Table 1.

Assessment, prevalence, and impact of osteosarcopenia on clinical outcomes in community-dwelling older adults.

Author, Year, Country	Design, Setting	Age Sample Size Male/Female, n (%)	Measurements	Diagnosis	Prevalence	Outcomes	Main Results
Wang, Y.J. et al. 2015 [23] China	Cross-sectional study, Community-dwelling	Men: 75.6 ± 4.8 Women: 74.9 ± 5.2 316 164(51.9)/152(41.8)	Muscle mass: BIA Muscle strength: grip strength BMD: DXA	Sarcopenia: AWGS Osteoporosis: WHO criteria	Men: 10.4% Women: 15.1%	Frailty (Frailty Phenotype)	≥80 years old (OR 4.8; 95% CI, 3.05–10.76), women (OR 2.6; 95% CI, 1.18–2.76), and higher level of comorbidity (OR 3.71; 95% CI) were independently associated with the likelihood of being osteosarcopenia. The likelihood of being frail/prefrail was substantially higher in the presence of osteosarcopenia (OR 4.16; 95% CI, 2.17–17.65 in men; and OR 4.67; 95% CI, 2.42–18.86 in women).
Huo YR et al. 2015 [24] Australia	Cross-sectional study, Patients referred to the Falls and Fractures Clinic	Mean 79 N = 679 224(35)/455(65)	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: EWGSOP Osteopenia, osteoporosis: WHO criteria	37%	Depression Nutritional status Comorbidity History of trauma fracture Mobility	Osteosarcopenia patients are older, mostly women, are at high risk for depression and malnutrition, have BMI < 25, and showed a higher prevalence of peptic disease, inflammatory arthritis, maternal hip fracture, history of a traumatic fracture, and impaired mobility.
Drey M et al. 2016 [25] Germany	Cross-sectional study, Community-dwelling	Osteosarcopenia: 78 ± 7.5 Sarcopenia: 76 ± 6.1 Osteopenia/osteoporosis: 81 ± 5.0 Control: 74 ± 6.4 N = 68 Osteosarcopenia: 32%/68% Sarcopenia: 29%/71% Osteopenia/osteoporosis: 29%/71% Control: 33%/67%	Muscle mass: DXA BMD: DXA	The 50th percentile of each sex Sarcopenia: aLM Female: <6.398 kg/m2 Male: <7.367 kg/m2 Osteopenia/osteoporosis T-score Female: <−0.6, Male: <−0.9	27.9%	Physical performance Bone turnover	Only osteosarcopenia showed significantly reduced hand grip strength, increased chair rising time, and sit to stand power time as well as significantly increased bone turnover markers.
Szlejf C et al. 2017 [22] Mexico	Cross-sectional study (of a prospective cohort), Community-dwelling	Mean 71.3 ± 9.5 N = 427 (all women)	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: FNIH criteria Osteopenia, osteoporosis: WHO criteria Obesity: WHO criteria (>35% body fat < 60 years, >40% body fat ≥ 60 years)	Osteosarcopenic obesity 19% (N = 81)	SPPB Frailty (Frailty Phenotype, GFST, the FRAIL scale)	Frailty (according to the Frailty Phenotype and the GFST) and poor physical performance measured by the SPPB were independently associated with osteosarcopenic obesity, controlled by age.
Suriyaarachchi P et al. 2018 [26] Australia	Cross-sectional study, Patients referred to the Falls and Fractures Clinic	Mean 79 N = 400	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: EWGSOP Osteopenia, osteoporosis: WHO criteria	40%	Serum PTH	Subjects with high PTH levels were more likely to be in the osteosarcopenia than in the non-sarcopenic or non-osteopenic (OR 6.88; CI: 1.9–9.2).
Susan Park et al. 2018 [27] Korea	Cross-sectional study, Community-dwelling	Mean 62.34 ± 0.31 N = 1344 (all women)	Muscle mass: DXA BMD: DXA	Sarcopenia: ASM less than 1 SD below the average of women aged 20–40 years Osteopenia, osteoporosis: WHO criteria Obesity: BMI >25 kg/m2	Osteosarcopenia: 314 (24.1%) Osteosarcopenic obesity: 455 (31.8%)	Dietary inflammatory index scores	Women with higher dietary inflammatory index scores were more likely to have risk of osteopenic obesity (OR = 2.757, 95% CI: 1.398–5.438, p < 0.01) and that of osteosarcopenic obesity (OR = 2.186, 95% CI: 1.182–4.044, p < 0.05).
Scott D et al. 2019 [28] Australia	Observational study, Community-dwelling	Mean 76.7 ± 5.4 N = 1575 (all men)	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: EWGSOP Osteopenia, osteoporosis: WHO criteria Obesity: BMI >25 kg/m2	8%	Incident fractures (6 ± 2 years) Incident falls (for 2 years)	Only men with osteosarcopenia had significantly increased fall (RR 1.41; 95% CI: 1.02 to 1.95) and fracture risk (HR: 1.87; 95% CI: 1.07 to 3.26) compared with men with neither osteopenia/osteoporosis nor sarcopenia.
Poggiogalle E et al. 2019 [29] USA	Cross-sectional study, Community-dwelling	Mean 92 ± 2 year N = 87 37(42.5)/50(57.5)	Muscle mass: DXA BMD: DXA	Sarcopenia: low ALM Osteopenia, osteoporosis: WHO criteria	31%	IGF-1	In osteosarcopenic men, IGF1-SDS values were lower than those in control males whereas IGF1-SDS were similar in the other body compositions phenotypes in female.
