老年学与老年病学研究

抽象的

Can Muscular Impairment be the “Key” for Femoral Fracture?

Piccirilli E, Gasbarra E, Baldi J, Pistillo P and Tarantino U

Background: Osteoporosis and osteoarthritis are the most common diseases of musculoskeletal system. Osteoporosis is characterized by low bone mass and microarchitetural deterioration of bone tissue. This disease is associated with sarcopenia and muscular impairment, while osteoarthritis seems to be independent of muscle quality. In the elderly, sarcopenia is characterized by an histological deterioration and by an important functional impairment. The aim of the present work is to show how bone weakening is associated with muscle aging in terms of fiber atrophy and physical activity reduction, producing disability and risk of fall and fractures.

Methods: A functional evaluation of muscular performance status in twenty osteoporotic women with a femoral fracture and in twenty osteoarthritic women with a Total Hip Arthroplasty (THA) in progress was realized through the PASE test (Physical Activity Scale for the Elderly). DeXa was performed and the T-score values were considered to classify osteoporotic and osteoarthritic patients. As a part of a multiparametric model of evaluation, biopsies of vastus lateralis muscle were analyzed to find a correlation with functional index.

Results: In osteoporotic patients, the PASE test showed a low or moderate level of physical activity before occurring the fracture while osteoarthritic patients had more intensive physical performances. Hystological analysis showed that osteoporosis is characterized by a type II fiber prevalent atrophy and data correlation showed that lower scores of PASE test are associated with a lower type II fiber diameter. No correlation was found between BMD values and PASE test.

Conclusion: We demonstrated that osteoporosis is closely related to sarcopenia. Infact, bone remodeling is related to both muscle morphological and functional impairment and sarcopenia is considered one of the major responsible factors for functional limitations and motor dependency in elderly osteoporotic persons. According to our study, physical activity should be strongly recommended in osteoporotic patients at diagnosis.