Seminar 30-11-2013 Sarcopenie en osteoporose

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Seminar 30-11-2013 Sarcopenie en osteoporose

  1. 1. Sarcopenia & osteoporosis Andrea Maier VUmc Prof. dr. A.B. Maie
  2. 2. Bijlsma et al. J. Age Res Rev, 2012 Prof. dr. A.B. Maie
  3. 3. Bijlsma et al. J. Age Res Rev, 2012 Prof. dr. A.B. Maie
  4. 4. Falls • 30% of the elderly 65+ years fall at least once a year • Increased risk to fall again • 1% of falls hip fracture • 10% of falls  fracture • Increased mortalityProf. dr. A.B. Maie
  5. 5. Risk factors for falls Prof. dr. A.B. Maie
  6. 6. 640 muscles contraction = movement glucose metabolisme protein storage Modifyable! Vesalius Muscle Prof. dr. A.B. Maie
  7. 7. sarx flesh penia deminished • • low skeletal muscle mass Sarcopenia Prof. dr. A.B. Maie
  8. 8. FP7, MYOAGE Prof. dr. A.B. Maie
  9. 9. Morgan Int J Biochem Cell Bio, 2003 Prof. dr. A.B. Maie
  10. 10. 21 jr 63 jr Prof. dr. A.B. Maie
  11. 11. = == Muscle mass Muscle strength Movement Prof. dr. A.B. Maie
  12. 12. Muscle mass 45-90% lean mass 10-40% fat mass Ling et al., J Nutr 2011; Ling et al., Age 2011Prof. dr. A.B. Maie
  13. 13. Muscle strength Grip strength Quadriceps strength Prof. dr. A.B. Maie
  14. 14. Beenakker et al., Ageing Res Rev, 2010 meta-regression lines with 95% confidence band (adjusted to 50% female) General population 20 40 60 80 100 0 10 20 30 40 50 60 Age (years) Gripstrength(kg) Prof. dr. A.B. Maie
  15. 15. 30 50-70 Prof. dr. A.B. Maie
  16. 16. 89 years HR 3.7, CI 2.5-5.7 HR 2.6, CI 1.6-4.4Ling et al. Ling et al., CMAJ 2009 Survival and muscle strength Prof. dr. A.B. Maie
  17. 17. Physical performance Mobility Physical performance Prof. dr. A.B. Maie
  18. 18. Andreas Vesalius 1514-1564Prof. dr. A.B. Maie
  19. 19. Prof. dr. A.B. Maie
  20. 20. 15 17 19 21 23 25 27 Meanhandgripstrength[kg] Lowest tertile Middle tertile Highest tertile MMSE 85 years MMSE 89 years both p for trend < 0.001 Taekema et al. 2011 Muscle strength and cognition Prof. dr. A.B. Maie
  21. 21. 21Taekema et al. J. Hypertension, 2010 Muscle strength and blood pressure Prof. dr. A.B. Maie
  22. 22. Muscle strenght Muscle strength and bone mineral density Bijlsma et al. Osteoporos Int, 2013 Prof. dr. A.B. Maie
  23. 23. SARCOPENIA MUSCLE MOBILITY HEALTH Interrelations Ageing x Disease Prof. dr. A.B. Maie
  24. 24. Sarcopenia Mobility Cluster 1 Cluster n Sarcopenia treatment Prof. dr. A.B. Maie
  25. 25. - Sarcopenia predicts physical, psychological and social outcome, interrelated with organ systems. Prof. dr. A.B. Maie
  26. 26. Muscle strength and age General population 20 40 60 80 100 0 10 20 30 40 50 60 Age (years) Gripstrength(kg) Beenakker et al., Age Res Rev 2010 ? Prof. dr. A.B. Maie
