Metabolic syndrome reduces spinal range of motion: The Yakumo study.

BACKGROUND: Excess visceral fat can accumulate owing to lack of exercise. The relationship between metabolic syndrome (MetS) and spinal range of motion (ROM) is not clear. The purpose of this study was to investigate the relationship between MetS and spinal alignment and ROM. METHODS: Orthopedic evaluation was prospectively performed in 544 participants. The participants were classified into two groups on the basis of the Japanese-specific MetS criteria proposed by the Japanese Committee of the Criteria for MetS (JCCMS). Lower back pain (LBP), knee joint pain with the visual analog scale (VAS), Kellgren-Lawrence (K-L) grade for knee osteoarthritis, body mass index (BMI), and spinal alignment and ROM were evaluated. RESULTS: Forty-four (8.1%) were diagnosed as having MetS. The prevalence rate of K-L grade 4 in the MetS group was significantly higher than that in the non-MetS group (p < 0.05). When sex, age, and BMI were evaluated as covariates, there were significant differences in the VAS score for knee pain (non-MetS group vs MetS group: 13.7 vs 23.3, p < 0.05), L1-S1 flexion spinal ROM (44.1° vs 38.1°, p < 0.001), flexion spinal inclination angle (SIA) ROM (107.6° vs 99.3°, p < 0.01), and SIA ROM (135.4° vs 124.0°, p < 0.05). CONCLUSIONS: Knee pain increased and flexion spinal ROM decreased significantly in the MetS group as compared with non-MetS group. Systemic factors associated with MetS may have a specific impact on spinal ROM while promoting knee osteoarthrosis and increased knee pain.

A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms.

BACKGROUND: Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. METHODS: A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. RESULTS: The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. CONCLUSIONS: The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. LEVEL OF EVIDENCE: II, prospective cohort study.

CTGF/CCN2 facilitates LRP4-mediated formation of the embryonic neuromuscular junction.

At the neuromuscular junction (NMJ), lipoprotein-related receptor 4 (LRP4) mediates agrin-induced MuSK phosphorylation that leads to clustering of acetylcholine receptors (AChRs) in the postsynaptic region of the skeletal muscle. Additionally, the ectodomain of LRP4 is necessary for differentiation of the presynaptic nerve terminal. However, the molecules regulating LRP4 have not been fully elucidated yet. Here, we show that the CT domain of connective tissue growth factor (CTGF/CCN2) directly binds to the third beta-propeller domain of LRP4. CTGF/CCN2 enhances the binding of LRP4 to MuSK and facilitates the localization of LRP4 on the plasma membrane. CTGF/CCN2 enhances agrin-induced MuSK phosphorylation and AChR clustering in cultured myotubes. Ctgf-deficient mouse embryos (Ctgf-/- ) have small AChR clusters and abnormal dispersion of synaptic vesicles along the motor axon. Ultrastructurally, the presynaptic nerve terminals have reduced numbers of active zones and mitochondria. Functionally, Ctgf-/- embryos exhibit impaired NMJ signal transmission. These results indicate that CTGF/CCN2 interacts with LRP4 to facilitate clustering of AChRs at the motor endplate and the maturation of the nerve terminal.

Differences in the prevalence of locomotive syndrome and osteoporosis in Japanese urban and rural regions: The Kashiwara and Yakumo studies.

OBJECTIVES: To clarify whether the prevalence of locomotive syndrome (LS) and osteoporosis differed according to region, gender, and physical functions in Japan. METHODS: Data were collected in Kashiwara City (urban region) and Yakumo Town (rural region). Totally, 208 participants from the urban region and 782 participants from the rural region were included in this study. LS was assessed using the 25-item Geriatric Locomotive Function Scale and osteoporosis was assessed using a quantitative ultrasound. Physical functions were measured using grip strength and the 3-m timed up-and-go test. Differences between urban and rural regions were investigated using standardized incidence ratio and multivariate analysis. RESULTS: The prevalence of LS and osteoporosis was 24.5% and 42.8% in the urban region and 10.9% and 28.8% in the rural region, respectively. The standardized incidence ratio of the urban region versus the rural region was 1.80 (95% confidence intervals [CI] = 1.35-2.39) for LS and 1.21 (95% CI = 1.32-2.43) for osteoporosis, showing that the prevalence of LS was significantly higher in the urban region. Multivariate analysis indicated that LS was significantly associated with the urban sample and timed up-and-go was significantly longer in the urban sample. CONCLUSION: Regional differences may be considered when evaluating LS in health checkups. Understanding the results of this study may help reduce LS prevalence.

