Keywords
sarcopenia
nutrition
diet
elderly
exercise
vitamin D
How to Cite
Abstract
Osteoporosis is considered the most frequent rheumatic pathology in the elderly population. It is often accompanied by sarcopenia, defined as the progressive loss of skeletal muscle mass and strength. Together, these conditions increase the risk of falls, fractures, disability, lower quality of life, and frequent hospitalization. This means increased healthcare costs for all European countries, due to the increase in the average age and elderly population. Multiple pharmacological therapies are available for osteoporosis, but the prevention seems to be an important tool to reduce the risk of fracture and hospitalization of patients. A healthy lifestyle, consisting of the right amount of nutrients and micronutrients and physical exercise can help prevent the development of osteoporosis and sarcopenia in the elderly. This review brings together the information present in the literature on the benefits that nutrients and micronutrients, naturally present in foods, have on the prevention of these pathologies. it is suggested that a correct intake of proteins, calcium, phosphorus, magnesium, vitamin.D, vitamin C and antioxidants, vitamin K and omega 3, associated with constant physical exercise, can help to contain osteoporosis. It also indicates the right physical exercise for older osteoporotic adults. This document drawn up by the CReI-Food study group of the Italian College of Rheumatologists aims to provide, based on the most recent scientific evidence, indications on correct nutrition and lifestyle for the prevention and treatment of osteoporosis in older people.
References
E. Commission Economic Policy Committee Economic and F. Affairs European Economy Institutional Papers, “The 2018 Ageing Report: Economic and Budgetary Projections for the EU Member States (2016-2070)”.
Barbabella F, et al. New Multilevel Partnerships and Policy Perspectives on Active Ageing in Italy: A National Plan of Action. Int J Environ Res Public Health 2020; 17(24): 1-17. https://doi.org/10.3390/ijerph17249585
World Bank Group - International Development, Poverty, & Sustainability. https://www.worldbank.org/en/home (accessed Jan. 05, 2023).
Home - Eurostat. https://ec.europa.eu/eurostat/web/main/ home (accessed Jan. 05, 2023).
Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9(8): 1137–1141. https://doi.org/10.1002/jbmr.5650090802
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006; 17(12): 1726-1733. https://doi.org/10.1007/s00198-006-0172-4
Pisani P, et al. Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop 2016; 7(3): 171-181. https://doi.org/10.5312/wjo.v7.i3.171
Salari N, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 2021; 16(1). https://doi.org/10.1186/s13018-021-02772-0
Hernlund E, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8(1). https://doi.org/10.1007/s11657-013-0136-1
Delmonico MJ, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc 2007; 55(5): 769-774. https://doi.org/10.1111/j.1532-5415.2007.01140.x
Goodpaster BH, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2006; 61(10): 1059-1064. https://doi.org/10.1093/gerona/61.10.1059
Cruz-Jentoft AJ, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39(4): 412-423. https://doi.org/10.1093/ageing/afq034
Papadopoulou SK, Tsintavis P, Potsaki G, Papandreou D. Differences in the Prevalence of Sarcopenia in Community-Dwelling, Nursing Home and Hospitalized Individuals. A Systematic Review and Meta-Analysis. J Nutr Health Aging 2020; 24(1): 83-90. https://doi.org/10.1007/s12603-019-1267-x
