The association between sarcopenia and fracture in middle-aged and elderly people: A systematic review and meta-analysis of cohort studies

Introduction: The association between sarcopenia and risk of fracture remained controversial. This systematic review and meta-analysis was conducted to evaluate the association between sarcopenia and fracture incidence in the middle-aged and elderly people. Materials and Methods: Web of Science, PubMed, EMBASE, and the Cochrane Library were searched. Weighted averages were reported as hazard risk (HR) values with 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran's Q test and the I-2 statistic. Results: A total of 5 cohort studies involving 27 990 participants were included in our study. The crude and adjusted effect sizes between sarcopenia and fracture were extracted from 2 and 5 studies, respectively. Sarcopenia was significantly associated with fracture incidence without adjusting covariates (crude HR, 1.69; 95% CI, 1.34-2.13). After adjusting for potential confounders, sarcopenia still demonstrated significant positive association with fracture (adjusted HR, 1.50;95%CI, 1.08-2.08). The sensitivity analysis confirmed the stability of the results. In the subgroup analysis of studies after adjusting covariates, there were significant associations between sarcopenia and fracture in the subgroups of male, older people, American and hip fracture patients. Conclusion: Our meta-analysis found that sarcopenia was significantly associated with fracture in middle aged and elderly people. However, more homogeneous studies are needed to fully clarify the relationship between sarcopenia and fracture. (C) 2020 Elsevier Ltd. All rights reserved.