Bone mineral density in patients with coronary artery disease and sarcopenia

Objective: to assess the relationship between bone mineral density (BMD) and the muscular apparatus in male patients with coronary heart disease (CHD).

Patients and methods. The investigation enrolled 79 male patients (median age, 63 [57; 66] years) with an established diagnosis of CHD verified by coronary angiography.
Muscle mass was assessed by multispiral computed tomography, by determining the axial muscle tissue area (cm2 ) at the level of L_III. Muscle strength was measured with a wrist dynamometer. Muscle function was examined using the tests of the Short Physical Performance Battery (SPPB). BMD at the neck and proximal femur as a whole and at the lumbar spine was measured by dual energy X-ray absorptiometry.
For comparative analysis, the patients were divided into three groups (EWGSOP, 2010). Group 1 included 31 patients without sarcopenia; Group 2 consisted of 21 patients with presarcopenia; and Group 3 comprised 27 patients with sarcopenia.

Results and discussion. Osteopenic syndrome was diagnosed in 34 (43%) patients: osteopenia and osteoporosis in 31 (39%) and 3 (4%) patients, respectively. Normal BMD values were observed in 45 (57%) men. The prevalence of osteopenic syndrome was significantly higher in the patients with sarcopenia than in those with presarcopenia (p=0.050) and was comparable to that in men without sarcopenia (p>0.050). BMD at the neck and proximal femur as a whole was significantly lower in the patients with sarcopenia than in those without sarcopenia or with presarcopenia (p<0.050). There was a direct correlation between BMD and the characteristics of muscle mass and muscle strength. Regression analysis showed that the total skeletal muscle area at the level of L_III had a significant direct impact on BMD at the neck and proximal femur as a whole, and the reverse – walking speed.

Conclusion. The relationship between the characteristics of the muscular apparatus and BMD requires further investigation.

1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169.

2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010 Jul;39(4):412-23. doi: 10.1093/ageing/afq034. Epub 2010 Apr 13.

3. Lesnyak OM, Belaya ZhE, Baranova IA. Osteoporoz: rukovodstvo dlya vrachei [Osteoporosis: a guide for physicians]. Moscow: GEOTAR-Media; 2016.

4. Shostak NA, Muradyants AA, Kondrashov AA. Sarcopenia and cross-syndromes-significance in clinical practice. Klinitsist. 2016;10(3):10-4. (In Russ.).

5. Gaba A, Kapus O, Pelclova J, Riegerova J. The relationship between accelerometerdetermined physical activity (PA) and body composition and bone mineral density (BMD) in postmenopausal women. Arch Gerontol Geriatr. May-Jun 2012;54(3):e315-21. doi: 10.1016/j.archger.2012.02.001. Epub 2012 Mar 8.

6. Zhou Z, Zheng L, Wei D, et al. Muscular strength measurements indicate bone mineral density loss in postmenopausal women. Clin Interv Aging. 2013;8:1451-9. doi: 10.2147/CIA.S48447. Epub 2013 Oct 25.

7. Kapus O, Gaba A, Svoboda Z, et al. Relationship between body composition and bone mineral density of the lumbar spine and proximal femur: influence of years since menopause. Mod Rheumatol. 2014 May;24(3): 505-10. doi: 10.3109/14397595.2013.844393. Epub 2013 Oct 21.

8. Ilesanmi-Oyelere BL, Coad J, Roy N, et al. Lean body mass in the prediction of bone mineral density in postmenopausal women. Biores Open Access. 2018 Oct 10;7(1): 150-8. doi: 10.1089/biores.2018.0025. eCollection 2018.

9. Kim S, Won CW, Kim BS, et al. The association between the low muscle mass and osteoporosis in elderly Korean people. J Korean Med Sci. 2014 Jul;29(7):995-1000. doi: 10.3346/jkms.2014.29.7.995. Epub 2014 Jul 11.

10. Huh JH, Song MK, Park KH, et al. Gender-specific pleiotropic bone-muscle relationship in the elderly from a nationwide survey (KNHANES IV). Osteoporos Int. 2014 Mar;25(3):1053-61. doi: 10.1007/s00198013-2531-2. Epub 2013 Oct 23.

11. Pereira FB, Leite AF, Paula AP, et al. Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men. Arch Endocrinol Metab. 2015 Feb;59(1): 59-65. doi: 10.1590/2359-3997000000011.

12. Blain H, Jaussent A, Thomas E, et al. Appendicular skeletal muscle mass is the strongest independent factor associated with femoral neck bone mineral density in adult and older men. Exp Gerontol. 2010 Sep;45(9): 679-84. doi: 10.1016/j.exger.2010.04.006. Epub 2010 Apr 27.

13. Coin A, Perissinotto E, Enzi G, et al. Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia. Eur J Clin Nutr. 2008 Jun;62(6):802-9. doi: 10.1038/sj.ejcn.1602779. Epub 2007 Jul 18.

14. Gonnelli S, Caffarelli C, Tanzilli L, et al. The associations of body composition and fat distribution with bone mineral density in elderly Italian men and women. J Clin Densitom. Apr-Jun 2013;16(2):168-77. doi: 10.1016/j.jocd.2012.02.013. Epub 2012 May 9.

15. Verschueren S, Gielen E, O'Neill TW, et al. Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men. Osteoporos Int. 2013 Jan;24(1):87-98. doi: 10.1007/s00198-0122057-z. Epub 2012 Jul 10.

16. Frost HM. The Utah paradigm of skeletal physiology: an overview of its insights for bone, cartilage and collagenous tissue organs. J Bone Miner Metab. 2000;18(6):305-16. doi: 10.1007/s007740070001.

17. Hasselstr ∅ m H, Karlsson KM, Hansen SE, et al. Sex differences in bone size and bone mineral density exist before puberty. The Copenhagen School Child Intervention Study (CoSCIS). Calcif Tissue Int. 2006 Jul; 79(1):7-14. doi: 10.1007/s00223-006-0012-8. Epub 2006 Jul 24.

18. Li YZ, Zhuang HF, Cai SQ, et al. Low grip strength is a strong risk factor of osteoporosis in postmenopausal women. Orthop Surg. 2018 Feb;10(1):17-22. doi: 10.1111/os.12360. Epub 2018 Feb 12.

19. Ahedi H, Aitken D, Scott D, et al. The association between hip muscle crosssectional area, muscle strength, and bone mineral density. Calcif Tissue Int. 2014 Jul; 95(1):64-72. doi: 10.1007/s00223-014-9863-6. Epub 2014 May 15.

20. Lesnyak OM, Benevolenskaya LI, editors. Osteoporoz. Diagnostika, profilaktika i lechenie. Klinicheskie rekomendatsii [Osteoporosis. Diagnostics, prevention and treatment. Clinical recommendations]. Moscow: GEOTAR-Media; 2020. 272 p.