肌少-骨质疏松症的临床诊疗进展

doi:10.3877/cma.j.issn.1674-0785.2026.05.007

肌少-骨质疏松症是指同时存在骨质疏松/骨量减少和肌少症，出现骨量减低、肌肉容量减少、肌肉强度降低，可能导致活动功能障碍、虚弱、跌倒、骨折等不良事件，严重影响老年人身体健康和生活质量。肌少-骨质疏松症在老年人群中高发，全球总患病率为18.5%（95%CI：16.7%~20.3%），中国患病率为19.8%（95%CI：6.5%~33.0%）。肌少-骨质疏松症明显增加患者的骨折（HR=2.13）、摔倒（HR=1.54）和死亡（HR=1.75）风险，并与许多慢性疾病相关，造成了严重的医疗、社会和经济负担。肌少-骨质疏松症的筛查需要结合肌少症筛选工具（如SARC-CalF量表）与骨质疏松风险评估（如FRAX®）共同完成，目前尚无单一的筛选工具。肌少-骨质疏松症的系统治疗中，改善肌肉容量，提高肌力，改善身体平衡及活动能力，提高骨密度，避免出现跌倒和骨折，保证生活质量，是预防及治疗的重点。肌少-骨质疏松症的预防主要依靠于营养支持、运动干预，目前缺乏有效的药物治疗，需要更多的研究研制安全、有效提高肌肉容量及肌力的药物。

关键词: 肌少-骨质疏松症, 诊断, 干预, 治疗

Osteosarcopenia is defined as the coexistence of osteopenia/osteoporosis and sarcopenia, characterized by concurrent declines in bone mass, muscle mass, and muscle strength. This synergistic condition contributes to functional impairment and adverse outcomes including fatigue, falls, and fractures, and substantially diminishes the health and quality of life of older adults. The prevalence of osteosarcopenia is notably high in the elderly population, with a global estimate of 18.5% (95% confidence interval [CI]: 16.7~20.3%) and a Chinese prevalence of 19.8% (95%CI: 6.5~33.0%). Osteosarcopenia significantly increases the risk of fractures (hazard ratio [HR]=2.13), falls (HR=1.54), and death (HR=1.75) in patients, and is associated with many chronic diseases, imposing a substantial medical, social, and economic burden. Currently, no single screening tool exists for osteosarcopenia; therefore, detection typically requires a combination of sarcopenia-specific instruments (e.g., the SARC-CalF questionnaire) and osteoporosis risk assessment tools (e.g., FRAX®). In terms of systematic management, the primary therapeutic goals are to improve muscle mass and strength, enhance balance and mobility, increase bone density, prevent falls and fractures, and maintain overall quality of life. At present, prevention and treatment rely mainly on nutritional support and exercise interventions, as pharmacological options remain limited. Further research is urgently needed to develop safe and effective pharmacotherapies capable of improving muscle capacity and strength in this population.

Key words: Osteosarcopenia, Diagnosis, Intervention, Treatment

图1 肌少-骨质疏松症临床管理路径

表1 肌少-骨质疏松症干预措施总结

干预类别	治疗方式	证据等级	推荐强度
营养干预	维生素D + 钙剂^［32-33］	明确证据	强
营养干预	蛋白质/氨基酸补充^{［34,35,36］}	明确证据	强
营养干预	能量与营养平衡^［16］	间接证据	弱
运动干预	抗阻+冲击+平衡训练^{［41,42,43］}	明确证据	强
药物干预	睾酮/SARM^{［45,46,47,48］}	有限证据支持	有条件推荐
药物干预	激活素受体抑制剂^［49-50］	探索阶段	临床研究
药物干预	地舒单抗^［51］	探索阶段（积极数据支持）	有条件推荐

表1 肌少-骨质疏松症干预措施总结

干预类别	治疗方式	证据等级	推荐强度
营养干预	维生素D + 钙剂^［32-33］	明确证据	强
营养干预	蛋白质/氨基酸补充^{［34,35,36］}	明确证据	强
营养干预	能量与营养平衡^［16］	间接证据	弱
运动干预	抗阻+冲击+平衡训练^{［41,42,43］}	明确证据	强
药物干预	睾酮/SARM^{［45,46,47,48］}	有限证据支持	有条件推荐
药物干预	激活素受体抑制剂^［49-50］	探索阶段	临床研究
药物干预	地舒单抗^［51］	探索阶段（积极数据支持）	有条件推荐

