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Introduction <p>Osteosarcopenia—the coexistence of osteoporosis and sarcopenia—reflects a dual loss of bone and muscle integrity that contributes to frailty, falls, and functional decline in aging populations. While both osteoporosis and sarcopenia have been individually linked to postoperative recovery, their combined effect after major orthopedic procedures remains unclear. This study investigated whether osteosarcopenia independently predicts health-related quality of life after total hip arthroplasty (THA), as a model for older adults with musculoskeletal deficits.</p> Materials and methods <p>A retrospective cohort of 214 patients aged ≥ 65&#xa0;years who underwent unilateral THA was analyzed. Preoperative evaluations included dual-energy X-ray absorptiometry (osteoporosis: lumbar T-score &lt;  − 2.5) and sarcopenia was defined in accordance with the 2019 Asian Working Group for Sarcopenia consensus. Patients were grouped as osteosarcopenia, sarcopenia-only, osteoporosis-only, or normal. Multivariate logistic regression was conducted to identify predictors of achieving the minimum clinically important difference (MCID) in the Hip Disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS-JR) at 24&#xa0;months postoperatively. Propensity score matching was used to compare patients with osteosarcopenia with matched controls.</p> Results <p>Both osteoporosis (OR 0.71, 95%CI 0.60–0.83) and sarcopenia (OR 0.79, 95%CI 0.64–0.97) were independent predictors of failure to achieve MCID (&gt; 18, 154/214). Post-matching, patients with osteosarcopenia (n = 25) had significantly lower HOOS-JR (P &lt; 0.001), EuroQol 5‐Dimension (P = 0.029), and satisfaction scores (P &lt; 0.001) than controls (n = 50).</p> Conclusion <p>Osteosarcopenia was associated with clinically inferior functional disability after THA. Preoperative identification of bone-muscle deficits could guide interventions—such as osteoporosis treatment and tailored rehabilitation—to enhance outcomes in older adults.</p>

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Osteosarcopenia as a predictor of postoperative adverse outcomes in older adults undergoing total hip arthroplasty

  • 期刊论文

  • 发表日期：

    2025年12月3日

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  • Yoshinori Okamoto,
  • Hitoshi Wakama,
  • Takafumi Saika,
  • Kengo Tani,
  • Shuhei Otsuki

摘要

Introduction

Osteosarcopenia—the coexistence of osteoporosis and sarcopenia—reflects a dual loss of bone and muscle integrity that contributes to frailty, falls, and functional decline in aging populations. While both osteoporosis and sarcopenia have been individually linked to postoperative recovery, their combined effect after major orthopedic procedures remains unclear. This study investigated whether osteosarcopenia independently predicts health-related quality of life after total hip arthroplasty (THA), as a model for older adults with musculoskeletal deficits.

Materials and methods

A retrospective cohort of 214 patients aged ≥ 65 years who underwent unilateral THA was analyzed. Preoperative evaluations included dual-energy X-ray absorptiometry (osteoporosis: lumbar T-score <  − 2.5) and sarcopenia was defined in accordance with the 2019 Asian Working Group for Sarcopenia consensus. Patients were grouped as osteosarcopenia, sarcopenia-only, osteoporosis-only, or normal. Multivariate logistic regression was conducted to identify predictors of achieving the minimum clinically important difference (MCID) in the Hip Disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS-JR) at 24 months postoperatively. Propensity score matching was used to compare patients with osteosarcopenia with matched controls.

Results

Both osteoporosis (OR 0.71, 95%CI 0.60–0.83) and sarcopenia (OR 0.79, 95%CI 0.64–0.97) were independent predictors of failure to achieve MCID (> 18, 154/214). Post-matching, patients with osteosarcopenia (n = 25) had significantly lower HOOS-JR (P < 0.001), EuroQol 5‐Dimension (P = 0.029), and satisfaction scores (P < 0.001) than controls (n = 50).

Conclusion

Osteosarcopenia was associated with clinically inferior functional disability after THA. Preoperative identification of bone-muscle deficits could guide interventions—such as osteoporosis treatment and tailored rehabilitation—to enhance outcomes in older adults.