Balogun S. et al. 2019 [30] Australia	Prospective study, Community-dwelling	Mean 62.9 ± 7.4 N = 1032	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: in the lowest 20% of the sex-specific distribution for ALM/BMI or grip strength Osteopenia, Osteoporosis: WHO criteria	8.3%	Mortality over 10 years Fractures over 10 years	Mortality risk was significantly higher only in participants with osteosarcopenia (RR = 1.49, 95% CI: 1.01–2.21) compared to without sarcopenia or osteopenia. Osteosarcopenia and osteodynapenia did not lead to a significantly greater fracture or mortality risk compared to having these conditions on their own.
Kobayashi K. et al. 2019 [31] Japan	Cross-sectional study, Community-dwelling	Mean 71.4 years N = 427 205(48.0)/222(52.0)	Muscle mass: DXA BMD: DXA	Sarcopenia: AWGS Osteoporosis: JOS-criteria	All subjects: 8% Females: 12% Males: 4%	Physical function	BMI and back muscle strength were significantly lower in osteosarcopenia than in sarcopenia alone (p < 0.05); and weight, BMI, body fat, grip strength, and back muscle strength were significantly lower in osteosarcopenia than in osteoporosis alone (p < 0.05).
Fahimfar N et al. et al. 2020 [32] Iran	Cross-sectional study, Community-dwelling	Osteosarcopenia: Mean 71.2 Non: Mean 68.3 N = 2353 1148(48.8)/1205(51.2)	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: AWGS Osteopenia, osteoporosis: WHO criteria	Men: 33.8% Women: 33.9%	Risk factor of cardiovascular diseases	BMI (PR 0.84, 95% CI 0.81–0.88 in men and 0.77, 95% CI 0.74–0.80 in women), high-fat mass was positively associated with osteosarcopenia [PR 1.46 (95% CI 1.11–1.92) in men, and 2.25 (95% CI 1.71–2.95) in women], Physical activity in men (PR = 0.64, 95% CI 0.46, 0.88), diabetes in men (PR 1.33, 95% CI 1.04–1.69) was showed a direct association with osteosarcopenia.
Okamura H et al. 2020 [8] Japan	Cross-sectional study, Regularly visited University Hospital	Mean 77.07 N = 276	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: AWGS Osteoporosis: JOS-criteria	19.6%	Frailty (Frailty Phenotype) Risk factors	Osteosarcopenia group had a greater risk of frailty than did those in the osteoporosis alone (OR 2.33; 95% CI, 1.13– 4.80, p = 0.028). Low BMI seemed to be the strongest factor related to the development of osteosarcopenia. Multiple logistic analyses revealed that patients aged 65–74 years who had comorbidities such as kidney dysfunction and high levels of HbA1c were at risk of developing osteosarcopenia.
Sepúlveda-Loyola W et al. 2020 [33] Australia	Cross-sectional study, Community-dwelling	Mean 77.9 ± 0.42 N = 253	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: EWGSOP, EWGSOP2, FNIH Osteopenia, osteoporosis: WHO criteria	11–21%	Falls Past fractures in the past 5 years	Osteosarcopenia was associated with worse SPPB, TUG, FSS, limit of stability, and falls and fractures history. Osteosarcopenia (using the severe sarcopenia classification) conferred an increased rate of falls (OR from 2.83 to 3.63; p < 0.05 for all) and fractures (OR from 3.86 to 4.38; p < 0.05 for all) when employing the EWGSOP2 and FNIH definitions.
Salech F et al. 2020 [34] Chile	Observational study, Community-dwelling	Mean 72 ± 6.7 N = 1119	Muscle mass: DXA Muscle strength: grip strength BMD: DXA	Sarcopenia: EWGSOP Osteopenia, osteoporosis: WHO criteria	16.4%	Mortality Fracture Falls Functional limitations	Cox Regression analysis, the hazard ratio for death in people with osteosarcopenia was 2.48. Falls, fractures, and functional impairment were significantly more frequent in osteosarcopenic patients.

Abbreviations: BIA—Bioimpedance analysis; BMD—Bone mineral density; DXA—Dual-energy X-ray absorptiometry; AWGS—Asian Working Group for Sarcopenia; EWGSOP—European Working Group on Sarcopenia in Older People; WHO—World Health Organization; OR—Odds ratio; CI—Confidence interval; BMI—Body mass index; aLM—Appendicular lean mass; FNIH—Foundation for the National Institutes of Health; SPPB—Short Physical Performance Battery; GFST—Gerontopole Frailty Screening Tool; PTH—Parathyroid hormone; ASM—Appendicular skeletal mass; SD—Standard deviation; HR—hazard ratio; IGF1−SDS—Insulin-like growth factor 1 Standard Deviation Scores; RR—Relative risk; JOS—Japan Osteoporosis Society; TUG—Timed Up and Go test; FSS—Four-Square Step test.