Effect of sarcopenia combined with Metabolic Syndrome (MS) on the prognosis of intertrochanteric fractures: a retrospective clinical study

BACKGROUND: Intertrochanteric fractures pose significant health risks for elderly patients. While metabolic syndrome (MS) and sarcopenia independently impact postoperative outcomes, their synergistic effects on intertrochanteric fracture prognosis remain unclear. This study investigates the individual and combined influence of MS and sarcopenia on complications and functional recovery in elderly patients with intertrochanteric fractures. METHODS: We retrospectively analyzed 460 elderly patients with intertrochanteric fractures, categorized into four groups: control (n = 174), MS (n = 122), sarcopenia (n = 89), and combined (n = 75). Preoperative-perioperative and postoperative data of the MS, sarcopenia, and combined groups were compared with the control group. Primary outcomes included 3-month Barthel Index (BI) and Harris Hip Score (HHS). Multivariate logistic regression identified predictors of poor recovery (HHS < 70). RESULTS: The MS group had younger patients with higher body mass index (BMI), hypertension, diabetes prevalence, and longer surgery durations (P < 0.05). Sarcopenia and combined groups exhibited lower weight, BMI, handgrip strength (HS), appendicular skeletal muscle mass index (ASMI), and higher American society of Aneshesiologists (ASA) scores (P < 0.05). The MS, sarcopenia, and combined groups had higher incidences of pulmonary infections and pressure ulcers compared with the control group (P < 0.05). The sarcopenia and combined groups also had higher rates of organ failure (P < 0.05), with the combined group showing increased ICU admission (P = 0.003) and in-hospital mortality (P = 0.027). At three months post-discharge, the sarcopenia and combined groups exhibited higher mortality rates (P < 0.001). At the 3-month follow-up, the sarcopenia and combined groups had significantly lower HHS and BI compared to the control group (P < 0.05). Multivariate logistic regression identified sarcopenia alone (OR 6.50, 95% CI 2.56-20.10; P < 0.001) and combined with MS (OR 9.46, 95% CI 3.33-34.80; P < 0.001) as significant predictors of poor postoperative recovery. CONCLUSION: Sarcopenia significantly worsens postoperative prognosis in elderly intertrochanteric fracture patients, with synergistic deterioration when combined with MS. Chronic inflammation, insulin resistance, and muscle-bone metabolic dysregulation drive adverse outcomes. Comprehensive preoperative screening for sarcopenia and MS, coupled with tailored nutritional support and early rehabilitation, is critical to mitigate complications and improve functional recovery. These findings advocate for integrated care protocols targeting metabolic-musculoskeletal health in geriatric fracture management.