MEDICAL RESEARCH CENTRE-KASTURBA HEALTH SOCIETY

CONFERENCE-3

Dr. Rama Vaidya- Director, Division of Endocrine and Metabolic Disorders of MRC-KHS gave an Oration lecture at the Annual Zonal Conference of the Indian Menopausal Society (Jaipur Chapter). The title of her talk was "Postmenopausal triad of sarcopenia, obesity and osteoporosis: a covert prodrome of frailty".

Today, India is staring at a population problem of increasing number of senior citizens. Roughly sixty million women in India are over 60 years. By 2026 the projected number of postmenopausal women in India would touch 103 million.1 

Frailty is known to occur in people over 65 years. If this frailty is not prevented and/or treated, it would lead to disability, falls, dependency, hospitalization / instituitionalization, and mortality. With increasing pattern of nuclear families and old frail parents having only one child they may be needed to be shifted to facility where “Assisted Living” is feasible.  

We at MRC-KHS have recognized the need to prevent frailty by identifying pre-frailty and reversing frailty through integrative trans-disciplinary rehabilitative programs. MAITREYI is one such module developed at the institute for menopausal and postmenopausal health care.

There is an interlinked triad of sarcopenia, obesity and osteoporosis in the elderly and there is an urgent need to identify those who are at risk whether they are obese or lean. While both may have equal possibility of sarcopenia and poor bone health, the thin/lean frails are easily identifiable while fat frails are not so easily identified.2 A review of literature has now established that obesity is not protective for bone health but the relationship of BMI to fracture risk is “U” shape.3 Therefore, the importance of maintaining peak muscle mass in young age and a check on menopausal phase-related accelerated loss of muscle mass and strength is critical.4,5,6 Moreover, the obese have ectopic fat in side vertebral bone marrow. Hence, the obese and adipose individuals not only have ectopic fat in their liver (NAFLD) but have osteosteatosis and myosteastosis. The accelerated aging was in direct proportion to BMI and fat percentage but  inversely proportion to skeletal muscle mass as was observed during MAITREYI health screening of  Ghoghari women. Targeting this ectopic fat through lifestyle change and weight loss and or specific targeted pharmacological measures is important.

References

  1. Chapter 2 census 2010 vital Statistics.
  2. Rama Vaidya. Obesity, sarcopenia and postmenopausal osteoporosis: An interlinked triad!  J Midlife Health. 2014;5(1):1–2.
  3. Andrea Palermo et al. BMI and BMD: The Potential Interplay between Obesity and Bone Fragility. Int J Environ Res Public Health.2016;13:544)  
  4. Skeletal  Muscle  Mass  Across  Life -Span Am J Hum Biol. 2010; 22: 76–82. 
  5. Vaidya RA  et al.  Sarcopenia at Menopause: Is it Phase-Specific or Multi-modal? Chapter 13 in Postmenopausal Ostoporosis. Ed Meeta. 1st Ed: 2013; pp 241-255.
  6. Rama Vaidya, Ashok Vaidya. Sarcopenic Obesity in postmenopausal women: A silent forerunner of frailty. Text Book of Geriatric Medicine.  Ed Pratap Sanchetee Publisher Paras Medical Publisher Aegis of Indian Academy of Geriatrics. Chapter 18. pp 320-323.