Predictors for quality of life improvement after surgery for degenerative cervical myelopathy: a prospective multi-center study.

BACKGROUND: Degenerative cervical myelopathy (DCM) can significantly impair a patient's quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. METHODS: This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. RESULTS: The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P < 0.001, P < 0.001, and P < 0.001, respectively). Univariable analysis revealed that preoperative EQ-5D and C-JOA scores were significantly associated with increased EQ-5D scores from preoperative assessment to 1 year after surgery (P < 0.0001 and P = 0.045). Multivariable regression analysis showed that the independent preoperative predictors of change in QOL were lumbar lordosis (LL), sacral slope (SS), and T1 pelvic angle (TPA). According to the prediction model, the increased EQ-5D score from preoperatively to 1 year after surgery = 0.308 - 0.493 × EQ-5D + 0.006 × LL - 0.008 × SS + 0.004 × TPA. CONCLUSIONS: Preoperative LL, SS, and TPA significantly impacted the QOL of patients who underwent surgery for DCM. Less improvement in QOL after surgery was achieved in patients with smaller LL and TPA and larger SS values. Patients with these risk factors may therefore require additional support to experience adequate improvement in QOL.

Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis.

PURPOSE: Tandem spinal stenosis (TSS) refers to coexisting lumbar and cervical canal stenosis. Evidence regarding whether cervical decompression improves lumbar symptoms in TSS is insufficient. Therefore, we determined the effectiveness of cervical decompression surgery for patients with lumbar spinal stenosis (LSS) and cervical spinal stenosis. METHODS: The records of 64 patients with TSS experiencing lumbar symptoms who underwent cervical decompression surgery between April 2013 and July 2017 at a single institution were retrospectively reviewed. We categorized patients into the Non-improved (n = 20), Relapsed (n = 30), and Maintained-improvement (n = 14) groups according to the presence or absence of improvement and relapse in lower limb symptoms in TSS following cervical decompression surgeries. RESULTS: Of 64 patients, 44 (69%) showed improved lower limb or low back symptoms, with 14 (22%) patients maintaining improvement. The preoperative cervical myelopathy-Japanese Orthopedic Association score and the preoperative number of steps determined using the 10-s step test were significantly lower in the Non-improved group than in the Maintained-improvement group. Receiver operating characteristic curve of preoperative 10-s step test results revealed 12 steps as a predictor for maintained improvement. CONCLUSION: The improvement of LSS symptoms following cervical decompression surgeries may be associated with the severity of cervical myelopathy as determined in clinical findings rather than in imaging findings. Patients with TSS having a 10-s step test result of < 12 steps were more likely to experience a relapse of lower limb symptoms following cervical decompression surgeries.

Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy.