1	Kara M, Kaymak B, Frontera W, et al. Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM [J]. J Rehabil Med, 2021,53(6): jrm00209.
2	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [J]. Age Ageing, 2019,48(1): 16-31.
3	Hirschfeld HP, Kinsella R, Duque G. Osteosarcopenia: where bone, muscle, and fat collide [J]. Osteoporos Int, 2017,28(10): 2781-2790.
4	Kirk B, Miller S, Zanker J, et al. A clinical guide to the pathophysiology, diagnosis and treatment of osteosarcopenia [J]. Maturitas, 2020, 140: 27-33.
5	黄宏兴, 史晓林, 李盛华, 等. 肌少-骨质疏松症专家共识 [J]. 中国骨质疏松杂志, 2022, 11(28): 1561-1570.
6	Chen S, Xu X, Gong H, et al. Global epidemiological features and impact of osteosarcopenia: a comprehensive meta-analysis and systematic review [J]. J Cachexia Sarcopenia Muscle, 2024, 15(1): 8-20.
7	Kirk B, Zanker J, Duque G. Osteosarcopenia: epidemiology, diagnosis, and treatment-facts and numbers [J]. J Cachexia Sarcopenia Muscle, 2020, 11(3): 609-618.
8	靳耀升, 赵朝阳, 郭娟娟. 基于Meta分析的亚洲人群肌少-骨质疏松症患病率的研究 [J]. 延边大学学报(自然科学版), 2025, 51(2): 110-118.
9	孙清, 吴玉霄, 崔立敏. 中国2型糖尿病患者肌少-骨质疏松症患病率的Meta分析 [J]. 中国全科医学, 2025 (12): 1520-1526.
10	Sepúlveda-Loyola W, Phu S, Bani Hassan E, et al. The joint occurrence of osteoporosis and sarcopenia (osteosarcopenia): definitions and characteristics [J]. J Am Med Dir Assoc, 2020, 21(2): 220-225.
11	Fahimfar N, Zahedi Tajrishi F, Gharibzadeh S, et al. Prevalence of osteosarcopenia and its association with cardiovascular risk factors in Iranian older people: Bushehr Elderly Health (BEH) program [J]. Calcif Tissue Int, 2020, 106(4): 364-370.
12	Torabi A, Afrashteh S, Moftian N, et al. The association between body fat distribution and osteosarcopenia in older adults: evidence from the PoCOsteo study [J]. Aging Clin Exp Res, 2025, 37(1): 336.
13	Yoshimura N, Muraki S, Oka H, et al. Do sarcopenia and/or osteoporosis increase the risk of frailty? A 4-year observation of the second and third ROAD study surveys [J]. Osteoporos Int, 2018, 29(10): 2181-2190.
14	Hairi NN, Cumming RG, Naganathan V, et al. Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the concord health and ageing in men project [J]. J Am Geriatr Soc, 2010, 58(11): 2055-2062.
15	Xu J, Wan CS, Ktoris K, et al. Sarcopenia is associated with mortality in adults: a systematic review and meta-analysis [J]. Gerontology, 2022, 68(4): 361-376.
16	Polito A, Barnaba L, Ciarapica D, et al. Osteosarcopenia: a narrative review on clinical studies [J]. Int J Mol Sci, 2022, 23(10): 5591.
17	Inoue T, Maeda K, Satake S, et al. Osteosarcopenia, the co-existence of osteoporosis and sarcopenia, is associated with social frailty in older adults [J]. Aging Clin Exp Res, 2022,34(3): 535-543.
18	Makizako H, Shimada H, Tsutsumimoto K, et al. Social frailty in community-dwelling older adults as a risk factor for disability [J]. J Am Med Dir Assoc, 2015, 16(11): 1003.e1007-1011.
19	Pasco JA, Mohebbi M, Holloway KL, et al. Musculoskeletal decline and mortality: prospective data from the Geelong osteoporosis study [J]. J Cachexia Sarcopenia Muscle, 2017, 8(3): 482-489.
20	Yoo JI, Kim H, Ha YC, et al. Osteosarcopenia in patients with hip fracture is related with high mortality [J]. J Korean Med Sci, 2018, 33(4): e27.
21	Janssen I, Shepard DS, Katzmarzyk PT, et al. The healthcare costs of sarcopenia in the United States [J]. J Am Geriatr Soc, 2004, 52(1): 80-85.
22	Zamboni M, Mazzali G, Fantin F, et al. Sarcopenic obesity: a new category of obesity in the elderly [J]. Nutr Metab Cardiovasc Dis, 2008, 18(5): 388-395.
23	刘娟, 丁清清, 周白瑜, 等. 中国老年人肌少症诊疗专家共识(2021) [J]. 中华老年医学杂志, 2021, 40(8): 943-952.
24	Tiftik T, Kara M, Koyuncu EG, et al. The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study [J]. Osteoporos Int, 2023, 34(1): 53-58.
25	Yang M, Hu X, Xie L, et al. Screening sarcopenia in community-dwelling older adults: SARC-F vs SARC-F combined with calf circumference (SARC-CalF) [J]. J Am Med Dir Assoc, 2018, 19(3): 277.e271-277.e278.
26	Kirk B, Cawthon PM, Arai H, et al. The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS) [J]. Age Ageing, 2024, 53(3): afae052.
27	Qiao X, Zhang L, Man F, et al. New indicators related to the osteosarcopenia in the elderly: assessment of intrinsic capacity [J]. BMC Geriatr, 2025, 25(1): 737.
28	Dolan E, Sale C. Protein and bone health across the lifespan [J]. Proc Nutr Soc, 2019, 78(1): 45-55.
