The Association of Bone Turnover Markers with Muscle Function, Falls, and Frailty in Older Women in Long-Term Care.

BACKGROUND: Osteoporosis and sarcopenia commonly coexist in older adults. There is strong evidence that bone and muscle impact each other through mechanical and biochemical cross-talk. OBJECTIVES: We sought to investigate the relationship between the markers of bone remodeling including the C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N propeptide (P1NP) with muscle function, falls, and frailty in older women residing in long-term care (LTC) facilities. DESIGN: A secondary analysis of a randomized controlled trial. SETTING: Residents of LTC. PARTICIPANTS: One hundred seventy-eight older women with osteoporosis. MEASUREMENTS: We measured and analyzed baseline CTX, P1NP, gait speed, sit to stand time, history of falls, and frailty index. RESULTS: Participants had a mean age of 86.7 years and BMI of 27.6 kg/m2. The correlation (r) of CTX with gait speed and sit to stand test, as indices for muscle function, were -0.193 (p=0.0163) and 0.152 (p=0.0507), respectively. Additionally, CTX level was significantly associated with history of falls (p=0.0068), recurrent falls (p=0.0260), and frail phenotype (p=0.0126). P1NP did not have a significant association with gait speed, sit to stand test, and history of falls; however, it was associated with frail phenotype (p=0.0137). Most findings persisted after adjusting for age. CONCLUSIONS: In older women residing in LTC facilities, CTX was associated with gait speed, falls history, and frail phenotype, whereas P1NP was only associated with frail phenotype. These findings suggest a relationship between bone remodeling and muscle function.

Does Zoledronic Acid Improve Appendicular Lean Mass in Older Women with Osteoporosis? A Sub-Analysis of a Randomized Clinical Trial.

BACKGROUND: Coexistence of osteoporosis and sarcopenia (osteosarcopenia), is associated with increased risk for fractures, falls, and mortality. Although there are multiple medications for management of osteoporosis, there are no approved pharmacotherapy for sarcopenia. OBJECTIVES: We examined the effect of zoledronic acid on muscle mass indices including ALM (Appendicular Lean Mass) and ALM/Height2 in a cohort of older women with osteoporosis who were residents of Long-Term Care Communities (LTCCs). DESIGN: A secondary analysis of a 2-year double-blind, randomized, placebo-controlled clinical trial. SETTING: Residents of LTCCs. PARTICIPANTS: Sixty-two postmenopausal women with osteoporosis. INTERVENTION: Participants either received 5 mg infusion of zoledronic acid or placebo, once at the start of the study. MEASUREMENTS: Participant's ALM/Height2, ALM, total hip BMD (Bone Mineral Density) and spine BMD were measured in 6, 12 and 24 months. RESULTS: On average, participants were 86.7 years old and had a BMI of 27.4 kg/m2. There was no significant difference in change from baseline (mean ± SE) between the treatment group and the placebo group in ALM/Height2: (-0.15 vs -0.02, p = 0.541) and (-0.17 vs 0.001, p = 0.315) and (-0.29 vs -0.19, p = 0.646) or ALM: (-0.38 vs -0.09, p = 0.455) and (-0.45 vs -0.005, p = 0.216) and (-0.70 vs -0.48, p = 0.553) at 6, 12, and 24 months respectively. In addition, after adjusting for a possible confounding, the ALM/Height2 or ALM did not have significant improvements from baseline at 6 months, 12 months, and 24 months either in the treatment group or in the placebo group. However, there were significant improvements in the BMD at the total hip and the spine in the treatment group compared with the placebo group at all three time points. CONCLUSIONS: Among older women residing in LTCCs, a single dose of zoledronic acid did not increase ALM/Height2 and ALM, despite improving the BMD at the total hip and the spine at the 2-year follow-up.