impedance, and assessments for aerobic capacity and muscle strength including the incremental shuttle walking test (ISWT), 6-minutes walking test (6MWT), handgrip strength (HGS) and sit-to stand test (STS). Static balance was assessed by one-legged stance test (OLST) and chronic inflammation by IL-6 and tumor necrosis factor alpha (TNF-α). Osteosarcopenia was defined as low bone mineral density (BMD) (T-score<-1) combined with low phase angle (PhA). Comparisons were run with Students T test and Man-Whitney test. Survival probabilities were estimated using the Kaplan-Meier method. Receiver operating characteristic curve was used to analyze the association of PhA with mortality and to find the best cut-point.

Results: The proportion of individuals who died in a 9-year follow up was higher in individuals with Osteosarcopenia (25%) compared to without osteosarcopenia (9%) (p=0.015). Osteosarcopenia was associated with mortality (HR: 1.4; 95% CI 1.02 - 1.29; p = 0.0151). Subjects with osteosarcopenia compared to without it presented worse performance in the ISWT (514 ±19 m vs. 621 ± 16 m), 6MWT (515 ± 7 m vs. 538 ± 6 m, p< 0.05), OLST (13.5 ±10.2 s vs.16.7 ±8.3 s) and HGS (25 ± 7 Kg vs. 28 ± 9 K5); p< 0.05 for all. The cut point used to PhA was ≤ 6.07º for both male and female (AUC: 0.687; Sensibility: 64% and Specificity: 61% for mortality).

Conclusion: Osteosarcopenia diagnosed with low phase angle combined with low BMD is highly associated with mortality. Additionally, older adults with osteosarcopenia presented worse aerobic capacity, balance and muscle strength.


Sepúlveda-Loyola W, Phu S, Bani Hassan E, Brennan-Olsen SL, Zanker J, Vogrin S, et al. The Joint Occurrence of Osteoporosis and Sarcopenia (Osteosarcopenia): Definitions and Characteristics. J Am Med Dir Assoc 2020;21:220–5. j.jamda.2019.09.005.

Kawao N, Kaji H. Interactions between muscle tissues and bone metabolism. J Cell Biochem 2015;116:687–95. 10.1002/jcb.25040.

Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Muir SW, et al. Phenotype of Osteosarcopenia in Older Individuals With a History of Falling. J Am Med Dir Assoc 2015;16:290–5.

Hirschfeld HP, Kinsella R, Duque G. Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 2017;28:2781–90.

Drey M, Sieber CC, Bertsch T, Bauer JM, Schmidmaier R, Group TF intervention, et al. Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clin Exp Res 2016;28:895–899.

Zanker J, Duque G. Osteosarcopenia: the Path Beyond Controversy. Curr Osteoporos Rep 2020;18:81–4. s11914-020-00567-6.

Kanis J a. Assessment of osteoporosis at the primary health care level. World Health 2007:339.

Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: An Undiagnosed Condition in Older Adults. Current Consensus Definition: Prevalence, Etiology, and

Consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc 2011;12:249–56. da.2011.01.003.

Cruz-Jentoft AJ, Landi F, Topinková E, Michel JP. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care 2010;13:1–7.

Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: Consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc 2014;15:95–101.

Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: Two sides of the same coin. Front Aging Neurosci 2014;6:1–4.

Sepulveda Loyola WA, Suziane Probst V. Sarcopenia, definición y diagnóstico. Rev Chil Ter Ocup 2020;20:259. 10.5354/0719-5346.2020.53583.

Norman K, Wirth R, Neubauer M, Eckardt R, Stobäus N. The bioimpedance phase angle predicts low muscle strength, impaired quality of life, and increased mortality in old patients with cancer. J Am Med Dir Assoc 2015;16:173.e17-173.e22.

Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis - Part I: Review of principles and methods. Clin Nutr 2004;23:1226–43. 10.1016/j.clnu.2004.06.004.

Sepúlveda-Loyola W, F. Vilaca Cavallari Machado, Castro LA De, Baltus THL, Morelli NR, Bonifácio KL, et al. Is oxidative stress associated with disease severity, pulmonary function and metabolic syndrome in chronic obstructive pulmonary disease? Rev Clínica Española 2019.

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

Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO. Phase angle and mortality: a systematic review. Eur J Clin Nutr 2019;73:495–508.

Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 2010;92:612–9. ajcn.2010.29215.

Llames L, Baldomero V, Iglesias ML, Rodota LP. Valores del ángulo de fase por bioimpedancia eléctrica; Estado nutricional y valor pronóstico. Nutr Hosp 2013;28:286–95. nh.2013.28.2.6306.

Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol 2002;86:509–16.

Norman K, Pirlich M, Sorensen J, Christensen P, Kemps M, Schütz T, et al. Bioimpedance vector analysis as a measure of muscle function. Clin Nutr 2009;28:78–82. j.clnu.2008.11.001.

Barbosa-Silva MCG, Barros AJD. Bioelectrical impedance analysis in clinical practice: A new perspective on its use beyond body composition equations. Curr Opin Clin Nutr Metab Care 2005;8:311–7.

Mella De Cuevas KM, Sepúlveda-Loyola W, Araya-Quintanilla F, de Barros Morselli J, Molari M, Probst VS. Association between clinical measures for the diagnosis of osteosarcopenia with functionality and mortality in older adults: longitudinal study. Nutr Clin y Diet Hosp 2022;42:143–51.

Abad S, Sotomayor G, Vega A, Pérez de José A, Verdalles U, Jofré R, et al. El ángulo de fase de la impedancia eléctrica es un predictor de supervivencia a largo plazo en pacientes en diálisis. Nefrologia 2011;31:670–6. pre2011.Sep.10999.

Maddocks M, Kon SSC, Jones SE, Canavan JL, Nolan CM,

Higginson IJ, et al. Bioelectrical impedance phase angle relates to function, disease severity and prognosis in stable chronic obstructive pulmonary disease. Clin Nutr 2015;34:1245–50.

Alves FD, Souza GC, Clausell N, Biolo A. Prognostic role of phase angle in hospitalized patients with acute decompensated heart failure. Clin Nutr 2016;35:1530–4. j.clnu.2016.04.007.

Marini E, Buffa R, Saragat B, Coin A, Toffanello ED, Berton L, et al. The potential of classic and specific bioelectrical impedance vector analysis for the assessment of sarcopenia and sarcopenic obesity. Clin Interv Aging 2012;7:585–91. 47/CIA.S38488.

Phu S, Al Saedi A, Zanker J, Bani Hassan E, Vogrin S, Duque G. Agreement Between Initial and Revised European Working Group on Sarcopenia in Older People Definitions. J Am Med Dir Assoc 2019:2018–20.

Lajoie Y, Gallagher SP. Predicting falls within the elderly community: Comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr 2004;38:11–26.




Cómo citar

sepulveda loyola, W., de Barros Morselli, J. ., Araya-Quintanilla, F. ., Teixeira, D. ., Alvarez-Bustos, A. ., Molari, M. ., … Probst, V. S. . (2023). Clinical impact of osteosarcopenia on mortality, physical function and chronic inflammation: a 9-year follow up cohort study.: Osteosarcopenia, mortality and physical function . Nutrición Clínica Y Dietética Hospitalaria, 43(4).