29	Xie C, Wang C, Luo H. Increased risk of osteoporosis in patients with cognitive impairment: a systematic review and meta-analysis [J]. BMC Geriatr, 2023, 23(1): 797.
30	Frost HM. Bone's mechanostat: a 2003 update [J]. Anat Rec A Discov Mol Cell Evol Biol, 2003, 275(2): 1081-1101.
31	Huang T, Li C, Chen F, et al. Prevalence and risk factors of osteosarcopenia: a systematic review and meta-analysis [J]. BMC Geriatr, 2023, 23(1): 369.
32	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2022) [J]. 中国全科医学, 2023, 26(14): 1671-1691.
33	张勤, 康琳, 王建业, 等. 老年人肌少症门诊管理规范中国专家共识(2024版) [J]. 中华老年医学杂志, 2024, 43(12): 1511-1517.
34	Negm AM, Lee J, Hamidian R, et al. Management of Sarcopenia: A Network Meta-Analysis of Randomized Controlled Trials [J]. J Am Med Dir Assoc, 2022, 23(5): 707-714.
35	Liao CD, Chen HC, Huang SW, et al. The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: a systematic review and meta-regression analysis of randomized trials [J]. Nutrients, 2019, 11(8): 1713.
36	Iuliano S, Poon S, Robbins J, et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial [J]. BMJ, 2021, 375: n2364.
37	Pedersen AN, Cederholm T. Health effects of protein intake in healthy elderly populations: a systematic literature review [J]. Food Nutr Res, 2014, 58.
38	Rogeri PS, Zanella R Jr, Martins GL, et al. Strategies to prevent sarcopenia in the aging process: role of protein intake and exercise [J]. Nutrients, 2021, 14(1): 52.
39	Kemmler W, Kohl M, Jakob F, et al. Effects of high intensity dynamic resistance exercise and whey protein supplements on osteosarcopenia in older men with low bone and muscle mass. Final results of the randomized controlled FrOST study [J]. Nutrients, 2020, 12(8): 2341.
40	Bettis T, Kim BJ, Hamrick MW. Impact of muscle atrophy on bone metabolism and bone strength: implications for muscle-bone crosstalk with aging and disuse [J]. Osteoporos Int, 2018, 29(8): 1713-1720.
41	Atlihan R, Kirk B, Duque G. Non-pharmacological interventions in osteosarcopenia: a systematic review [J]. J Nutr Health Aging, 2021, 25(1): 25-32.
42	Hoffmann I, Shojaa M, Kohl M, et al. Exercise reduces the number of overall and major osteoporotic fractures in adults. Does supervision make a difference? Systematic review and meta-analysis [J]. J Bone Miner Res, 2022, 37(11): 2132-2148.
43	Papadopoulou SK, Papadimitriou K, Voulgaridou G, et al. Exercise and nutrition impact on osteoporosis and sarcopenia-the incidence of osteosarcopenia: a narrative review [J]. Nutrients, 2021, 13(12): 4499.
44	Banitalebi E, Faramarzi M, Ghahfarokhi MM, et al. Osteosarcopenic obesity markers following elastic band resistance training: a randomized controlled trial [J]. Exp Gerontol, 2020, 135: 110884.
45	Laurent MR, Dedeyne L, Dupont J, et al. Age-related bone loss and sarcopenia in men [J]. Maturitas, 2019, 122: 51-56.
46	Ng Tang Fui M, Hoermann R, Bracken K, et al. Effect of testosterone treatment on bone microarchitecture and bone mineral density in men: a 2-year RCT [J]. J Clin Endocrinol Metab, 2021, 106(8): e3143-e3158.
47	Laurent MR, Dubois V, Claessens F, et al. Muscle-bone interactions: From experimental models to the clinic? A critical update [J]. Mol Cell Endocrinol, 2016, 432: 14-36.
48	Mohan D, Rossiter H, Watz H, et al. Selective androgen receptor modulation for muscle weakness in chronic obstructive pulmonary disease: a randomised control trial [J]. Thorax, 2023, 78(3): 258-266.
49	Attie KM, Borgstein NG, Yang Y, et al. A single ascending-dose study of muscle regulator ACE-031 in healthy volunteers [J]. Muscle Nerve, 2013, 47(3): 416-423.
50	Becker C, Lord SR, Studenski SA, et al. Myostatin antibody (LY2495655) in older weak fallers: a proof-of-concept, randomised, phase 2 trial [J]. Lancet Diabetes Endocrinol, 2015, 3(12): 948-957.
51	Chotiyarnwong P, McCloskey E, Eastell R, et al. A pooled analysis of fall incidence from placebo-controlled trials of denosumab [J]. J Bone Miner Res, 2020, 35(6): 1014-1021.
52	Fang X, Xiao Y, Zhao X. Beyond symptoms: Uncovering the multidimensional impact of depression on sarcopenia and cardiovascular health [J]. J Affect Disord, 2025, 379: 605-606.
53	Park KS, Lee GY, Seo YM, et al. Disability, Frailty and depression in the community-dwelling older adults with osteosarcopenia [J]. BMC Geriatr, 2021, 21(1): 69.