  27. 27. Code Formula Cut-off point Cohort used as reference population Reference† Sarcopenia present Men Women A ALM/height2 > 2 SD below RP 7.26 kg/m2 5.45 kg/m2 Rosetta Study (1986-1992) non-Hispanic white men and women aged 18-40 years Baumgartner 1998 B ALM/height2 Under 20th percentile 7.25 kg/m2 5.67 kg/m2 Health ABC Study (1997/1998), 2976 men and women 70-79 years old black and white, Pittsburgh, Pennsylvania and Memphis, Tenessee Delmonico 2007 C ALM/height2 > 2 SD below RP 6.19 kg/m2 4.73 kg/m2 NHANES survey (1999 - 2004) white men and women aged 20 years Kelly 2009 D ALM with height and fat mass Under 20th percentile NA NA NA Delmonico 2007 E Skeletal lean mass/body mass * 100% >2 SD below RP is class II sarcopenia 1-2 SD below RP is class I sarcopenia 31% 37% 22% 28% NHANES III (1988-1994), 6414 men and women aged 18-39 years non-Hispanic white, non-Hispanic black and Mexican-American Janssen 2002 F Skeletal lean mass/ height2 ROC analysis 8.50 10.75 kg/m2 5.75 6.75 kg/m2 NHANES III (1988-1994), 60 years plus, non-Hispanic white, black and Mexican- American Janssen 2004 G Optimal cutpoint for grip strength, walking slower than 0.8 m/s Below optimal cutpoint 30.3 kg 19.3 kg InCHIANTI (1998-2000), 1030 subjects aged 20 - 102 years, , Lauretani 2003 Used definitions Bijlsma et al. 2012, Age Prof. dr. A.B. Maie
  28. 28. ‘Concordance’ sarcopenia Bijlsma et al. 2012, Age Prof. dr. A.B. Maie
  29. 29. Code Formula Cut-off point Cohort used as reference population Reference† Sarcopenia present Men Women A ALM/height2 > 2 SD below RP 7.26 kg/m2 5.45 kg/m2 Rosetta Study (1986-1992) non-Hispanic white men and women aged 18-40 years Baumgartner 1998 B ALM/height2 Under 20th percentile 7.25 kg/m2 5.67 kg/m2 Health ABC Study (1997/1998), 2976 men and women 70-79 years old black and white, Pittsburgh, Pennsylvania and Memphis, Tenessee Delmonico 2007 C ALM/height2 > 2 SD below RP 6.19 kg/m2 4.73 kg/m2 NHANES survey (1999 - 2004) white men and women aged 20 years Kelly 2009 D ALM with height and fat mass Under 20th percentile NA NA NA Delmonico 2007 E Skeletal lean mass/body mass * 100% >2 SD below RP is class II sarcopenia 1-2 SD below RP is class I sarcopenia 31% 37% 22% 28% NHANES III (1988-1994), 6414 men and women aged 18-39 years non-Hispanic white, non-Hispanic black and Mexican-American Janssen 2002 F Skeletal lean mass/ height2 ROC analysis 8.50 10.75 kg/m2 5.75 6.75 kg/m2 NHANES III (1988-1994), 60 years plus, non-Hispanic white, black and Mexican- American Janssen 2004 G Optimal cutpoint for grip strength, walking slower than 0.8 m/s Below optimal cutpoint 30.3 kg 19.3 kg InCHIANTI (1998-2000), 1030 subjects aged 20 - 102 years, , Lauretani 2003 Used definitions-no concordance Bijlsma et al. 2012, Age Prof. dr. A.B. Maie
  30. 30. European consensus Cruz-Jentoft et al., Age Ageing 2010 Prof. dr. A.B. Maie
  31. 31. “Sarcopenia with limited mobility” is defined as a person with muscle loss whose walking speed is equal to or less than 1 m/s or who walks less than 400 m during a 6-minute walk, and who has a lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean of healthy persons between 20 and 30 years of age of the same ethnic group. Morley et al. JAMDA 2011 International consensus Prof. dr. A.B. Maie
  32. 32. • Rockwood: 2 items of cognitive decline or disabilities in activities of daily living or urinary incontinence • Fried: 3 items of exhaustion, weight loss, slow gait speed, low handgrip strength, low physical activity • low handgrip strength (women <17.5 kg; men <30 kg) • Gait speed less than 1.0 m/s Frailty definitions Prof. dr. A.B. Maie
