A micro-costing analysis of post-fracture care pathways: results from the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS).

This study identified the costs and health-related quality of life impacts of several post-fracture multidisciplinary care pathways specific to individual skeletal site (hip, distal forearm, vertebrae, humerus). These care pathways may assist healthcare providers in allocating resources for osteoporotic fractures in more effective and cost-efficient ways. INTRODUCTION: This micro-costing study was undertaken to provide the estimated healthcare costs of several fracture site-specific health service use pathways associated with different trajectories of health-related quality of life (HRQoL) 12-months post-fracture. METHODS: The study included 4126 adults aged ≥ 50 years with a fragility fracture (1657 hip, 681 vertebrae, 1354 distal forearm, 434 humerus) from the International Costs & Utilities Related to Osteoporotic fractures Study (ICUROS). ICUROS participants were asked to recall the frequency and duration (where applicable) of their health and community care service use at 4- and 12-month follow-up visits. Patient-level costs were identified and aggregated to determine the average cost of healthcare use related to the fracture in each care pathway (presented in Australian 2021 dollars). Mean cost differences were calculated and analysed using a one-way analysis of variance (ANOVA) and post hoc Bonferroni correction to determine any statistically significant differences. RESULTS: The total direct cost of fractures was estimated at $89564, $38926, $18333, and $38461AUD per patient for hip, vertebral, wrist, and humeral participants, respectively. A Kruskal-Wallis test yielded a statistically significant difference in cost values between most care pathways (p < 0.001). Of the 20 care pathways, those associated with recovery of HRQoL had lower mean costs per patient across each fracture site. CONCLUSIONS: This study identified the costs and HRQoL impacts of several multidisciplinary care pathways for individual fracture sites based on the health service utilization of an international cohort of older adults. These care pathways may assist healthcare providers in allocating resources for fragility fractures in more effective and cost-efficient ways.

The Effect of the ENJOY Seniors Exercise Park Physical Activity Program on Falls in Older People in the Community: A Prospective Pre-Post Study Design.

BACKGROUND: The ENJOY project (Exercise interveNtion outdoor proJect in the cOmmunitY for older people) is a community-based research project actively promoting physical activity engagement through the delivery of an exercise program using outdoor multimodal exercise equipment. This study investigated the impact of the physical activity program on falls in older people. METHOD: This study was a multi-site prospective study with a pre-post intervention design and 12-month follow up. Eighty older people with increased falls risk underwent a 12-week supervised outdoors exercise program followed by a 6-month maintenance phase. The proportion of fallers and falls incidence were compared between the preceding and the prospective years. RESULTS: A sample of 54 (age 72.4±7.3, 79.6% women) was available for the 12 months analysis (due to COVID19 lockdowns, data of 19 participants were excluded and 4 dropped out). Number of fallers (from 51.8% to 31.4%, p=0.03) and falls incidence (from 42 to 29 falls, p<0.01) were significantly reduced at the 12-months follow up. CONCLUSION: The ENJOY Seniors Exercise Park program integrates outdoor multimodal exercise stations including specific exercises designed to challenge dynamic balance during functional daily movements. The outcomes provide preliminary evidence for the potential positive impact of the ENJOY Seniors Exercise Park in reducing falls for older people.

The role of estrogens in osteosarcopenia: from biology to potential dual therapeutic effects.

Osteoporosis and sarcopenia are two conditions associated with aging and characterized by a simultaneous decline in bone and muscle mass, respectively. These conditions share common risk factors (genetic, endocrine, nutritional and lifestyle factors) and biological pathways that often co-exist in a syndrome known as osteosarcopenia. Among the endocrine causes, estrogens play a critical role, especially in women. Estrogens have been demonstrated to exert a positive effect on bone and muscle development and maintenance. For this reason, menopause is characterized by a loss in bone mineral density and skeletal muscle quality and quantity. To date, studies indicate a positive effect of hormonal therapy on the prevention and management of osteoporosis, to the point that estrogen is prescribed as a first-line treatment for osteoporosis by the major international authorities. While results on sarcopenia are still disputable, such that estrogens are not recommended to prevent muscle loss in postmenopausal women, increased response to anabolic stimuli with estrogen therapy suggests similar beneficial effects on muscle as seen with bone, particularly when combined with resistance exercise.

Sex differences in recovery of quality of life 12 months post-fracture in community-dwelling older adults: analyses of the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS).

