Assessment of endocrine and nutritional status in age-related catabolic states of muscle and bone
Assessment of endocrine and nutritional status in age-related catabolic states of muscle and bone
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DOI：
10.1097/mco.0b013e3282cfa32f
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发表时间：
2007-09-01
影响因子：
3.1
通讯作者：
Tolis, George
中科院分区：
文献类型：
--
作者：
Lytras, Aristides;Tolis, George
综述目的骨丢失和肌肉萎缩与老年人发病率和死亡率的增加有关，最常见的原因是骨折和不良的神经肌肉调节导致意外跌倒。本文综述了免疫和内分泌系统与骨骼和肌肉病理生理学的联系，以及营养和体力活动对这些系统的影响的数据。最近的发现生长激素-胰岛素样生长因子I轴和性类固醇激素在衰老过程中的缺乏似乎与下丘脑-垂体-肾上腺轴和免疫功能的变化有关，并伴随着肿瘤坏死因子-α轴的活性增加。这与RANK/RANKL/护骨素途径的激活和胰岛素抵抗有关，从而影响肌肉和骨生理。维生素D缺乏会导致骨丢失和肌肉萎缩，而其他营养缺陷，如锌或镁的缺乏，可能会使这些分解代谢状态进一步复杂化。总结：由于导致骨骼和肌肉紊乱的营养缺乏是可纠正的因素，除了内分泌和免疫状态的评估外，仔细的营养评估可能提供重要的临床信息，使面临神经肌肉功能障碍、意外摔倒和骨折危险的老年患者能够成功地进行治疗。
Purpose of reviewBone loss and muscle wasting are associated with increased morbidity and mortality in the elderly, most frequently as a result of fractures associated with poor neuromuscular conditioning leading to accidental falls. This paper reviews data that link pathways of the immune and endocrine systems with bone and muscle pathophysiology, as well as data on the impact of nutrition and physical activity on these systems.Recent findingsThe growth hormone-insulin-like growth factor I axis and deficiencies in sex steroid hormones in aging appear linked with changes in the hypothalamic-pituitary-adrenal axis and immune function, accompanied by increased activity of the tumour necrosis factor-alpha axis. This is associated with activation of the RANK/RANKL/osteoprotegerin pathway and insulin resistance, affecting muscle and bone physiology. Vitamin D deficiency contributions to bone loss and muscle wasting, whereas other nutritional defects such as zinc or magnesium deficiencies may further complicate these catabolic states.SummaryAs nutritional deficiencies responsible for bone and muscle derangement are correctable factors, careful nutritional assessment, in addition to evaluation of endocrine and immune status, may provide clinically important information allowing successful management of elderly patients in danger of neuromuscular dysfunction, accidental falls and bone fractures.