What question did this study set out to answer?

Examine the relationship between body composition and bone microarchitecture in frail older women.

January 23, 2026

Bone Health and Body Composition in Pre-Frail and Frail Older Adult Women: Insights from High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT)

AFAlan L FernandesUniversidade Federal da Bahia DDDiogo S DomicianoHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo VCValeria F CaparboHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Key Points

Examine the relationship between body composition and bone microarchitecture in frail older women.
Cross-sectional study involving 280 older women, with 109 meeting frailty criteria.
Body composition assessed via dual-energy x-ray absorptiometry, categorized into four phenotypes.
Bone microarchitecture evaluated using high-resolution peripheral quantitative computed tomography.
Statistical analyses included generalized estimating equations and χ2 tests.
LALM group exhibited significantly smaller cortical area and thinner cortex at both tibia and radius compared to the obesity group.
Significantly lower bone strength was observed in the LALM group compared to obesity and obesity plus LALM groups.
Obesity was linked to more favorable bone microarchitecture than low muscle mass without obesity.

Abstract

Abstract Background Age-related muscle decline and obesity are associated with impaired bone health and substantially increased fragility and fracture risk; however, evidence in frail populations remains inconsistent. We investigated differences in bone microarchitecture across body composition phenotypes in frail older women. Methods This cross-sectional study included 280 older women, of whom 109 met the Fried frailty criteria. Body composition was assessed by dual-energy X-ray absorptiometry and categorized into four phenotypes: low appendicular lean mass (LALM; 20th percentile of residuals, −1.45), obesity (fat mass index 13 kg/m2), obesity with LALM, or neither condition. Bone microarchitecture was evaluated using high-resolution peripheral quantitative computed tomography (HR-pQCT). Statistical analyses included generalized estimating equations (GEE) with Bonferroni correction, χ2 tests, and Fisher’s exact tests. Results Compared with the obesity group, the LALM group exhibited smaller cortical area (Ct.Ar 7123 vs. 9018 mm2; age-adjusted p=.008) and thinner cortex (Ct.Th 0.8580.202 vs. 1.0310.217 mm; p=.043) at the tibia. Similar differences were observed at the radius (Ct.Ar 3312 vs. 4310 mm2; p=.002; Ct.Th 0.6420.175 vs. 0.7790.157 mm; p=.005). Additionally, compared with the obesity plus LALM group, the LALM group showed lower Ct.Ar, Ct.Th, total volumetric bone density (Tt.vBMD), and trabecular number (Tb.N), along with greater trabecular area (Tb.Ar) and trabecular separation (Tb.Sp) at the radius. Bone strength was significantly lower in the LALM group than in the obesity and obesity plus LALM groups. Conclusions Among pre-frail and frail older women, obesity was associated with favorable cortical and trabecular bone microarchitecture than those with low muscle mass without obesity, suggesting that excess adiposity may partially mitigate skeletal deterioration. Longitudinal studies are warranted to clarify the impact of body composition on fracture risk in frail adults.

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Cite This Study

Fernandes et al. (Mon,) studied this question.

synapsesocial.com/papers/69731022c8125b09b0d1fe92 https://doi.org/https://doi.org/10.1093/gerona/glag013

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