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ObjectiveTo evaluate the associations between definitions of sarcopenia and clinical outcomes and the ability of the definitions to discriminate those with a high likelihood of having these outcomes from those with a low likelihood.DesignOsteoporotic Fractures in Men Study.SettingSix clinical centers.ParticipantsCommunity-dwelling men aged 65 and older (N = 5,934).MeasurementsSarcopenia definitions from the International Working Group, European Working Group on Sarcopenia in Older Persons, Foundation for the National Institutes of Health Sarcopenia Project, Baumgartner, and Newman were evaluated. Recurrent falls were defined as two or more self-reported falls in the year after baseline (n = 694, 11.9%). Incident hip fractures (n = 207, 3.5%) and deaths (n = 2,003, 34.1%) were confirmed according to central review of medical records over 9.8 years. Self-reported functional limitations were assessed at baseline and 4.6 years later. Logistic regression or proportional hazards models were used to estimate associations between sarcopenia and falls, hip fractures, and death. The discriminative ability of the sarcopenia definitions (vs reference models) for these outcomes was evaluated using area under the receiver operating characteristic curve or C-statistics. Referent models included age alone for falls, functional limitations and mortality, and age and bone mineral density for hip fractures.ResultsThe association between sarcopenia according to the various definitions and risk of falls, functional limitations, and hip fractures was variable; all definitions were associated with greater risk of death, but none of the definitions materially changed discrimination based on the AUC and C-statistic when compared with reference models (change ≤1% in all models).ConclusionSarcopenia definitions as currently constructed did not consistently improve prediction of clinical outcomes in relatively healthy older men.

ObjectivesTo determine whether older women with diabetes mellitus have a greater longitudinal decline in physical performance than those without and whether any decline differs according to insulin sensitizer use.DesignProspective cohort study.SettingBaltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela, Pennsylvania.ParticipantsCommunity-dwelling women (mean age 78.5 ± 3.6) enrolled in the Study of Osteoporotic Fractures in 1997-98 and restudied 4.9 ± 0.6 years later (N = 2,864).MeasurementsWomen were categorized as having no diabetes mellitus (n = 2,680) or having diabetes mellitus (n = 184). A prescription medication inventory was used to determine use of insulin sensitizers (metformin and thiazolidinedione). The outcomes were longitudinal changes in physical performance measures, including grip strength, usual walk speed, and rapid walk speed.ResultsEstimates from fully adjusted models showed that women with diabetes mellitus had greater declines in usual walk speed (-0.16 m/s, 95% confidence interval (CI) = -0.19 to -0.14) and rapid walk speed (-0.21 m/s, 95% CI = -0.24 to -0.17) than those without (usual walk speed -0.11 m/s, 95% CI = -0.12 to -0.11, P < .001; rapid walk speed -0.15 m/s, 95% CI = -0.16 to -0.14; P = .005). Women with diabetes mellitus taking insulin sensitizers had less decline in usual walk speed than those not taking insulin sensitizers (P < .001). Declines in grip strength did not differ significantly by diabetes mellitus status or insulin sensitizer use.ConclusionOlder women with diabetes mellitus have a greater decline in walk speed, but not grip strength, than older women without diabetes mellitus. Clinical studies in older adults to determine whether diabetes mellitus treatments such as insulin sensitizers can prevent loss in walk speed and mobility are needed.