Gluteal muscle composition differentiates fallers from non-fallers in community dwelling older adults

Mario Inacio, Alice S Ryan, Woei-Nan Bair, Michelle Prettyman, Brock A Beamer, Mark W Rogers, Mario Inacio, Alice S Ryan, Woei-Nan Bair, Michelle Prettyman, Brock A Beamer, Mark W Rogers

Abstract

Background: Impaired balance, loss of mobility and falls are major problems associated with changes in muscle in older adults. However, the extent to which muscle composition and related performance measures for different lower limb muscles are associated with falls in older individuals is unclear. This study evaluated lower limb muscle attenuation, intramuscular adipose tissue (IMAT) infiltration and muscle performance in older fallers and non-fallers.

Methods: For this cross-sectional study, fifty-eight community dwelling older individuals (>65 years) were classified into fallers (n = 15) or non-fallers (n = 43). Computed tomography (CT) was used to determine muscle attenuation and intramuscular adipose tissue (IMAT) of multiple thigh and hip muscles. Muscle performance was assessed with isokinetic dynamometry.

Results: For both groups, Rectus Femoris showed the highest muscle attenuation and lowest IMAT infiltration, and Gluteus Maximus and Gluteus Medius/Minimus muscles had the lowest muscle attenuation and highest IMAT infiltration. Fallers exhibited lower muscle attenuation and higher IMAT infiltration than non-faller participants in most muscles, where the gluteal muscles were the most affected (p < 0.05). Fallers also showed a lower peak hip abduction torque (p < 0.05). There were significant associations (r = 0.31 to 0.53) between joint torques and muscle composition, with the strongest associations between Gluteus Medius/Minimus and hip abduction strength.

Conclusions: While fallers were generally differentiated from non-fallers by muscle composition, the most affected muscles were the proximal gluteal muscles of the hip joint accompanied by lower hip abduction strength, which may contribute to impaired balance function and increased risk for falls.

Figures

Figure 1
Figure 1
Representative example of computed tomography (CT) scans from an older adult showing A) abdominal scan; B) hip scan; C) thigh scan. 1. Psoas; 2. Gluteus Medius and Minimus; 3. Gluteus Maximus; 4. Rectus Femoris; 5. Vastus Lateralis; 6. Hamstrings compartment; 7. Adductor Magnus and Longus.
Figure 2
Figure 2
Comparison between non-faller and faller groups for muscle attenuation (HU). Data expressed as Mean ± SEM. * indicates significant difference (p < 0.05).
Figure 3
Figure 3
Comparison between non-faller and faller groups for normalized intramuscular adipose tissue (IMAT) (%). Data expressed as Mean ± SEM. *indicates significant difference (p < 0.05).

