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

Osteosarcopenia (OSP) is a major public health concern, but its association with mortality, remains understudied. We aimed to examine the associations between osteoporosis, sarcopenia, and OSP with mortality. We used 2 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 yr 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 and FNIH2), European Working Group on Sarcopenia in Older People (EWGSOP2), Asian Working Group for Sarcopenia (AWGS), and International Working Group on Sarcopenia (IWG). Disease was classified as follows: osteoporosis only (individuals with osteoporosis alone), sarcopenia only (individuals with sarcopenia alone), and OSP (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 yr in the MBMDD cohort and 59.1 ± 8.5 yr in the NHANES. Mortality was significantly higher in those with osteoporosis (MBMDD: hazard ratio [HR]: 1.26, 95% 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 OSP (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 OSP were all significantly associated with increased mortality risk. Osteosarcopenia exhibited a stronger association with mortality than either osteoporosis or sarcopenia alone.