Kaur D, et al. Nutritional Interventions for Elderly and Considerations for the Development of Geriatric Foods. Curr Aging Sci 2019; 12(1): 15-27. https://doi.org/10.2174/1874609812666190521110548
Barkoukis H. Nutrition Recommendations in Elderly and Aging. Med Clin North Am 2016; 100(6): 1237-1250. https://doi.org/10.1016/j.mcna.2016.06.006
Izquierdo M, et al. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25(7): 824-853. https://doi.org/10.1007/s12603-021-1665-8
Scientific Opinion on Dietary Reference Values for energy. EFSA Journal 2013; 11(1). https://doi.org/10.2903/j.efsa.2013.3005
Lemming EW, Byberg L. Is a Healthy Diet Also Suitable for the Prevention of Fragility Fractures? Nutrients 2020; 12(9): 1-13. https://doi.org/10.3390/nu12092720
Ilesanmi-Oyelere BL, Kruger MC. Nutrient and Dietary Patterns in Relation to the Pathogenesis of Postmenopausal Osteoporosis-A Literature Review. Life (Basel) 2020; 10(10): 1-13. https://doi.org/10.3390/life10100220
Rizzoli R, et al. Benefits and safety of dietary protein for bone health-an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteopororosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation. Osteoporos Int 2018; 29(9): 1933-1948. https://doi.org/10.1007/s00198-018-4534-5
Bolland MJ, et al. Calcium intake and risk of fracture: systematic review. BMJ 2015; 351. https://doi.org/10.1136/bmj.h4580
Rizzoli R, et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas 2014; 79(1): 122-132. https://doi.org/10.1016/j.maturitas.2014.07.005
Deane CS, Bass JJ, Crossland H, Phillips BE, Atherton PJ. Animal, Plant, Collagen and Blended Dietary Proteins: Effects on Musculoskeletal Outcomes. Nutrients 2020; 12(9): 1-42. https://doi.org/10.3390/nu12092670
Itkonen ST, et al. Partial Replacement of Animal Proteins with Plant Proteins for 12 Weeks Accelerates Bone Turnover Among Healthy Adults: A Randomized Clinical Trial. J Nutr 151(1): 2021; 11-19. https://doi.org/10.1093/jn/nxaa264
Bonjour JP. Nutritional disturbance in acid-base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney. Br J Nutr 2013; 110(7): 1168-1177. https://doi.org/10.1017/S0007114513000962
Isanejad M, et al. Higher protein intake is associated with a lower likelihood of frailty among older women, Kuopio OSTPRE-Fracture Prevention Study. Eur J Nutr 2020; 59(3): 1181-1189. https://doi.org/10.1007/s00394-019-01978-7
Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr Rev 2019; 77(1): 1-18. https://doi.org/10.1093/nutrit/nuy045
Shams-White MM, et al. Animal versus plant protein and adult bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation. PLoS One 2018; 13(2). https://doi.org/10.1371/journal.pone.0192459
Chuang TL, Lin CH, Wang YF. Effects of vegetarian diet on bone mineral density. Tzu Chi Med J 2020; 33(2): 128-134. https://doi.org/10.4103/tcmj.tcmj_84_20
Scientific Opinion on Dietary Reference Values for calcium. EFSA Journal 2015; 13(5). https://doi.org/10.2903/j.efsa.2015.4101
Scientific Opinion on Dietary Reference Values for water. EFSA Journal 2010; 8(3). https://doi.org/10.2903/j.efsa.2010.1459
Quattrini S, Pampaloni B, Brandi ML. Natural mineral waters: chemical characteristics and health effects. Clin Cases Miner Bone Metab 2016; 13(3): 173-180. https://doi.org/10.11138/ccmbm/2016.13.3.173
Meunier PJ, Jenvrin C, Munoz F, de La Gueronnière V, Garnero P, Menz M. Consumption of a high calcium mineral water lowers biochemical indices of bone remodeling in postmenopausal women with low calcium intake. Osteoporos Int 2005; 16(10): 1203-1209. https://doi.org/10.1007/s00198-004-1828-6
Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Nutrients and Dietary Patterns Related to Osteoporosis. Nutrients 2020; 12(7): 1-15. https://doi.org/10.3390/nu12071986
Zhao JG, Zeng XT, Wang J, Liu L. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA 318(24): 2466-2482. https://doi.org/10.1001/jama.2017.19344
Chiodini I, Bolland MJ. Calcium supplementation in osteoporosis: useful or harmful? Eur J Endocrinol 2018; 178(4): D13-D25. https://doi.org/10.1530/EJE-18-0113
Cano A, et al. Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas 2018; 107: 7-12. https://doi.org/10.1016/j.maturitas.2017.10.004
Hiligsmann M, et al. Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts’ consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation. Osteoporos Int 2019; 30(1): 45-57. https://doi.org/10.1007/s00198-018-4744-x
Bresson JL, et al. Dietary reference values for vitamin D. EFSA Journal 2016; 14(10). https://doi.org/10.2903/j.efsa.2016.4547
Scientific Opinion on Dietary Reference Values for phosphorus. EFSA Journal 2015; 13(7). https://doi.org/10.2903/j.efsa.2015.4185
Lee AW, Cho SS. Association between phosphorus intake and bone health in the NHANES population. Nutr J 2015; 14(1). https://doi.org/10.1186/s12937-015-0017-0
Ciosek Ż, Kot K, Kosik-Bogacka D, Łanocha-Arendarczyk N, Rotter I. The Effects of Calcium, Magnesium, Phosphorus, Fluoride, and Lead on Bone Tissue. Biomolecules 2021; 11(4). https://doi.org/10.3390/biom11040506
Martiniakova M, Babikova M, Mondockova V, Blahova J, Kovacova V, Omelka R. The Role of Macronutrients, Micronutrients and Flavonoid Polyphenols in the Prevention and Treatment of Osteoporosis. Nutrients 2022; 14(3). https://doi.org/10.3390/nu14030523
de Baaij JHF, Hoenderop JGJ, Bindels RJM. Magnesium in man: implications for health and disease. Physiol Rev 2015; 95(1): 1-46. https://doi.org/10.1152/physrev.00012.2014
Uwitonze AM, Razzaque MS. Role of Magnesium in Vitamin D Activation and Function. J Am Osteopath Assoc 2018; 118(3): 181-189. https://doi.org/10.7556/jaoa.2018.037
Orchard TS, et al. Magnesium intake, bone mineral density, and fractures: results from the Women’s Health Initiative Observational Study. Am J Clin Nutr 2014; 99(4): 926-933. https://doi.org/10.3945/ajcn.113.067488
Barbagallo M, Veronese N, Dominguez LJ. Magnesium in Aging, Health and Diseases. Nutrients 2021; 13(2): 1-20. https://doi.org/10.3390/nu13020463
Veronese N. Dietary magnesium intake and fracture risk: data from a large prospective study. Br J Nutr 2017; 117(11): 1570-1576. https://doi.org/10.1017/S0007114517001350
Scientific Opinion on Dietary Reference Values for magnesium. EFSA Journal 2015; 13(7). https://doi.org/10.2903/j.efsa.2015.4186
Doseděl M, et al. Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination. Nutrients 2021; 13(2): 1-36. https://doi.org/10.3390/nu13020615
Snoddy AME, Buckley HR, Elliott GE, Standen VG, Arriaza BT, Halcrow SE. Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide. Am J Phys Anthropol 2018; 167(4): 876-895. https://doi.org/10.1002/ajpa.23699
Aghajanian P, Hall S, Wongworawat MD, Mohan S. The Roles and Mechanisms of Actions of Vitamin C in Bone: New Developments. J Bone Miner Res 2015; 30(11): 1945-1955. https://doi.org/10.1002/jbmr.2709
Kim YA, et al. Favorable effect of dietary vitamin C on bone mineral density in postmenopausal women (KNHANES IV, 2009): discrepancies regarding skeletal sites, age, and vitamin D status. Osteoporos Int 2015; 26(9): 2329-2337. https://doi.org/10.1007/s00198-015-3138-6
