Polypharmacy as a Risk Factor for Clinically Relevant Sarcopenia: Results From the Berlin Aging Study II
Polypharmacy as a Risk Factor for Clinically Relevant Sarcopenia: Results From the Berlin Aging Study II
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DOI：
10.1093/gerona/glx074
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发表时间：
2018-01-01
影响因子：
5.1
通讯作者：
Norman, Kristina
中科院分区：
文献类型：
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作者：
Koenig, Maximilian;Spira, Dominik;Norman, Kristina
背景：肌肉减少症影响超过10%的老年人。除了与年龄相关的生理变化，糖尿病或炎症，神经，恶性和内分泌疾病等疾病可能会导致肌肉减少症的发展。同样，多药疗法，即，多种药物的使用，在老年人中很常见。虽然这两种情况经常同时发生，但多药治疗与肌肉减少症的关系尚未得到研究。我们调查了一个大的队列社区居住的老年人（60-84岁）的多药和肌肉减少症的协会：一千五百两个参与者从柏林老龄化研究II。多重用药定义为同时使用5种或以上药物（处方药和非处方药）。采用双能X线吸收法测定身体成分，计算四肢瘦体重（ALM）。肌肉减少症被定义为低ALM体重指数（BMI）的比率，使用有效的性别特异性cutoffs.Results：平均年龄为68.7 +/- 3.7岁，50.7%是女性。药物的中位数（四分位距）为2（1-4）; 21.1%的受试者报告经常使用≥ 5种药物。根据所应用的ALM/BMI截止值，具有多种药物的受试者更经常肌肉减少（16.3%对6.9%，p < 0.001），具有较高的BMI（p < 0.001）和较低的ALM/ BMI（p < 0.001），但平均ALM没有显著差异。值得注意的是，多种药物也与步态速度降低和疲惫的发生率较高有关。即使在多变量调整（性别、年龄、共病状况和体力活动）后，多药治疗始终与肌肉减少症的显著增加的可能性相关（比值比= 2.24，95%置信区间[CI] = 1.33-3.75）。
Background: Sarcopenia affects more than 10% of older adults. Next to age-associated physiologic changes, diseases like diabetes or inflammatory, neurological, malignant and endocrine disorders may contribute to the development of sarcopenia. Likewise, polypharmacy, i.e., multiple drug use, is common among older adults. Although the two conditions frequently co-occur, the association of polypharmacy with sarcopenia has not yet been examined. We investigated the association of polypharmacy and sarcopenia in a large cohort of community-dwelling older adults (60-84 years).Methods: Thousand five hundred and two participants from the Berlin Aging Study II were included. Polypharmacy was defined as concurrent use of 5 or more drugs (prescription and nonprescription). Body composition was assessed with dual-energy X-ray absorptiometry, and appendicular lean mass (ALM) was calculated as sum of the four limbs' lean mass. Sarcopenia was defined as low ALM-to-body mass index (BMI)-ratio using validated sex-specific cutoffs.Results: Mean age was 68.7 +/- 3.7 years, 50.7% were female. The median (interquartile range) number of drugs was 2 (1-4); 21.1% of subjects reported regular use of >= 5 drugs. Subjects with polypharmacy were more often sarcopenic according to the applied ALM/BMI-cutoffs (16.3% vs 6.9%, p < 0.001), with a higher BMI (p < 0.001) and lower ALM/ BMI (p < 0.001), but no significant difference in mean ALM. Notably, polypharmacy was also associated with higher rates of reduced gait speed and exhaustion. Even after multivariable adjustment (sex, age, comorbid conditions and physical activity) polypharmacy was consistently associated with a significantly increased likelihood of sarcopenia (odds ratio = 2.24, 95% confidence interval [CI] = 1.33-3.75).Conclusion: Polypharmacy is associated with clinically relevant sarcopenia, as assessed by a low ALM/BMI.