Sarcopenia and osteoporosis are prevalent age-related musculoskeletal disorders that frequently coexist and interact, giving rise to the clinical entity known as osteosarcopenia. Although traditionally considered distinct entities, growing evidence indicates that muscle and bone are functionally integrated through biomechanical and biochemical crosstalk. Sarcopenia is characterized by progressive loss of skeletal muscle mass, strength, and function, whereas osteoporosis is defined by reduced bone mineral density (BMD) and microarchitectural deterioration, resulting in increased fracture risk. Both conditions share common risk factors, including aging, chronic inflammation, hormonal changes, physical inactivity, and nutritional deficiencies. Emerging evidence highlights the important role of muscle-derived myokines, bone-derived osteokines, and adipokines in mediating inter-organ communication within the musculoskeletal unit. This narrative review synthesizes current evidence supporting osteosarcopenia as an integrated musculoskeletal syndrome, with a particular focus on biomechanical loading, biochemical crosstalk, and inflammatory signaling. In addition, we discuss diagnostic challenges and therapeutic strategies, emphasizing integrated assessment and management approaches that target skeletal fragility, muscle dysfunction, and musculoskeletal interfaces to reduce frailty, falls, and fractures in aging populations.
Jeonghyeon Seo, Sang Hoon Hwang, Ji Yeon Yoon et al.· Journal of Korean Neurosurgi...· 0 citations
OBJECTIVE
To develop and validate a hierarchical deep learning model for differentiating acute and chronic lumbar osteoporotic vertebral compression fractures (OVCFs) using X-ray images.
MATERIALS AND METHODS
We retrospectively reviewed approximately 2600 lateral lumbar radiographs obtained from patients clinically suspected of having OVCFs between 2007 and 2022. After excluding poor-quality images and surgically instrumented vertebrae, 1299 radiographs (6495 vertebral patches, L1-L5) were included. Labeling was performed by neurosurgeons and radiologists using X-ray images, with CT and/or MRI findings serving as the reference standard. A two-step hierarchical classification was implemented: first classifying vertebrae into Normal-Chronic, Acute, and Indeterminate (cement-augmented vertebrae without instrumentation) groups, followed by subdivision of the Normal-Chronic group into Normal and Chronic categories.
RESULTS
A total of 1299 radiographs were evaluated. The hierarchical model achieved an accuracy of 91% in the initial three-class step. For the detection of acute fractures in the final classification step, the model demonstrated a sensitivity of 91.0% (95% CI 84.8-95.0%), a specificity of 82.1% (95% CI 79.8-84.5%), and a high negative predictive value (NPV) of 98.8% (95% CI 97.9-99.3%). The Normal-aligned hierarchical approach outperformed the Acute-aligned and end-to-end models, particularly for acute and chronic cases.
CONCLUSION
The proposed hierarchical approach enhances the diagnostic utility of standard X-ray images by enabling more accurate classification of lumbar fracture types. This study is limited by its single-institution retrospective design. This model may reduce reliance on advanced imaging and support faster and more informed clinical decision-making.
Joohyun Kim, Keewon Shin, Sungjae An et al.· Skeletal Radiology· 0 citations
Thoracolumbar trauma in elderly patients has become increasingly important as population aging has reshaped the epidemiology of spinal injury. In the aging spine, low-energy trauma can produce clinically significant or unstable fractures because osteoporosis, degenerative stiffness, and rigid spine disorders alter mechanical behavior. Conventional classification systems and guideline-based algorithms remain useful for describing fracture morphology, neurological status, and structural instability. However, their applicability in elderly patients is limited because treatment decisions must account for frailty-related vulnerability and the functional consequences of immobilization. This review summarizes the distinctive features of thoracolumbar trauma in the aging spine and proposes an integrated framework that combines structural injury severity with frailty-based assessment of treatment tolerance. Frailty reduces physiologic reserve and limits the ability to tolerate treatment and recover after injury, while poor bone quality and spinal rigidity increase the risk of structural failure even with guideline-concordant care. Treatment should aim to restore stability, preserve neurological function, control pain, and enable early mobilization while minimizing physiologic burden. Depending on structural demand, treatment may range from non-operative care or vertebral augmentation in appropriate patients to definitive fixation, with selection guided by bone quality, frailty, and expected functional benefit. Thoracolumbar trauma in the aging spine should be managed as a distinct clinical entity for which an integrated frailty-based framework may better support practical, patient-centered decision-making.
Seung-Hoon Lee, Matthew W. Scarsbrook, Joonho Byun et al.· Journal of Korean Neurosurgi...· 0 citations
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