Malmir H, Shab-Bidar S, Djafarian K. Vitamin C intake in relation to bone mineral density and risk of hip fracture and osteoporosis: a systematic review and meta-analysis of observational studies. Br J Nutr 2018; 119(8): 847-858. https://doi.org/10.1017/S0007114518000430
Brzezińska O, Łukasik Z, Makowska J, Walczak K. Role of Vitamin C in Osteoporosis Development and Treatment-A Literature Review. Nutrients 2020; 12(8): 1-22. https://doi.org/10.3390/nu12082394
Scientific Opinion on Dietary Reference Values for vitamin C. EFSA Journal 2013; 11(11). https://doi.org/10.2903/j.efsa.2013.3418
Zhao F, Guo L, Wang X, Zhang Y. Correlation of oxidative stress-related biomarkers with postmenopausal osteoporosis: a systematic review and meta-analysis. Arch Osteoporos 2021; 16(1). https://doi.org/10.1007/s11657-020-00854-w
Chen C. Pigments in fruits and vegetables: Genomics and dietetics. Pigments in Fruits and Vegetables 2015; 1-277. https://doi.org/10.1007/978-1-4939-2356-4_1
Young AJ, Lowe GL. Carotenoids-Antioxidant Properties. Antioxidants (Basel) 2018; 7(2). https://doi.org/10.3390/antiox7020028
Martínez-González MA, Salas-Salvadó J, Estruch R, Corella D, Fitó M, Ros E. Benefits of the Mediterranean Diet: Insights From the PREDIMED Study. Prog Cardiovasc Dis 2015; 58(1): 50-60. https://doi.org/10.1016/j.pcad.2015.04.003
Khoo HE, Azlan A, Tang ST, Lim SM. Anthocyanidins and anthocyanins: colored pigments as food, pharmaceutical ingredients, and the potential health benefits. Food Nutr Res 2017; 61(1). https://doi.org/10.1080/16546628.2017.1361779
Lu W, et al. Antioxidant Activity and Healthy Benefits of Na-tural Pigments in Fruits: A Review. Int J Mol Sci 2021; 22(9). https://doi.org/10.3390/ijms22094945
Torbergsen AC, et al. Vitamin K1 and 25(OH)D are independently and synergistically associated with a risk for hip fracture in an elderly population: a case control study. Clin Nutr 2015; 34(1): 101-106. https://doi.org/10.1016/j.clnu.2014.01.016
Finnes TE, et al. A combination of low serum concentrations of vitamins K1 and D is associated with increased risk of hip fractures in elderly Norwegians: a NOREPOS study. Osteoporos Int 2016; 27(4): 1645-1652. https://doi.org/10.1007/s00198-015-3435-0
Capozzi A, Scambia G, Lello S. Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health. Maturitas 2020; 140: 55-63. https://doi.org/10.1016/j.maturitas.2020.05.020
Wu WJ, Kim MS, Ahn BY. The inhibitory effect of vitamin K on RANKL-induced osteoclast differentiation and bone resorption. Food Funct 2015; 6(10): 3351-3358. https://doi.org/10.1039/C5FO00544B
Su S, He N, Men P, Song C, Zhai S. The efficacy and safety of menatetrenone in the management of osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2019; 30(6): 1175-1186. https://doi.org/10.1007/s00198-019-04853-7
Fusaro M, et al. Vitamin K and Osteoporosis. Nutrients 2020; 12(12): 1-13. https://doi.org/10.3390/nu12123625
Turck D, et al. Dietary reference values for vitamin K. EFSA Journal 2017; 15(5).
Cholewski M, Tomczykowa M, Tomczyk M. A comprehensive review of chemistry, sources and bioavailability of omega-3 fatty acids. Nutrients 2018; 10(11). https://doi.org/10.3390/nu10111662
Shahidi F, Ambigaipalan P. Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits 2018. https://doi.org/10.1146/annurev-food-111317-095850
Saini RK, Keum YS. Omega-3 and omega-6 polyunsaturated fatty acids: Dietary sources, metabolism, and significance — A review. Life Sciences 203. Elsevier Inc.: 2018; pp. 255-267. https://doi.org/10.1016/j.lfs.2018.04.049
Food and Agriculture Organization of the United Nations Fats and fatty acids in human nutrition 2010.