References

    1. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health. 1992;14(7):1020–1023. doi: 10.2105/AJPH.82.7.1020.
    1. Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. J Forensic Sci. 1996;14(5):733–746.
    1. Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist. 1994;14(1):16–23. doi: 10.1093/geront/34.1.16.
    1. Stevens J. Fatalities and injuries from falls among older adults–United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006;14(45):1221–1224.
    1. Brauer SG, Burns YR, Galley P. A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers. J Gerontol A Biol Sci Med Sci. 2000;14(8):M469–M476. doi: 10.1093/gerona/55.8.M469.
    1. De Rekeneire N, Visser M, Peila R, Nevitt MC, Cauley JA, Tylavsky FA, Simonsick EM, Harris TB. Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study. J Am Geriatr Soc. 2003;14(6):841–846. doi: 10.1046/j.1365-2389.2003.51267.x.
    1. Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille ML, Zhang Y, Rogers MW. Lateral balance factors predict future falls in community-living older adults. Arch Phys Med Rehabil. 2008;14(9):1708–1713. doi: 10.1016/j.apmr.2008.01.023.
    1. Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol. 1994;14(2):M72–M84. doi: 10.1093/geronj/49.2.M72.
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;14(26):1701–1707. doi: 10.1056/NEJM198812293192604.
    1. Mille ML, Johnson ME, Martinez KM, Rogers MW. Age-dependent differences in lateral balance recovery through protective stepping. Clin Biomech (Bristol, Avon) 2005;14(6):607–616. doi: 10.1016/j.clinbiomech.2005.03.004.
    1. Mille M, Hilliard M, Martinez K, Zhang Y, Edwards B, Rogers M. One step, two steps, three steps more … directional vulnerability to falls in community dwelling older people. J Gerontol A Biol Sci Med Sci. 2013;14(12):1540–1548. doi: 10.1093/gerona/glt062.
    1. DiPietro L. Physical activity in aging: changes in patterns and their relationship to health and function. J Gerontol A Biol Sci Med Sci. 2001;14:13–22.
    1. Gottschall JS, Okita N, Sheehan RC. Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking. J Electromyogr Kinesiol. 2012;14(1):67–73. doi: 10.1016/j.jelekin.2011.10.003.
    1. Rogers MW, Mille ML. Lateral stability and falls in older people. Exerc Sport Sci Rev. 2003;14(4):182–7. doi: 10.1097/00003677-200310000-00005.
    1. Johnson ME, Mille ML, Martinez KM, Crombie G, Rogers MW. Age-related changes in hip abductor and adductor joint torques. Arch Phys Med Rehabil. 2004;14(4):593–7. doi: 10.1016/j.apmr.2003.07.022.
    1. Rasch A, Bystrom AH, Dalen N, Berg HE. Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis. Acta Orthop. 2007;14(4):505–10. doi: 10.1080/17453670710014158.
    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;14(4):412–23. doi: 10.1093/ageing/afq034.
    1. Cawthon PM, Fox KM, Gandra SR, Delmonico MJ, Chiou CF, Anthony MS, Sewall A, Goodpaster B, Satterfield S, Cummings SR, Harris TB. Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc. 2009;14(8):1411–9. doi: 10.1111/j.1532-5415.2009.02366.x.
    1. Lang T, Cauley JA, Tylavsky F, Bauer D, Cummings S, Harris TB. Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: the health, aging, and body composition study. J Bone Miner Res. 2010;14(3):513–9. doi: 10.1359/jbmr.090807.
    1. Goodpaster BH, Carlson CL, Visser M, Kelley DE, Scherzinger A, Harris TB, Stamm E, Newman AB. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. J Appl Physiol. 2001;14(6):2157–65.
    1. Nakagawa Y, Hattori M, Harada K, Shirase R, Bando M, Okano G. Age-related changes in intramyocellular lipid in humans by in vivo H-MR spectroscopy. Gerontology. 2007;14(4):218–23. doi: 10.1159/000100869.
    1. Cree MG, Newcomer BR, Katsanos CS, Sheffield-Moore M, Chinkes D, Aarsland A, Urban R, Wolfe RR. Intramuscular and liver triglycerides are increased in the elderly. J Clin Endocrinol Metab. 2004;14(8):3864–71. doi: 10.1210/jc.2003-031986.
    1. Marcus RL, Addison O, Kidde JP, Dibble LE, Lastayo PC. Skeletal muscle fat infiltration: impact of age, inactivity, and exercise. J Nutr Health Aging. 2010;14(5):362–6. doi: 10.1007/s12603-010-0081-2.
    1. Ryan AS, Nicklas BJ. Age-related changes in fat deposition in mid-thigh muscle in women: relationships with metabolic cardiovascular disease risk factors. Int J Obes Relat Metab Disord. 1999;14(2):126–32. doi: 10.1038/sj.ijo.0800777.
    1. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, Simonsick EM, Harris TB. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. 2005;14(3):324–33. doi: 10.1093/gerona/60.3.324.