BACKGROUND: Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. We aimed to identify clinical and radiological predictors associated with neurological recovery after ADF. METHODS: This post-hoc analysis from a prospective multicenter study included patients who were scheduled for ADF for DCM. The patients who received other surgeries (laminoplasty, posterior decompression and fusion) were excluded. The associations between baseline clinical and radiographic variables (age, sex, body mass index, etiology, cervical lordosis, range of motion, C7 slope, C2-7 sagittal vertical axis [SVA], thoracic kyphosis [TK], lumbar lordosis, sacral slope, SVA, pelvic tilt, T1 pelvic angle [TPA], the Japanese Orthopedic Association score for the assessment of cervical myelopathy [C-JOA], European Quality of Life Five Dimensions Scale [EQ-5D], Neck Disability Index [NDI], Physical Component Summary of the SF-36 [PCS], and Mental Component Summary of the SF-36) and the recovery rates as the outcome variables were investigated in the univariate regression analysis. Then, the independent predictors for increased recovery rates were evaluated using a stepwise multiple regression analysis. RESULTS: In total, 37 patients completed the 1 year follow-up. The recovery rate was significantly correlated with SVA (p = 0.001) and TPA (p = 0.03). Univariate regression analyses showed that age (Regression coefficient = - 0.92, p = 0.049), SVA (Regression coefficient  = - 0.57, p = 0.004) and PCS (Regression coefficient = 0.80, p = 0.03) score were significantly associated with recovery rate. Then, a stepwise multiple regression analysis identified the independent predictors of recovery rate after ADF as TK (p = 0.01), PCS (p = 0.03), and SVA (p = 0.03). According to this prediction model, the following equation was obtained: recovery rate = - 8.26 + 1.17 × (TK) - 0.45 × (SVA) + 0.85 × (PCS) (p = 0.002, R2 = 0.44). CONCLUSION: Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, patients with DCM and these predictors who undergo ADF should be warned about poor recovery and be required to provide adequate informed consent.

The 5-question Geriatric Locomotive Function Scale predicts postoperative fall risk in patients undergoing surgery for degenerative cervical myelopathy.

BACKGROUND: Falling is one of the main reasons for which older adults require nursing care. Locomotive syndrome (LS) predicts the need for nursing care; however, the relationship between falling and LS remains unclarified. This study aimed to determine whether the 5-question Geriatric Locomotive Function Scale (GLFS-5) predicts postoperative fall risk in patients with degenerative cervical myelopathy (DCM). METHODS: This study is a post hoc analysis of the data from a prospective cohort of patients undergoing surgery for DCM. Participants recorded their falls in a fall diary from the time of study enrollment (baseline) to 1 year postoperatively. Functional assessments were conducted at baseline, hospital admission for surgery, and 1 year postoperatively. Outcome measures included the GLFS-5, Japanese Orthopaedic Association score, Neck Disability Index, EuroQol 5 Dimensions, and 12-Item Short Form Health Survey. Risk factors for falls were investigated, including previous falls, number of medications, and grip strength. Fallers were divided into two categories: all fallers (≥1 falls), and recurrent fallers (≥2 falls). Variables that were significant in univariate analyses were applied in multiple logistic regression models to adjust for confounders. RESULTS: From the initial group of 168 participants, 159 attended the 1-year follow-up, and 132 fall diaries were retrieved and analyzed. Of these 132 patients, 42 (32%) reported at least one fall, while 25 (19%) reported recurrent falls during the postoperative observation period. The GLFS-5 significantly increased from baseline to admission, and significantly decreased from admission to 1 year postoperatively. In multiple logistic regression analysis, the independent predictors of postoperative recurrent falls were previous falls and a higher baseline GLFS-5. The optimal cut-off value of GLFS-5 for predicting all falls/recurrent falls was 12. CONCLUSIONS: The GLFS-5 reflected time-dependent functional changes in patients undergoing surgery for DCM. Previous falls and a higher baseline GLFS-5 were independent predictors of postoperative recurrent falls.

Overcoming locomotive syndrome: The Yakumo Study.

OBJECTIVES: Improvement of life expectancy is increasingly important with the aging of society. The aim of the study was to compare physical performance in elderly people in two 3-year periods (2001-2003) and (2016-2018). METHODS: The participants were healthy Japanese elderly adults who attended public health check-ups in Yakumo. Results for 10 m gait time, two-step test, back muscle strength, and grip strength were examined prospectively for participants in 2001-2003 (Group A: n = 488) and 2016-2018 (Group B: n = 309) by gender and age (65-74 and 75-84 years). RESULTS: There were significant differences between Groups A and B for 10 m gait time (age 65-74: male: 5.6 vs. 5.2 s, female: 6.3 vs. 5.5 s; age 75-84: male: 6.1 vs. 5.5 s, female: 6.7 vs. 5.8 s; all p < .05) and two-step test (age 65-74: male: 1.41 vs. 1.48, female: 1.35 vs. 1.44; age 75-84: male: 1.32 vs. 1.41, female: 1.30 vs. 1.38; all p < .05), but not for back muscle strength or grip strength. CONCLUSION: Our results suggest a phenomenon of 'overcoming locomotive syndrome', in which physical performance changed by aging, including motor functions such as 10 m gait time and two-step test, has improved in the current population compared with a similar population from 15 years ago.

