Associations of osteoporosis, sarcopenia, and osteosarcopenia with mortality: a comparative analysis for different sarcopenia definitions in the Manitoba and NHANES populations

Osteosarcopenia is a major public health concern, but its association with mortality, remains understudied. We aimed to examine the associations between osteoporosis, sarcopenia, and osteosarcopenia with mortality. We used two populations: the Manitoba Bone Mineral Density Database (MBMDD) study (1999-2018) and the National Health and Nutrition Examination Survey (NHANES) study (2001-2019). Individuals aged 50 years or above with complete data on BMD, appendicular lean body mass, demographic characteristics and comorbidity measures. Five definitions for diagnosis of SP were considered: Foundation for the National Institutes of Health (FNIH1, FNIH2); European Working Group on Sarcopenia in Older People (EWGSOP2); Asian Working Group for Sarcopenia (AWGS); International Working Group on Sarcopenia (IWG). Disease was classified as follows: osteoporosis only (individuals with osteoporosis alone), sarcopenia only (individuals with sarcopenia alone), osteosarcopenia (individuals with both osteoporosis and sarcopenia). The main outcome was all-cause mortality. The MBMDD and NHANES included 69,497 (90.8% females) and 8134 (52.1% females), respectively. The average ages were 65.6±9.5 years in the MBMDD cohort and 59.1±8.5 years in the NHANES. Mortality was significantly higher in those with osteoporosis (MBMDD: hazard ratio [HR]: 1.26, 95%confidence interval [CI]: 1.21-1.32; NHANES: HR: 1.31, 95%CI: 1.07-1.60), sarcopenia (EWGSOP2: MBMDD: HR: 1.64, 95%CI: 1.52-1.78; NHANES: HR: 1.45, 95%CI: 1.30-1.62) and osteosarcopenia (EWGSOP2: MBMDD: HR: 2.05, 95%CI: 1.91-2.19; NHANES: HR: 1.91, 95%CI: 1.45-2.52). In summary, osteoporosis, sarcopenia and osteosarcopenia were all significantly associated with increased mortality risk. Osteosarcopenia exhibited a stronger association with mortality than either osteoporosis or sarcopenia alone.