Sarcopenia Ren Rizzoli Division of Bone Diseases Geneva University - - PowerPoint PPT Presentation

René Rizzoli

Division of Bone Diseases Geneva University Hospitals and Faculty of Medicine Geneva, Switzerland

Nice, September 22nd 2017

Role of Vitamin D and Calcium in the Prevention and Management of Sarcopenia

Disclosure

Speaker Bureau or Member of Scientific Advisory Boards for Amgen, Danone, Labatec, Nestlé, ObsEva, Radius Health

Pathogenesis of Osteoporotic Fracture

Fracture Rehabilitation

• > To Restore Independence
• > To Reduce Disabilities

Prevention Subsequent Fracture Mechanical Overload Mechanical Incompetence Fracture Repair

Falls

Sway Walking Muscle Strength Neuro-muscular Impairment

Osteoporosis Calcium? Vitamin D ?

Sarcopenia and Calcium Intakes

(Cross-sectional Studies)

Author Sample Size (% Women) Mean Age/ Calcium Intake Outcome Results Seo et al. 2013 1’339 (53) (KNHANES IV) 70.1 3rd Tertile ≥444 mg/d Muscle Mass Sarcopenia (DXA) Prevalence (tertiles): 6.3, 4.3, 2.7 % OR: 0.259 Waters et al. 2014 315 (62) (New Mexico Aging Process) 76.5 769 vs 909 mg/d in M Performance (Gait speed, m/s) M: 0.8; W: 0.7 OR (lowest quartile: 2.18 (NS) Lower Calcium in M Oh et al. 2015 1’433 (64) KNHANES 68.6 69 vs 77 %DRI Sarcopenia (DXA, Muscaritoli) Difference in Men, not in Women Ter Borg et al. 2016 227 (52) 74.0 869 mg/d Sarcopenia (Cruz-Jentoft) No difference in calcium intake Verlaan et al. 2017 (Case-Control) 132 (59) 71.0 830 mg/d Sarcopenia (Cruz-Jentoft) No difference in calcium intake

Institute of Medicine 2010

Dose-response for 25(OH)D and function

20 40 60 80 100 120 140 160 180 200 220 240 3.5 4 4.5 20 40 60 80 100 120 140 160 180 200 220 240 14 15 16

8-Foot walk Repeated sit-to-stand

25-OHD nmol/l 25-OHD nmol/l

Bischoff-Ferrari HA, Dawson-Hughes B et al. Am J Clin Nutr. 2004;80:752–758. Sec Sec

Effect was similar between more or less active individuals, men or women, calcium intake

NHANES III: n = 4100 community–dwelling older individuals age 60+

Beaudard et al JCEM 2014

Muir et al JAGS 2011

Balance TUG

No Effect on Gait Speed

Meta-analyses on Vitamin D and Fall Prevention

Harvey, Biver et al 2016

26 RCT,n=45’782

26 RCT/ 12 Meta-analyses = 2.1

Uusi-Rasi et al JAMA Int Med 2015

Vitamin D and Exercise in Fall Prevention Among Older Women

Baseline 25OHD 27 ng/ml (67.5 nmol/l) No Exercise ± VitD With Exercise ± VitD 800I U/d

Severe Vitamin D Deficiency in Hip Fracture Patients

10 20 30 40 50 60 70 80

% with severe deficiency % supplemented

home assisted living nursing home Bischoff-Ferrari et al Bone 2007

%

Severe 25(OH)D deficiency: 25(OH)D < 30 nmol/l (n = 222)

Bischoff-Ferrari et al. Arch Intern Med 2010

Extended Physiotherapy -> Reduction Falls, but not Hospital Readmission Vitamin D 2’000 IU/d -> Reduction Hospital Readmission, but not Falls

Baseline 25OH D 32 nmol/l

Relative Risk of Falling with Vitamin D Supplementation

Bischoff-Ferrari BMJ 2011

High-Dose Vitamin D (500’000 IU) and Falls and Fractures in Older Women

Cumulative incidence of falls %

75 50 25 100

Time (Years)

Vitamin D Placebo

1 2 3 4 5

Cumulative Incidence of fractures %

15 10 5 20

Time (Years)

Vitamin D Placebo

1 2 3 4 5

HR 1.16 (CI 1.05-1.28) HR 1.26 (CI 0.99-1.59)

Falls Fractures

P = 0.003 P =0.06

Sanders et al., JAMA 2010;303:1815-1822

Bischoff-Ferrari et al JAMA Int Med 2016

78 Yrs (>70), 58% with 25OHD < 20 ng/ml (50 nmol/l), 12 Mo Monthly: 24’000 IU VitD3 vs 60’000 IU VitD3 vs 24’000 IU VitD3 & 300 µg Calcifediol

Smith et al J Ster Bioch Mol Biol 2017

75-100 nmol/l Baseline 25OHD: 38 nmol/l 12 Months

• Summary

– Vitamin D Supplementation Seems to Reduce Fall Risk – Particularly in Vitamin D-insufficient Subjects – Dose (800-1’000 IU/day) and Continuous Administration are Likely Important Factors

Vitamin D and Sarcopenia

• Conclusion

– Vitamin D Repletion is Efficacious and Safe, and should be Included in Strategies Aimed at Preventing Sarcopenia

Institute of Medicine 2010

May be for Falls, Upper Intake of Vitamin Should be Revisited