In this study of 695 Australian older adults (aged ≥50 years), we found that men and women had a similar trajectory of health-related quality of life (HRQoL) recovery following fragility fracture at any skeletal site. These results provide us with critical knowledge that improves our understanding of health outcomes post-fracture. INTRODUCTION: Mortality is higher in men than that in women following a fragility fracture, but it is unclear whether recovery of patient-reported outcomes such as health-related quality of life (HRQoL) differs between sexes. This study aimed to identify sex differences in HRQoL recovery 12 months post-fracture. METHODS: Data were from the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Participants recruited to AusICUROS were adults aged ≥50 years who sustained a fragility fracture. HRQoL was measured using the EQ-5D-3L at three time-points post-fracture: within 2 weeks (including pre-fracture recall) and at 4 and 12 months. Multivariate logistic regression analyses were undertaken, adjusting for confounders including age, education, income, and healthcare utilization post-fracture. RESULTS: Overall, 695 AusICUROS participants (536 women, 77.1%) were eligible for analysis with fractures at the hip (n = 150), distal forearm (n = 261), vertebrae (n = 61), humerus (n = 52), and other skeletal sites (n = 171). At the time of fracture, men were younger, reported a higher income, and were more likely to be employed, compared with women. For all fracture sites combined, there were no differences between men and women in recovery to pre-fracture HRQoL at 12-month follow-up (adjusted OR = 1.09; 95% CI: 0.75-1.61). When stratified by fracture site, no significant sex differences were seen for hip (OR = 1.02; 95% CI: 0.42-2.52), distal forearm (OR = 1.60; 95% CI: 0.68-3.78), vertebral (OR = 2.28; 95% CI: 0.61-8.48), humeral (OR = 1.62; 95% CI: 0.16-9.99), and other fractures (OR = 1.00; 95% CI: 0.44-2.26). CONCLUSION: Community-dwelling men and women who survived the 12 months following fragility fracture had a similar trajectory of HRQoL recovery at any skeletal site.

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines.

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.

Non-Pharmacological Interventions in Osteosarcopenia: A Systematic Review.

BACKGROUND: Osteosarcopenia is a geriatric syndrome defined by the concomitant presence of osteopenia/osteoporosis (loss of bone mineral density (BMD)) and sarcopenia (loss of muscle mass and/or function), which increases the risk of falls, fractures, and premature mortality. OBJECTIVE: To examine the efficacy of non-pharmacological (exercise and/or nutritional) interventions on musculoskeletal measures and outcomes in osteosarcopenic adults by reviewing findings from randomized controlled trials (RCTs). METHODS: This review was registered at PROSPERO (registration number: CRD42020179292) and conducted in accordance with the PRISMA guidelines. Electronic databases were searched for RCTs assessing the effect of at least one non-pharmacological intervention (any form of exercise and/or supplementation with protein, vitamin D, calcium or creatine) on any musculoskeletal measure/outcome of interest (BMD, bone strength/turnover, muscle mass and strength, physical performance, falls/fractures) in adults with osteosarcopenia as defined by any proposed criteria. RESULTS: Two RCTs (of n=106 older osteosarcopenic adults (≥65 years)) assessing the effects of progressive resistance training (RT) (via resistance bands or machines; 2-3 times/week; ~60 minutes in duration) were eligible for inclusion. The two RCTs demonstrated moderate quality evidence that RT increases muscle mass, strength, and quality, with changes in strength and quality occurring before muscle mass (12 vs 28 weeks). There was low quality evidence that RT increases lumbar spine BMD and maintains total hip BMD when performed for 12 and 18 months, respectively, and moderate quality evidence that RT has no effect on markers of bone turnover or physical performance. No major adverse effects were recorded in either of the RCTs. There were no eligible RCTs examining the impact of nutritional interventions. CONCLUSION: Chronic RT is safe and effective at potentiating gains in muscle mass, strength, and quality, and increasing or maintaining BMD in older osteosarcopenic adults. No RCT has examined the effects of protein, vitamin D, calcium, or creatine against a control/placebo in this high-risk population.

CNN-based framework using spatial dropping for enhanced interpretation of neural activity in motor imagery classification.