Risk Factors for Neuropathic Pain in Middle-Aged and Elderly People: A Five-Year Longitudinal Cohort in the Yakumo Study.

OBJECTIVE: To determine the risk factors for new neuropathic pain (NeP) after five years in healthy middle-aged and elderly volunteers. DESIGN: Prospective longitudinal cohort study (Yakumo study). SETTING: Clinical evaluation in a health checkup. SUBJECTS: A total of 366 people (male N = 146, female N = 220, average age = 63.5 years) who did not have NeP in 2013 were examined. METHODS: NeP was diagnosed based on a painDETECT questionnaire score ≥13. Body mass index (BMI), comorbidity, low back pain (LBP), sciatica, physical ability, grip and back muscle strength, osteoporosis, sarcopenia, frailty, spinal alignment, and quality of life (QOL) with the SF36 in 2013 were compared between NeP(+) and NeP(-) subjects in 2018 using multivariate logistic regression analysis. RESULTS: The NeP(+) rate in 2018 was 5.2%, with no significant differences in age and gender. NeP(+) subjects had significantly lower BMI, severe sciatica, poor gait ability, higher rates of osteoporosis and sarcopenia, greater lumbar kyphosis and spinal inclination, and poorer mental health in 2013. Poor gait ability (odds ratio [OR] = 8.05), low BMI (OR = 2.31), lumbar kyphosis (OR = 1.38), low percentage of the young adult mean (OR = 1.15), and low mental QOL (OR = 1.06) were identified as significant and independent risk factors for new NeP after five years. CONCLUSIONS: This longitudinal cohort study identified five independent risk factors for development of new NeP after five years, with related factors of spinal inclination, sarcopenia, and sciatica. New NeP may be prevented by intervention or treatment of these factors at an early stage in relatively healthy middle-aged and elderly people.

Age-related changes in upper and lower cervical alignment and range of motion: normative data of 600 asymptomatic individuals.

PURPOSE: To identify age-related changes and the relationship between upper and lower cervical sagittal alignment and the range of motion (ROM). METHODS: A total of 600 asymptomatic volunteers were enrolled. There were 50 males and 50 females in each decade of life between the third and the eighth. The O-C2 angle and the C2-7 angle were measured using the neutral radiographs of the cervical spine. ROM was assessed by measuring the difference in alignment in the neutral, flexion, and extension positions. RESULTS: The mean O-C2 angle in the neutral position was 14.0° lordotic. The mean ROM of the O-C2 angle was 23.1°. The mean C2-7 angle in the neutral position was 14.3° lordotic. The mean ROM of the C2-7 angle was 56.0°. The O-C2 angle was 16.1° in the third decade and gradually decreased to 11.4° in the eighth decade. There were no significant age-related changes in the ROM of the O-C2 angle. The C2-7 angle was 7.2° in the third decade and gradually increased to 20.8° in the eighth decade, and the ROM gradually decreased with increasing age. Significant negative correlation was observed between O-C2 angle and C2-7 angle. CONCLUSION: The O-C2 angle gradually decreased and the C2-7 angle increased with age. The ROM of the O-C2 angle did not change, but the ROM of the C2-7 angle decreased with age. The upper and lower cervical spine showed different age-related changes.

Impact of pelvic incidence on lumbar osteophyte formation and disc degeneration in middle-aged and elderly people in a prospective cross-sectional cohort.