    1. Schafer AL, Vittinghoff E, Lang TF, Sellmeyer DE, Harris TB, Kanaya AM, Strotmeyer ES, Cawthon PM, Cummings SR, Tylavsky FA, Scherzinger AL, Schwartz AV. Fat infiltration of muscle, diabetes, and clinical fracture risk in older adults. J Clin Endocrinol Metab. 2010;14(11):E368–72. doi: 10.1210/jc.2010-0780.
    1. Tuttle LJ, Sinacore DR, Mueller MJ. Intermuscular adipose tissue is muscle specific and associated with poor functional performance. J Aging Res. 2012;14:1–7.
    1. W.H.O. Falls. 2012. Available from: .
    1. Bouche KG, Vanovermeire O, Stevens VK, Coorevits PL, Caemaert JJ, Cambier DC, Verstraete K, Vanderstraeten GG, Danneels LA. Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients. BMC Musculoskelet Disord. 2011;14:65. doi: 10.1186/1471-2474-12-65.
    1. Ryan AS, Nicklas BJ, Dennis KE. Aerobic exercise maintains regional bone mineral density during weight loss in postmenopausal women. J Appl Physiol (1985) 1998;14(4):1305–10.
    1. Lord SR, Rogers MW, Howland A, Fitzpatrick R. Lateral stability, sensorimotor function and falls in older people. J Am Geriatr Soc. 1999;14(9):1077–81.
    1. Goodpaster BH, Thaete FL, Kelley DE. Composition of skeletal muscle evaluated with computed tomography. Ann N Y Acad Sci. 2000;14:18–24.
    1. Hatton AL, Sportsphysio JL, Brauer SG, Clark RA, Crossley KM. Dynamic single-leg balance performance is impaired in individuals with hip chondropathy. Arthritis Care Res (Hoboken) 2013. doi:10.1002/acr.22193.
    1. Sims KJ, Richardson CA, Brauer SG. Investigation of hip abductor activation in subjects with clinical unilateral hip osteoarthritis. Ann Rheum Dis. 2002;14(8):687–92. doi: 10.1136/ard.61.8.687.
    1. Marcus RL, Addison O, Dibble LE, Foreman KB, Morrell G, Lastayo P. Intramuscular adipose tissue, sarcopenia, and mobility function in older individuals. J Aging Res. 2012;14:629–637.
    1. Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2012. [Epub ahead of print]
    1. Grabiner MD, Bareither ML, Gatts S, Marone J, Troy KL. Task-specific training reduces trip-related fall risk in women. Med Sci Sports Exerc. 2012;14(12):2410–4.
    1. Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, Tylavsky FA. Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain. J Gerontol A Biol Sci Med Sci. 2005;14(11):1420–4. doi: 10.1093/gerona/60.11.1420.
    1. Owings TM, Pavol MJ, Grabiner MD. Mechanisms of failed recovery following postural perturbations on a motorized treadmill mimic those associated with an actual forward trip. Clin Biomech (Bristol, Avon) 2001;14(9):813–9. doi: 10.1016/S0268-0033(01)00077-8.
    1. Lim YP, Lin YC, Pandy MG. Muscle function during gait is invariant to age when walking speed is controlled. Gait Posture. 2013;14(2):253–9. doi: 10.1016/j.gaitpost.2012.11.020.
    1. Schulz BW, Ashton-Miller JA, Alexander NB. Compensatory stepping in response to waist pulls in balance-impaired and unimpaired women. Gait Posture. 2005;14(3):198–209. doi: 10.1016/j.gaitpost.2004.09.004.
    1. Goodpaster BH, Chomentowski P, Ward BK, Rossi A, Glynn NW, Delmonico MJ, Kritchevsky SB, Pahor M, Newman AB. Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial. J Appl Physiol. 2008;14(5):1498–503. doi: 10.1152/japplphysiol.90425.2008.
    1. Prior SJ, Joseph LJ, Brandauer J, Katzel LI, Hagberg JM, Ryan AS. Reduction in midthigh low-density muscle with aerobic exercise training and weight loss impacts glucose tolerance in older men. J Clin Endocrinol Metab. 2007;14(3):880–6. doi: 10.1210/jc.2006-2113.
    1. Ryan AS, Nicklas BJ, Berman DM, Dennis KE. Dietary restriction and walking reduce fat deposition in the midthigh in obese older women. Am J Clin Nutr. 2000;14(3):708–13.
    1. Sipila S, Suominen H. Effects of strength and endurance training on thigh and leg muscle mass and composition in elderly women. J Appl Physiol. 1995;14(1):334–40.
    1. Taaffe DR, Henwood TR, Nalls MA, Walker DG, Lang TF, Harris TB. Alterations in muscle attenuation following detraining and retraining in resistance-trained older adults. Gerontology. 2009;14(2):217–23. doi: 10.1159/000182084.
    1. Conroy MB, Kwoh CK, Krishnan E, Nevitt MC, Boudreau R, Carbone LD, Chen H, Harris TB, Newman AB, Goodpaster BH. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis Care Res (Hoboken) 2012;14(1):15–21. doi: 10.1002/acr.20588.
    1. Mackenzie L, Byles J, D’Este C. Validation of self-reported fall events in intervention studies. Clin Rehabil. 2006;14(4):331–9. doi: 10.1191/0269215506cr947oa.

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