[1]	王子怡, 谢苗苗, 薄舟洋, 孙园园, 武莉娜, 王睿丽. 产后子宫坏死的超声造影表现及诊断价值[J/OL]. 中华医学超声杂志（电子版）, 2026, 23(05): 400-407.
[2]	曾维波, 何燕妮, 熊燃, 王珍, 许智莉, 刘红梅. 两广地区颈动脉狭窄及广东地区肾动脉狭窄与血管超声危急值管理现状调研[J/OL]. 中华医学超声杂志（电子版）, 2026, 23(05): 355-359.
[3]	陈曼, 郑雯, 常才, 俞清, 肖沪生, 赵宝珍, 施仲伟, 陈悦, 李丽蟾, 王文平. 上海市超声诊断设备配置现状调查与质量控制管理策略优化[J/OL]. 中华医学超声杂志（电子版）, 2026, 23(05): 369-373.
[4]	王鑫, 阎龙, 戴朝六. 人工智能化与个体化在肝癌微创外科的应用[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 315-318.
[5]	吴禹锟, 项方政, 郑伏甫. 上尿路尿路上皮癌保肾策略新进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(04): 367-372.
[6]	中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南（2026年版）[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 443-507.
[7]	李海波, 李洋, 曾涛, 冯程, 李华. 基于3期RCT中国人群数据的肝细胞癌一线治疗方案网状Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 558-567.
[8]	苟亚博, 肖晋昌, 神斌, 黄乾鑫, 魏宁, 刘洪涛, 徐浩, 祖茂衡, 张庆桥. 不同类型肝静脉型布加综合征介入治疗疗效分析[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 591-599.
[9]	林婉琪, 任芳菲, 钟伟航, 杨卿, 马玲, 陈海丽, 向莎, 陈孟娇, 朱丽萍, 何心念, 张献玲. 基于多维度评估的前瞻性干预策略在肝癌肝移植围手术期的应用及效果[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 612-618.
[10]	谢敖文, 雷金, 王攀, 王文儿, 于毅, 彭欣然, 陶承刚, 黄熙龙. 脾外伤分级及治疗：单中心260例经验总结[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 627-633.
[11]	柴鑫茹, 张小杉, 刘笑笑, 姜莹, 赵捷, 施依璐, 张丹, 段莎莎. 卵圆孔未闭与老年隐源性卒中的相关性及治疗的研究进展[J/OL]. 中华临床医师杂志(电子版), 2026, 20(05): 381-385.
[12]	洪士皓, 杨昕. 个性化骨科手术中3D打印技术的临床应用与展望[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 249-255.
[13]	席雅楠, 姚国栋, 郭秀珍, 高斌礼, 赵渊, 李婷, 钟李岩, 李梦倩. IDEAS模式对机器人辅助结直肠癌根治术患者康复结局的影响[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 285-291.
[14]	新昕, 王永柏. 孤独症谱系障碍儿童自传体记忆异常对社会功能影响及干预策略[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 320-326.
[15]	齐洪武, 徐泽雨. 脑脓肿的临床诊治进展[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 327-331.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Advances in the diagnosis and treatment of osteosarcopenia

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Advances in the diagnosis and treatment of osteosarcopenia