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Do Older Adults with Low Muscle Mass or Strength, in the Presence of Obesity, Have an Increased Risk of Joint Replacement Over 13 Years?

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Abstract

This study aims to assess whether older adults with low muscle mass or strength, in the presence of obesity, have an increased risk of knee (TKR) and hip replacement (THR) over 13 years. 1082 community-dwelling older adults (51% women; mean age 62.9 ± 7.5 years) were studied at baseline and multiple time points over 13 years. The incidence of TKR and THR was determined by data linkage to National Joint Replacement Registry. Appendicular lean and fat mass were measured using DXA. Lower-limb muscle strength (LMS) was assessed by dynamometer. Low muscle mass and strength were defined as the lowest sex-specific tertiles for appendicular lean mass (adjusted for height and total body fat mass) and lower-limb strength, respectively. Obesity was defined as the highest sex-specific tertile for total body fat mass. Competing risk regression models were used to estimate the sub-distribution hazard ratio (SHR) for TKR and THR. Over 13 years of follow-up, 6.8% (n = 74/1082) of the participants had a TKR and 4.7% (n = 50/1066) had THR. Participants with the combination of obesity and low muscle strength (SHR   3.36, 95% CI 1.50, 7.53) but low muscle mass (SHR 1.11, 95% CI 0.52, 2.40) had a significantly increased risk of TKR, compared to individuals with neither obesity nor low muscle mass/strength. However, obesity with low muscle strength did not lead to a significantly greater risk of TKR compared to having low muscle strength or obesity alone. There was no evidence for an association between obesity with low muscle mass or strength and THR (all p > 0.05). This finding suggests that combining muscle and fat assessments to predict the future risk of TKR is no better than each condition on its own.

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Data are available upon request.

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Funding

This work was supported by the National Health and Medical Research Council of Australia (302204); Arthritis Foundation of Australia (MRI06161); Royal Hobart Hospital Research Foundation; and Tasmanian Community Fund (D0015018). SB is supported by the Australian Rheumatology Association and the Farrell Family research fellowship. DS, GJ and DA are supported by the National Health and Medical Research Council of Australia Fellowships. We are grateful to the TASOAC participants, staff and volunteers. The funding organizations have no substantial role in the study or manuscript preparation.

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Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    Saliu A. Balogun, David Scott, Graeme Jones & Dawn Aitken

  2. National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia

    Saliu A. Balogun

  3. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia

    Stephen E. Graves

  4. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia

    Michelle Lorimer

  5. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Flavia Cicuttini

  6. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia

    David Scott

  7. Australian Institute for Musculoskeletal Science, Melbourne Medical School (Western Campus), The University of Melbourne, Melbourne, VIC, Australia

    David Scott

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  1. Saliu A. Balogun
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  2. Stephen E. Graves
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  3. Michelle Lorimer
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  4. Flavia Cicuttini
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  5. David Scott
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  6. Graeme Jones
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  7. Dawn Aitken
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Corresponding author

Correspondence to Saliu A. Balogun.

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Conflict of interest

Saliu A. Balogun, Stephen E. Graves, Michelle Lorimer, Flavia Cicuttini, David Scott, Graeme Jones, Dawn Aitken declare that they have no competing interests.

Human and Animal Rights and Informed Consent

The study was approved by the Tasmanian Health and Medical Research Ethics Committee and written informed consent was obtained from all participants.

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Balogun, S.A., Graves, S.E., Lorimer, M. et al. Do Older Adults with Low Muscle Mass or Strength, in the Presence of Obesity, Have an Increased Risk of Joint Replacement Over 13 Years?. Calcif Tissue Int 107, 10–17 (2020). https://doi.org/10.1007/s00223-020-00698-z

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  • DOI: https://doi.org/10.1007/s00223-020-00698-z

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