Interpretation of brain activity responses using motor imagery (MI) paradigms is vital for medical diagnosis and monitoring. Assessed by machine learning techniques, identification of imagined actions is hindered by substantial intra- and inter-subject variability. Here, we develop an architecture of Convolutional Neural Networks (CNN) with an enhanced interpretation of the spatial brain neural patterns that mainly contribute to the classification of MI tasks. Two methods of 2D-feature extraction from EEG data are contrasted: Power Spectral Density and Continuous Wavelet Transform. For preserving the spatial interpretation of extracting EEG patterns, we project the multi-channel data using a topographic interpolation. Besides, we include a spatial dropping algorithm to remove the learned weights that reflect the localities not engaged with the elicited brain response. We evaluate two labeled scenarios of MI tasks: bi-class and three-class. Obtained results in an MI database show that the thresholding strategy combined with Continuous Wavelet Transform improves the accuracy and enhances the interpretability of CNN architecture, showing that the highest contribution clusters over the sensorimotor cortex with a differentiated behavior of rhythms [Formula: see text] and [Formula: see text].

The Effect of ß-hydroxy-ß-methylbutyrate (HMB) on Sarcopenia and Functional Frailty in Older Persons: A Systematic Review.

BACKGROUND: Beta-hydroxy-beta-methylbutyrate (HMB) has been shown to be effective and superior to other types of protein supplements to attenuate loss of muscle mass, strength and function, however, its benefits in sarcopenic and frail older people remain unclear. OBJECTIVE: We seek to determine the effect of HMB on muscle mass, strength and function in older people with sarcopenia or frailty by reviewing results from available randomized controlled trials (RCTs). DESIGN: This review was registered at PROSPERO (University of York) with registration number CRD42018088462 and conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Using a pre-determined e-search strategy, we searched PubMed, Medline, EMBASE, CINAHL, LILACS, Web of Science, Cochrane and Scopus databases. Our inclusion criteria were RCTs that assessed the effect of HMB on muscle mass, strength and function in older people with sarcopenia and frailty aged ≥60 years. The main outcomes were lean body mass, handgrip, leg press strength, and Short Physical Performance Battery (SPPB) score. RESULTS: Three studies matched our eligibility criteria which enrolled 203 subjects through a variety of definitions of sarcopenia or frailty. Lean body mass increased and muscle strength and function were preserved following HMB supplementation. CONCLUSION: HMB improves lean muscle mass and preserves muscle strength and function in older people with sarcopenia or frailty.

Arthritis in adults, socioeconomic factors, and the moderating role of childhood maltreatment: cross-sectional data from the National Epidemiological Survey on Alcohol and Related Conditions.

These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history. INTRODUCTION: CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis. METHODS: Data were drawn from Wave 2 (2004-2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis. RESULTS: Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis. CONCLUSIONS: Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.

Utility of four sarcopenia criteria for the prediction of falls-related hospitalization in older Australian women.

Numerous sarcopenia definitions are not associated with increased falls-related hospitalization risk over 5 years to 9.5 years in older community-dwelling Australian women. Measures of muscle strength and physical function, but not appendicular lean mass (measured by dual-energy X-ray absorptiometry) may help discriminate the risk of falls-related hospitalization. INTRODUCTION: The aim of this prospective, population-based cohort study of 903 Caucasian-Australian women (mean age 79.9 ± 2.6 years) was to compare the clinical utility of four sarcopenia definitions for the prediction of falls-related hospitalization over 9.5 years. METHODS: The four definitions were the United States Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP), and modified FNIH (AUS-POPF) and EWGSOP (AUS-POPE) definitions using Australian population-specific cut points (< 2 SD below the mean of young healthy Australian women). Components of sarcopenia including muscle strength, physical function, and appendicular lean mass (ALM) were quantified using hand grip strength, timed-up-and-go (TUG), and dual-energy X-ray absorptiometry (DXA), respectively. Incident 9.5-year falls-related hospitalization were captured by linked data. RESULTS: Baseline prevalence of sarcopenia according to FNIH (9.4%), EWGSOP (24.1%), AUS-POPF (12.0%), and AUS-POPE (10.7%) differed substantially. Sarcopenia did not increase the relative hazard ratio (HR) for falls-related hospitalization before or after adjustment for age (aHR): FNIH aHR 1.00 95%CI (0.69-1.47), EWGSOP aHR 1.20 95%CI (0.93-1.54), AUS-POPF aHR 0.96 95%CI (0.68-1.35), and AUS-POPE aHR 1.33 95%CI (0.94-1.88). When examining individual components of sarcopenia, only muscle strength and physical function but not ALM (adjusted for height2 or BMI) were associated with falls-related hospitalization. CONCLUSION: Current definitions of sarcopenia were not associated with falls-related hospitalization risk in this cohort of community-dwelling older Australian women. Finally, measures of muscle strength and physical function, but not ALM (measured by DXA) may help discriminate the risk of falls-related hospitalization.