PURPOSE: Pelvic incidence (PI) is unique to each individual and does not change throughout life. High PI is related to lumbar spondylolisthesis, but associations of PI with lumbar osteophyte formation and disc degeneration are unclear. The objective was to evaluate relationships of PI with lumbar osteophyte formation and disc degeneration, as well as spinal sagittal alignment and geriatric diseases, in middle-aged and elderly people. METHODS: A total of 1002 volunteers (male: 434, female: 568, average age: 63.5) were prospectively examined for lumbar osteophyte formation (Nathan class ≥ 2) and disc degeneration (disc score ≥ 3). High (PI > 51, n = 501) and low (PI ≤ 51, n = 501) PI groups were defined. Clinical factors, frailty, sarcopenia, and physical quality of life (QOL) were compared between these groups, and risk factors for lumbar osteophyte formation and disc degeneration were identified in multivariate logistic regression analysis. RESULTS: Physical QOL was poorer in people with lumbar osteophyte formation (54.8%) and disc degeneration (33.6%). Age, male gender, spinal parameters including PI, bone mineral density, back muscle strength, and gait ability differed significantly between the groups, whereas frailty and sarcopenia were not significantly different. Low PI, low lumbar lordosis, elder age, male gender, high BMI, and weak back muscle strength were significant risk factors for lumbar osteophyte formation and disc degeneration. CONCLUSIONS: Low PI was identified as a risk factor for lumbar osteophyte formation and disc degeneration, both of which reduce physical QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.

Relationship between lumbopelvic discordance and locomotive syndrome in a middle-aged community-living population: The Yakumo study.

BACKGROUND: Locomotive syndrome (LS) affects the quality and activities of daily living. Although spinal sagittal balance influences LS, no report elucidated the relationship between LS risk and lumbopelvic discordance. This study aimed to investigate the relationship between lumbopelvic discordance and LS in a middle-aged community. METHODS: The subjects (n = 135) were divided into three groups based on the LS risk stage, which was evaluated through spinopelvic sagittal alignment and lumbopelvic mismatch prevalence (Pelvic incidence-Lumbar lordosis >10°:PI-LL mismatch).Then, the subjects were divided into two groups (lumbopelvic matched and mismatched groups) and analyzed based on the demographic data, physical test, stabilometry, and body pain using the visual analog scale. RESULTS: There were 76, 37 and 22 subjects in stages 0, 1, and 2, respectively. The pelvic incidence-lumbar lordosis (PI-LL) mismatched group had a higher prevalence in LS risk stage 2 than in LS risk stage 0. The prevalence of PI-LL mismatch was significantly different among the groups. Post hoc test revealed the differences in spinopelvic alignment among the stages. In each LS risk stage, the degree of PI-LL was significantly higher in stage 2 than that in stages 0 and 1. On comparing the PI-LL matched (n = 67) and mismatched groups (n = 68) with a stabilometer, the envelopment area tracing by the movement of the center of pressure and locus length/second was greater in the PI-LL mismatched group than that in the PI-LL matched group with/without eyes opened. CONCLUSIONS: The prevalence of LS risk stage 2 was more frequently observed in the PI-LL mismatched group. The degree of PI-LL was evaluated through the LS risk stages. Physical dysfunction in the PI-LL mismatched group was related to trunk imbalance based on stabilometry. These findings will help manage LS and PI-LL mismatched subjects.

Differences of locomotive syndrome and frailty in community-dwelling middle-aged and elderly people: Pain, osteoarthritis, spinal alignment, body balance, and quality of life.

Purpose: To identify differences between locomotive syndrome (LS) and frailty.Methods: A total of 1016 subjects (males 427, females 589, mean age 64 years) were prospectively examined in the Yakumo study. LS was defined as ≥16 on the GLFS-25 questionnaire. Frailty was diagnosed as ≥3 of unintentional weight loss, grip strength weakness, low walking speed, exhaustion, and low physical activity.Results: LS (14.4%) and frailty (10.8%) were more significant in older, female subjects with weaker muscle strength, lower gait speed, severer pain, poorer spinal alignment, and poor quality of life (QOL). LS strongly reflected musculoskeletal and neuropathic pain, knee and lumbar degeneration with poor spinal alignment, and poorer body balance, whereas frailty reflected muscle weakness. In multivariate analysis adjusted for age and gender, the significant independent risk factors were LS (odds ratio (OR) 10.6), frailty (OR 3.6), pain (OR 1.02) for poor physical QOL, and LS (OR 4.4) and lower gait speed (OR 1.6) for poor mental QOL.Conclusion: LS is more strongly related to musculoskeletal factors and may be more important than frailty for poor physical and mental QOL. LS should be checked early especially in independent elderly people to maintain activities of daily living and QOL.

