L Egund, T K Paulin, H Ekstubbe, P Bartosch, L Malmgren
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引用次数: 1
Abstract
Background: FGF23 has been associated with frailty and functional performance in older individuals, but the association to sarcopenia is unknown.
Objectives: To investigate the association between FGF23, frailty, sarcopenia and fractures in older community dwelling women.
Design: Prospective longitudinal cohort study.
Setting: Malmö, Sweden.
Participants: 995 75-year-old women, followed prospectively for ten years, with re-investigations after five (n=667) and ten (n=324) years.
Measurements: C-terminal levels of FGF23 were measured and a frailty index of 'deficits in health' created. Sarcopenia was defined by low muscle mass and strength and "probable sarcopenia" by low muscle mass only. Incident fractures were continuously registered for 10-years. Based on tertiles of FGF23, odds ratio for frailty, sarcopenia and probable sarcopenia was investigated using logistic regression models adjusted for: eGFR, PTH, calcium, vitamin D and phosphate. Fracture-free survival during 10-year follow-up was depicted using Kaplan Meier curves.
Results: While fracture-free survival did not differ between tertiles, women in the highest tertile of FGF23 had lower muscle strength and gait speed, and higher proportion with impaired mobility at baseline. At age 75, these women had higher odds of also being frail (ORadj 1.6 (95% CI 1.1-2.4)) and suffering from probable sarcopenia (ORadj 1.8 (95% CI 1.1-3.1)), but not sarcopenia. At follow-up the association between FGF23 and probable sarcopenia was not evident. While the association with frailty was attenuated at age 80 after adjustment (ORadj 1.6 (95% CI 1.0-2.5)), women in the highest tertile had higher odds of being frail at age 85 (ORadj 3.4 (95% CI 1.7-6.6)).
Conclusions: FGF23 may be a promising clinical marker for muscle strength, functional performance, and frailty in older women, but not for future fragility fractures. Whether FGF23 is also associated with sarcopenia requires further investigation.
背景:FGF23与老年人的虚弱和功能表现有关，但与肌肉减少症的关系尚不清楚。目的:探讨FGF23与老年社区妇女身体虚弱、肌肉减少症和骨折之间的关系。设计:前瞻性纵向队列研究。地点:Malmö，瑞典。参与者:995名75岁的女性，前瞻性随访10年，在5年(n=667)和10年(n=324)后再次调查。测量方法:测量了FGF23的c端水平，并创建了“健康缺陷”的脆弱指数。肌肉减少症的定义是肌肉质量和力量低，“可能的肌肉减少症”仅是肌肉质量低。意外骨折连续记录了10年。根据FGF23的分位数，使用经eGFR、PTH、钙、维生素D和磷酸盐校正的logistic回归模型，研究虚弱、肌肉减少和可能的肌肉减少的优势比。10年随访期间的无骨折生存率用Kaplan Meier曲线描述。结果:虽然无骨折存活率在各组之间没有差异，但FGF23最高组的女性在基线时肌肉力量和步态速度较低，活动能力受损的比例较高。在75岁时，这些女性身体虚弱(ORadj 1.6 (95% CI 1.1-2.4))和可能患有肌肉减少症(ORadj 1.8 (95% CI 1.1-3.1))的几率更高，但没有肌肉减少症。在随访中，FGF23与可能的肌肉减少症之间的关联并不明显。虽然调整后与虚弱的关联在80岁时减弱(ORadj 1.6 (95% CI 1.0-2.5))，但最高生育水平的女性在85岁时身体虚弱的几率更高(ORadj 3.4 (95% CI 1.7-6.6))。结论:FGF23可能是老年女性肌肉力量、功能表现和脆弱性的一个有希望的临床指标，但对于未来的脆弱性骨折则不是。FGF23是否也与肌肉减少症相关还有待进一步研究。
期刊介绍：
The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons. The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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