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Calcif Tissue Int. 2019 May 16. doi: 10.1007/s00223-019-00561-w. [Epub ahead of print]

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

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Center for Geriatric Medicine, University of Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Heidelberg, Germany.
Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium.
WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium.
Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
INSERM, UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon Cedex 03, France.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
Department of Geriatrics, Neurosciences and Orthopaedics, Orthogeriatric Unit, Teaching Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, Rome, Italy.
Scientific Office, Federal Office for Safety in Health Care, Austrian Agency for Health and Food Safety, Vienna, Austria.
Aging Program, National Research Council, Padua, Italy.
Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
Mellanby Centre for Bone Research and Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038, ‎Zallaq, Bahrain.
Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
CHU Toulouse, Médecine Gériatrie Gérontopôle, Cité de la Santé, 20 Rue du Pont Saint Pierre, Inserm 1027, 31059, Toulouse, France.
IRCCS Mondino Foundation, Pavia, Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Pavia, Italy.
INSERM, UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
Medical Faculty, Department of Pharmacology, Medical University Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria.
NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.


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.


Obesity; Osteoporosis; Osteosarcopenia; Sarcopenia; Sarcopenic obesity


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