Establishing an Operational Definition of Sarcopenia in Australia and New Zealand: Delphi Method Based Consensus Statement.

BACKGROUND: Globally there are several operational definitions for sarcopenia, complicating clinical and research applications. OBJECTIVE: The objective of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Task Force on Diagnostic Criteria for Sarcopenia was to reach consensus on the operational definition of sarcopenia for regional use by clinicians and researchers. METHOD: A four-Phase modified Delphi process was undertaken in which 24 individuals with expertise or a recognised interest in sarcopenia from different fields across Australia and New Zealand were invited to be Task Force members. An initial face-to-face meeting was held in Adelaide, South Australia, in November 2017, followed by two subsequent online Phases conducted by electronic surveys. A final Phase was used to approve the final statements. Responses were analysed using a pre-specified strategy. The level of agreement required for consensus was 80%. RESULTS: In Phase 2, 94.1% of Task Force respondents voted in favour of adopting an existing operational definition of sarcopenia. In Phase 3, 94.4% of respondents voted in favour of adopting the European Working Group on Sarcopenia in Older People (EWGSOP) definition as the operational definition for sarcopenia in Australia and New Zealand. CONCLUSION: With consensus achieved, the ANZSSFR will adopt, promote and validate the EWGSOP operational definition of sarcopenia for use by clinicians and researchers in Australia and New Zealand.

Association between High Levels of Parathyroid Hormone and Frailty: The Nepean Osteoporosis and Frailty (NOF) Study.

BACKGROUND: Frailty is associated with poor outcomes hence identification of risks factors is pivotal. Since the independent role of parathyroid hormone (PTH) in frailty remains unexplored, we aimed to determine this in a population of older individuals with a history of falling. DESIGN: Cross-sectional study. SETTING: Falls and Fracture Clinic, Nepean Hospital (Penrith, Australia). PARTICIPANTS: 692 subjects (mean age=79, 65% women) assessed between 2009-2015. MEASUREMENTS: Assessment included clinical examination, mood, nutrition, grip strength, gait velocity, bone densitometry and posturography. Chemistry included serum PTH, calcium, vitamin D (25(OH)D3), creatinine and albumin. Normocalcemic subjects were divided into 4 groups: (1) Normal: 25(OH)D3 >50nmol/L and PTH between 1.6-6.8pmol/L; (2) PTH responsive: low 25(OH)D3 (<50nmol/L) and high PTH (>6.8pmol/L); (3) PTH unresponsive: low 25(OH)D3 and normal PTH; (4) Hyper PTH (>6.8pmol/L) with normal 25(OH)D3. Frailty was defined using Fried's criteria. Difference between the groups was assessed using one-way ANOVA and X2 analysis. Multinomial logistic regression evaluated the association between the groups and the number of Fried's criteria adjusted for age, BMI, renal function, 25(OH)D3 levels, and albumin. RESULTS: 22.6% subjects had high PTH levels (>6.8pmol/L). All subjects in the high PTH groups had significantly lower grip strength, gait velocity, limits of stability, and higher BMI. The PTH responsive group had a higher risk of pre-frailty (ß=3.8, 95% CI = 3.42 - 5.22, p≷ 0.01) and frailty (ß=8.26, 95% CI = 2.8-16.1, p<0.01). The risk of frailty was also higher in the Hyper PTH group (ß=2.3, 95% CI = 1.74-4.32, p<0.01). CONCLUSION: We have reported an independent association of high PTH levels with high number of falls and with the clinical components of physical frailty in community dwelling older persons. Our results suggest a possible role of PTH in frailty that deserves further exploration.

El humanismo en la formación del médico. Papel de la neurociencia y la sicología cognitiva / Humanism in the training of the doctor. Role of neuroscience and cognitive psychology

The objective of this article is to present a proposal for professional training consistent with the vocation of the doctor. From the cognitive psychology and the neuroscience the praxis of the humanism is approached, without trying to deepen but to give motivating ideas that allow to transform the medical education with educational innovations. The article includes 3 components, a clinical case, a new view from neuroscience and cognitive psychology, and a proposal that welcomes these innovations directly related to humanism, to transform education in the classrooms and in the various practices of medicine and Health Sciences

El objetivo del presente artículo es exponer una propuesta para la formación profesional consecuente con la vocación del médico. Desde la psicología cogni- tiva y la neurociencia se aborda la praxis del humanismo, sin pretender profun- dizar sino dar unas ideas motivadoras que permitan transformar la educación médica con innovaciones educativas. El artículo comprende 3 componentes, un caso clínico, una nueva mirada desde la neurociencia y la sicología cognitiva, y una propuesta que acoja estas innovaciones directamente relacionadas con el humanismo, para transformar la educación en las aulas y en las diversas prácticas de medicina y las ciencias de la salud

Association of hypovitaminosis D with triceps brachii muscle fatigability among older women: Findings from the EPIDOS cohort.