  33. 33. ddddd ddddd ddd JAGS 2006 ‘Concordance’ frailty Prof. dr. A.B. Maie
  34. 34. - Sarcopenia predicts physical, psychological and social outcome, interrelated with other organ systems. - Sarcopenia has become a syndrome / disease. No clear definition yet. Prof. dr. A.B. Maie
  35. 35. • resistance, endurance, balance training • Prevent inactivity! • Diet, amino acids, vitamins • Prevent catabolic state! • Phase II trails (Wnt signalling, hormons etc) Sarcopenia interventions Prof. dr. A.B. Maie
  36. 36. 16 weeks 3 x /week Sipila et al., 1994 Am Physiol Soc Prof. dr. A.B. Maie
  37. 37. Leg press after intervention Peterson, Age Res Rev 2010 Prof. dr. A.B. Maie
  38. 38. Osteoporos Int, 2013 Physical exercise 3/week, 65+ yrs Prof. dr. A.B. Maie
  39. 39. Sarcopenia interventions • resistance, endurance, balance training • Prevent inactivity! • Diet, amino acids, vitamins • Prevent catabolic state! • Phase II trails (Wnt signalling, hormons etc) Prof. dr. A.B. Maie
  40. 40. Elderly general population: Undernutrition: 10% (NL) Prof. dr. A.B. Maie
  41. 41. Houston et al., 2008 Am J Clin Nutr 3years low protein intake high Prof. dr. A.B. Maie
  42. 42. 12 g amino acids / d 3 month Cognamiglio et al., 2005 Gerontology Prof. dr. A.B. Maie
  43. 43. N=154, 75y+ Exercise AND amino acid supplementation, exercise, amino acid supplementation, health education Prof. dr. A.B. Maie
  44. 44. Prof. dr. A.B. Maie
  45. 45. old onset monkeys young onset monkeys Caloric restriction - lifespan 30% decrease ad libitum feeding without malnutrition (mech via oxidative damage, mitochondrial function) Mattison et al., Nature 2012Prof. dr. A.B. Maie
  46. 46. Caloric restriction - healthspan 30% decrease ad libitum feeding without malnutrition (mech via oxidative damage, mitochondrial function) young onset monkeys CVD, DM, cancer Mattison et al., Nature 2012Prof. dr. A.B. Maie
  47. 47. Sarcopenia interventions • resistance, endurance, balance training • Prevent inactivity! • Diet, amino acids, vitamins • Prevent catabolic state! • Phase II/III trails (Wnt signalling, hormons, myostatin inhibition etc) Prof. dr. A.B. Maie
  48. 48. Murphy et al., 2010 FASEB - TGF-b superfamily - inhibition of muscle growth - associated with low BMD Prof. dr. A.B. Maie
  49. 49. Prof. dr. A.B. Maie
  50. 50. Prof. dr. A.B. Maie
  51. 51. Elimination of senescent cells Aging stopped Biological young Biological old Baker et al.,Nature, 2011 Target: senescent cells Prof. dr. A.B. Maie
  52. 52. Regeneration capacity muscle / heart pre + + + - - - post + + + + - - Influence of factor x en y in blood Loffredo et al., Cell 2013, Conboy et al., Nature 2007Prof. dr. A.B. Maie
  53. 53. - Sarcopenia predicts physical, psychological and social outcome, interrelated with other organ systems. - Sarcopenia has become a disease. No clear definition yet. -Prevent decline of muscle mass in early stages and increase muscle mass by targeted intervention. Drug therapy will be available next years.Prof. dr. A.B. Maie
  54. 54. Prof. dr. A.B. Maie
  55. 55. Prof. dr. A.B. Maie

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