Impact of comorbidity rates of lumbar spondylosis, knee osteoarthritis, and osteoporosis on physical QOL and risk factors for poor physical QOL in middle-aged and elderly people.

Purpose: To examine effects of combined osteoporosis (P), knee osteoarthritis (K-OA), and lumbar spondylosis (L-OA) on quality of life (QOL), and identify risk factors for poor QOL.Methods: 1021 subjects (440 males, 581 females, mean age: 63.4 years) were prospectively included. Osteoporosis (%YAM ≤70%), K-OA (Kellgren-Lawrence grade ≥2), and L-OA (Nathan class ≥3) were defined. Subjects were divided into groups 0 to 3 based on the number of comorbid diseases, and into groups P, K, and L (one disease), PK, PL, and KL (two diseases), and PKL (three diseases). Clinical variables and QOL were compared, and risk factor analysis was conducted.Results: BMI, muscle strength, pain, and spinal inclination significantly increased and physical QOL worsened with more comorbidities. Though age did not differ among disease groups, BMI was significantly higher in groups K and L than in group P. Groups including subjects with L-OA had significantly lower lumbar lordosis and larger spinal inclination. In multivariate logistic regression analysis adjusted for age and gender, group KL, spinal inclination, gait speed, grip strength, and pain were risk factors for poor physical QOL.Conclusion: Increased comorbidity has a negative impact on physical QOL, and six risk factors for poor physical QOL were identified.

Weakness of grip strength reflects future locomotive syndrome and progression of locomotive risk stage: A 10-year longitudinal cohort study.

Objectives: Grip strength is a simple indicator of physical function. The goal of this retrospective study was to examine whether grip strength reflects locomotive syndrome and locomotive risk stage 10 years later.Methods: The participants were 88 Japanese adults aged >40 years who attended a health check-up in 2006. Relationships of baseline grip strength with physical performance and locomotive risk stage after 10 years were assessed in males and females.Results: The 88 subjects (31 males, 57 females; average age 61.6 in 2006) were followed for 10 years. Grip strength in 2006 had significant positive correlations with grip strength and back muscle strength, and negative correlations with 10 m-gait time and 3m Timed Up and Go (3m-TUG) test after 10 years (p < .05). Subjects with higher and lower grip strength in 2006 did not differ significantly in age, but had significant differences in physical performance, GLFS-25 (25-question Geriatric Locomotive Function Scale) scores and locomotive risk stage after 10 years (p < .05). Same result was also obtained in the examination by gender.Conclusion: Weak grip strength was significantly related to future physical status, and these findings were unaffected by age. Weak grip strength could be a risk factor for future locomotive syndrome and locomotive risk in community-dwelling people.

Declining neck circumference is an anthropometric marker related to frailty in middle-aged and elderly women.

Objectives: Neck circumference (NC) has been associated with cardiovascular disease and metabolic syndrome. However, the association between NC and frailty remains unknown. We aimed to determine the relationship between frailty and NC in middle-aged and elderly women.Methods: Frailty was diagnosed based on the Japanese version of the Cardiovascular Health Study criteria. Of women who underwent health checkup, 295 women with the following measurements were targeted: four trunk circumferences and appendicular skeletal muscle index (aSMI) measured using bioelectrical impedance analysis; albumin, total cholesterol, triglycerides, and C-reactive protein levels measured using a blood test; and physical function measured using back muscle strength and timed up-and-go test (TUG). Normal and frailty group comparisons were conducted using a statistical method.Results: Significant differences were observed between the two groups in terms of age, body mass index, all trunk circumferences, aSMI, back muscle strength, and TUG. Logistic regression analysis showed that NC was more related with frailty among the four trunk circumferences. In multiple regression analysis, declining NC was significantly associated with frailty.Conclusion: In middle-aged and elderly women, NC has a significant association with frailty. Declining NC was shown to be an anthropometric marker of frailty, and may be a frailty risk factor.