BACKGROUND: Vitamin D affects physical performance in older adults. Its effects on muscles, notably on muscle strength, remain unclear. The objective of this cross-sectional study was to determine whether hypovitaminosis D is associated with triceps brachii muscle fatigability in community-dwelling older women. METHODS: A randomized subset of 744 women aged ≥75years from the EPIDOS cohort was categorized into two groups according to triceps brachii muscle fatigability, defined as loss of strength >5% between two consecutive maximal isometric voluntary contractions. Hypovitaminosis D was defined using consensual threshold values (i.e., serum 25-hydroxyvitamin D concentration [25OHD] ≤10 ng/mL, ≤20 ng/mL, and ≤30 ng/mL). Age, body mass index, comorbidities, use psychoactive drugs, physical activity, first triceps strength measure, hyperparathyroidism, serum concentrations of calcium, albumin and creatinine, season and study centers were used as potential confounders. RESULTS: The prevalence of hypovitaminosis D ≤ 30 ng/mL was greater among women with muscle fatigability compared with the others (P = .009). There was no between-group difference using the other definitions of hypovitaminosis D. The serum 25OHD concentration was inversely associated with the between-test change in triceps strength (adjusted ß = -0.09 N, P = .04). Hypovitaminosis D ≤ 30 ng/mL was positively associated with triceps fatigability (adjusted OR = 3.15, P = .02). CONCLUSIONS: Vitamin D concentration was inversely associated with the ability to maintain strength over time in this cohort of community-dwelling older women. This is a relevant new orientation of research toward understanding the involvement of vitamin D in muscle function.

Osteosarcopenia: where bone, muscle, and fat collide.

As the world's population ages, the prevalence of chronic diseases increases. Sarcopenia and osteoporosis are two conditions that are associated with aging, with similar risk factors that include genetics, endocrine function, and mechanical factors. Additionally, bone and muscle closely interact with each other not only anatomically, but also chemically and metabolically. Fat infiltration, a phenomenon observed in age-related bone and muscle loss, is highly prevalent and more severe in sarcopenic and osteoporotic subjects. Clinically, when individuals suffer a combination of both disorders, negative outcomes such as falls, fractures, loss of function, frailty, and mortality increase, thus generating significant personal and socio-economic costs. Therefore, it is suggested that when bone mineral density loss is synchronic with decreased muscle mass, strength, and function, it should be interpreted as a single diagnosis of osteosarcopenia, which may be preventable and treatable. Simple interventions such as resistance training, adequate protein and calcium dietary intake, associated with maintenance of appropriate levels of vitamin D, have a dual positive effect on bone and muscle, reducing falls, fractures, and, consequently, disability. It is essential that fracture prevention approaches-including postfracture management-involve assessment and treatment of both osteoporosis and sarcopenia. This is of particular importance as in older persons the combination of osteopenia/osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. This review summarizes osteosarcopenia epidemiology, pathophysiology, diagnosis, outcomes, and management strategies.

The Effect of Physical Exercise on Frail Older Persons: A Systematic Review.

Physical exercise is one of the most effective non-pharmacological interventions aimed to improve mobility and independence in older persons. The effect of physical exercise and the most effective type of exercise in frail older persons remain undefined. This systematic review examines the effectiveness of physical exercise on frail older persons. Seven databases were search for randomized control trials which assessed the effect of exercise on participants who were identified as being frail using specific and validated criteria. Nine articles were reviewed from eight studies, from which seven used a validated definition of frailty. Based on the articles analyzed in our systematic review, the evidence suggests that exercise has a positive effect on various measures used to determine frailty including cognition, physical functioning, and psychological wellbeing. Some studies revealed that exercise may prevent or delay the onset of frailty which can enhance quality of life in older adults. Despite the evidence for exercise interventions in frail older adults, it appears that there is no clear guidance regarding the most effective program variables. The reviewed studies were generally long in duration (≥6 months) with sessions lasting around 60 minutes performed three or more times per week, including multicomponent exercises. In conclusion, although exercise interventions appear to be effective in managing the various components of frailty and preventing/delaying the onset of frailty, the most effective exercise program in this population remains unidentified.