It is therefore not surprising that recent reports find sarcopenia and osteoporosis commonly co-exist in older adults who have sustained a hip fracture [6, 7]. Indeed, the parallels between osteoporosis and sarcopenia are striking [8]. Both are age-related decrements in mass and quality of bone and muscle, respectively [9]. Both cause major personal morbidity, increase healthcare costs, and reduce quantity/quality of life. Moreover, both are multifactorial in origin being caused PF-562271 supplier (at least in part) by inflammation, hormonal and/or nutritional deficits, toxins, and sedentariness

[10]. Thus, it could be argued that they are the same disease manifest in different physiologic systems. However, while osteoporosis is widely recognized, sarcopenia remains largely unknown and undiagnosed in clinical care. In part, this clinical nonrecognition reflects lack of a single consensus definition; clearly, the osteoporosis field advanced coincident with widespread adoption of a diagnostic see more approach provided by the World Health Organization DNA Damage inhibitor classification based on BMD [11]. This approach provided a framework to increase disease recognition, allowed clinical application, and facilitated medication development. However, it is apparent that bone loss, and thus low bone mass, is not sufficient to explain the dramatic increase in fracture risk with advancing age. Most simply,

there is not an exponential decline in BMD coincident with the near exponential increase in fracture risk in older age. This has been recognized and it is now widely appreciated that a simple mass-based approach is not ideal to identify those at risk for fragility fracture; this appreciation has led to development of fracture risk calculators such as FRAX [12]. Such calculators are a major advance, but remain imperfect as some individuals currently identified as being at low risk

do sustain fragility fracture [13]. Perhaps these individuals at “low risk” simply sustained falls to cause their fracture. Thus, while an oversimplification, we believe that much of the increased fracture risk currently attributed to advancing age results from impaired mobility (“dysmobility”) leading to falls and resulting in fractures [14]. If this is correct, clinical recognition and resulting treatment of dysmobility syndrome could Roflumilast be a major advance in care of older adults. Is another syndrome needed? Why not just diagnose sarcopenia? As noted above, it seems likely that sarcopenia, the age-related decline in muscle mass and function, [15] is a major contributor to the increased falls and fracture risk seen with advancing age [5, 16, 17]. However, despite burgeoning interest in and expansion of pathophysiologic knowledge regarding sarcopenia, there has been virtually no translation of this entity to clinical care. In part, this reflects lack of widespread agreement on diagnostic criteria [5].