Shoulder pain has most impact on poor quality of life among various types of musculoskeletal pain in middle-aged and elderly people: Yakumo study.

Objectives: To investigate the severity and effect on quality of life (QOL) of various types of pain in healthy volunteers.Methods: A total of 384 subjects (male: 158, female: 226, average age: 63 years) were included in a prospective cohort study (Yakumo study). Shoulder pain, low back pain (LBP), sciatica, knee pain, and the American Shoulder and Elbow Surgeons (ASES) shoulder score were evaluated with SF-36.Results: The prevalence of shoulder pain, LBP, sciatica, and knee pain was 42%, 44%, 16%, and 48%, respectively, with similar severities of pain. Shoulder pain visual analogue scale (VAS) and ASES shoulder scores were significantly correlated with SF-36 domains. Subjects with poor physical QOL had significantly higher VAS scores for all pain types and a lower ASES shoulder score. Shoulder pain VAS was also significantly related to poor mental QOL. Multivariate regression analysis adjusted for age and gender showed that shoulder pain VAS (OR: 1.25, p < .05) and 10-m gait speed (OR: 1.82, p < .05) were significant independent risk factors for poor physical QOL.Conclusion: Only shoulder pain of similar severity to other pain and shoulder complaints impacted on both physical and mental QOL. The severity of shoulder pain was an independent risk factor for poor physical QOL.

Epidemiology and effect on physical function of osteosarcopenia in community-dwelling elderly people in Japan.

Objective: To determine the prevalence of osteosarcopenia and its relationship with physical function in elderly people in Japan.Methods: The subjects were 427 healthy volunteers over 65 years old (205 males, 222 females, average age 71.4 years) who attended health checkups in 2016 and 2017. Body mass index (BMI), bone mineral density in the calcaneus (%YAM), physical parameters, and skeletal muscle mass were measured. The appendicular skeletal muscle index (aSMI) was calculated as arm and leg skeletal muscle mass/height2. Osteoporosis was defined as %YAM < 70%, sarcopenia as aSMI < 7.0 kg/m2 (males) and <5.8 kg/m2 (females), and osteosarcopenia as the presence of sarcopenia and osteoporosis.Results: Osteoporosis alone was diagnosed in 60 subjects (14%), sarcopenia alone in 55 (13%), and osteosarcopenia in 36 (8%). The prevalence of osteosarcopenia was 8% in all subjects, 12% in females, and 4% in males. BMI and back muscle strength were significantly lower in osteosarcopenia than in sarcopenia alone (p < .05); and weight, BMI, body fat, grip strength, and back muscle strength were significantly lower in osteosarcopenia than in osteoporosis alone (p < .05).Conclusion: Osteosarcopenia was significantly associated with muscle weakness. Further studies to identify other related factors are needed for prevention and treatment of osteosarcopenia.

Reduction in body cell mass as a predictor of osteoporosis: A cross-sectional study.

Objectives: Improvement of nutritional status, which may help prevent osteoporosis, can be assessed using the body cell mass (BCM) index, measured by the bioelectrical impedance analysis (BIA). However, the relationship between BCM and osteoporosis is not clear. This cross-sectional study investigated the association between osteoporosis and four components of body composition, including BCM.Methods: The study included 600 participants who underwent measurements of bone status by quantitative ultrasound and body composition by BIA at an annual health check-up. Normal and osteoporosis groups were compared.Results: There were 414 and 186 participants in the normal and osteoporosis groups, respectively. Significant differences between the two groups were observed in age, sex, height, weight, BCM, extracellular water (ECW) content, and minerals, even after adjusting for age and sex. In logistic regression analysis, BCM, age, and ECW were significant risk factors for osteoporosis. Furthermore, BCM and ECW in males and BCM and age in females were significant risk factors for osteoporosis.Conclusion: Of the four body composition components measured with BIA, reduction in BCM most reflected osteoporosis. BCM was a significant risk factor in both sexes for osteoporosis. BCM can be easily measured, and may be useful in the prevention and treatment of osteoporosis.