Calf circumference as a simple tool versus chest-CT derived skeletal muscle index in assessing osteosarcopenia and one-year outcomes in osteoporotic vertebral fractures

Sep 30, 2026

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Osteosarcopenia, the co-occurrence of osteoporosis and sarcopenia, is often missed because diagnostic approaches are limited, despite its strong links to fractures and falls in older adults. This study compared calf circumference and chest CT–derived T12 skeletal muscle index to assess osteosarcopenia and to predict one-year outcomes after percutaneous vertebroplasty for osteoporotic vertebral fractures, including refractures, falls, ADL, and ODI.

LanguageEnglish

CategoryResearch & Report

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Abstract

Background and aims

Methods

Results

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Introduction

Aging Clinical and Experimental Research (2026) 38:30 [https://doi.org/10.1007/s40520-025-03281-4](https://doi.org/10.1007/s40520-025-03281-4) RESEARCH Calf circumference as a simple tool versus chest-CT derived skeletal muscle index in assessing osteosarcopenia and one-year outcomes inosteoporotic vertebral fractures Fangying Lu1,2 · Jiangjie Chen1,2 · Zhaokai Liu1,2 · Chenghao Xu1,2 · Chiting Yuan2 · Shaohua Fan2 · Tao-Hsin Tung3 · Liwei Zhang1,2,4 · Dun Hong1,2,4 Received: 22 August 2025 / Revised: 30 October 2025 / Accepted: 1 December 2025 © The Author(s) 2026 Abstract Background and aims Osteosarcopenia, the coexistence of osteoporosis and sarcopenia, is underdiagnosed due to limited diagnostic methods despite its strong association with fractures and falls in older adults. This study compared calf circumference (CC) with chest-CT for assessing osteosarcopenia and predicting outcomes in patients with osteoporotic vertebral fractures (OVFs), aiming to assess simpler and more accessible tools for osteosarcopenia in resource-limited settings. Methods We studied 149 patients with OVFs who underwent percutaneous vertebroplasty (PVP), using chest-CT (T12 skeletal muscle index, T12 SMI) and CC to diagnose sarcopenia, alongside grip strength (GS) and Short Physical Performance Battery (SPPB) tests. We compared outcomes like re-fractures, falls, Activities of Daily Living (ADL), and Oswestry Disability Index (ODI) scores over one year. Results Osteosarcopenia prevalence was 47% with chest-CT and 52% with CC, showing moderate agreement (Kappa = 0.60) . Osteosarcopenia patients had worse outcomes, including lower ADL, higher ODI, and more re-fractures and falls. CC had high sensitivity (84%) but moderate specificity (76%) . Binary logistic regression identified abdominal circumference (AC) as the main factor affecting diagnostic consistency. Osteosarcopenia diagnosed by chest-CT were association with re-fracture in one year. Conclusion Chest-CT derived T12 SMI defined osteosarcopenia is associated with re-fractures in OVF, while CC provides a simple and sensitive screening tool for osteosarcopenia patients, particularly in fracture patients without markedly high AC. Keywords Osteosarcopenia · Vertebral fractures · Calf circumference · Chest-CT · Re-fractures · Falls Fangying Lu and Jiangjie Chen contributed equally to this work. 􀀍 Liwei Zhang [medzlw@sina.com](medzlw@sina.com) 􀀍 Dun Hong [hongd@enzemed.com](hongd@enzemed.com) 1 Bone Metabolism and Development Research Center, Taizhou Hospital, Wenzhou Medical University, Linhai, China 2 Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China 3 Department of Clinical Research, Enze Medical Center, Taizhou, China 4 Bone Metabolism and Development Research Center, Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, 150 Ximen St, Linhai, Zhejiang 317000, China Introduction Osteoporosis and sarcopenia are both prevalent age-related diseases. In 2009, the coexistence of osteopenia/osteoporosis and sarcopenia was described as “sarco-osteopenia” or“sarco-osteoporosis” [1] . In 2017, “osteosarcopenia” was introduced to define the simultaneous presence of osteoporosis and sarcopenia in older adults [2] . This term has since been widely adopted in subsequent research [3] . Studies demonstrated that osteosarcopenia increased the risk of fractures, falls, and mortality [4] . Epidemiological studies reported osteosarcopenia prevalence of 5–37% in community-dwelling older adults and about 46% in those with lowtrauma fractures [5] . Osteoporotic vertebral fractures (OVFs) have emerged asa major cause of back pain and long-term disability in the 1 3 aging population [6] . Sarcopenia was a known risk factor for OVFs, but osteosarcopenia in these patients was often not clearly defined [7–10] . This gap can be attributed to several reasons.

FAQs

What was the main purpose of comparing calf circumference with chest-CT in this study?

To assess osteosarcopenia and predict one-year outcomes in patients with osteoporotic vertebral fractures, while evaluating simpler tools suitable for resource-limited settings.

How did the diagnostic prevalence of osteosarcopenia differ between chest-CT and calf circumference?

Osteosarcopenia prevalence was 47% with chest-CT and 52% with calf circumference, with moderate agreement (Kappa = 0.60).

What outcomes were worse in osteosarcopenia patients, and what did calf circumference offer?

Osteosarcopenia patients had lower ADL, higher ODI, and more re-fractures and falls. Calf circumference showed high sensitivity (84%) but moderate specificity (76%) as a simple screening tool.

Sep 30, 2026

Upload by Levi