Bhattacharya A, Rahman M, Sun D, Fernandes G. Effect of fish oil on bone mineral density in aging C57BL/6 female mice. Journal of Nutritional Biochemistry 2007; 18(6): 372-379. https://doi.org/10.1016/j.jnutbio.2006.07.002
Ragab AA, Nalepka JL, Bi Y, Greenfield EM. Cytokines synergistically induce osteoclast differentiation: support by immortalized or normal calvarial cells 2002. https://doi.org/10.1152/ajpcell.00421.2001
Abou-Saleh H, Ouhtit A, Halade GV, Rahman MM. Bone benefits of fish oil supplementation depend on its EPA and DHA content. Nutrients 2019; 11(11). https://doi.org/10.3390/nu11112701
Zalloua PA, et al. Impact of seafood and fruit consumption on bone mineral density. Maturitas 2007; 56(1): 1-11. https://doi.org/10.1016/j.maturitas.2006.05.001
van Papendorp D, Coetzer H, Kruger M. Biochemical profile of osteoporotic patients on essential fatty acid supplementation 1995. https://doi.org/10.1016/0271-5317(95)00002-X
Kruger MC, Coetzer H, de Winter R, Gericke G, van Papendorp DH. Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging (Milano) 1998; 10(5): 385-394. https://doi.org/10.1007/BF03339885
Lavado-García J, et al. Long-chain omega-3 polyunsaturated fatty acid dietary intake is positively associated with bone mineral density in normal and osteopenic Spanish women. PLoS One 2018; 13(1). https://doi.org/10.1371/journal.pone.0190539
Bao M, et al. Therapeutic potentials and modulatory mechanisms of fatty acids in bone. Cell Proliferation. Blackwell Publishing Ltd, 2020; 53(2). https://doi.org/10.1111/cpr.12735
Kelly OJ, Gilman JC, Kim Y, Ilich JZ. Long-chain polyunsaturated fatty acids may mutually benefit both obesity and osteoporosis. Nutrition Research 2013; 33(7): 521-533. https://doi.org/10.1016/j.nutres.2013.04.012
Abshirini M, Ilesanmi-Oyelere BL, Kruger MC. Potential modulatory mechanisms of action by long-chain polyunsaturated fatty acids on bone cell and chondrocyte metabolism. Progress in Lipid Research. Elsevier Ltd., 2021; 83. https://doi.org/10.1016/j.plipres.2021.101113
Yao Y, et al. The Macrophage-Osteoclast Axis in Osteoimmunity and Osteo-Related Diseases. Frontiers in Immunology 12. Frontiers Media S.A., 2021. https://doi.org/10.3389/fimmu.2021.664871
Abedi E, Sahari MA. Long-chain polyunsaturated fatty acid sources and evaluation of their nutritional and functional properties. Food Science and Nutrition 2(5. Wiley-Blackwell) 2014; pp. 443-463. https://doi.org/10.1002/fsn3.121
Scientific Opinion on the Tolerable Upper Intake Level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA). EFSA Journal 2012; 10(7). https://doi.org/10.2903/j.efsa.2012.2815
Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood) 2008; 233(6): 674-688. https://doi.org/10.3181/0711-MR-311
Peñalver R, Lorenzo JM, Ros G, Amarowicz R, Pateiro M, Nieto G. Seaweeds as a functional ingredient for a healthy diet. Marine Drugs 2020; 18(6). https://doi.org/10.3390/md18060301
Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48(1): 16-31. https://doi.org/10.1093/ageing/afy169
Bischoff-Ferrari HA, et al. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 2015; 26(12): 2793-2802. https://doi.org/10.1007/s00198-015-3194-y
Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 2016; 7(1): 28-36. https://doi.org/10.1002/jcsm.12048
Bahat G, Ilhan B. Sarcopenia and the cardiometabolic syndrome: A narrative review. Eur Geriatr Med 2016; 7(3): 220-223. https://doi.org/10.1016/j.eurger.2015.12.012
Bone AE, Hepgul N, Kon S, Maddocks M. Sarcopenia and frailty in chronic respiratory disease. Chron Respir Dis 2017; 14(1): 85-99. https://doi.org/10.1177/1479972316679664
Tagliaferri C, Wittrant Y, Davicco MJ, Walrand S, Coxam V. Muscle and bone, two interconnected tissues. Ageing Res Rev 2015; 21: 55-70. https://doi.org/10.1016/j.arr.2015.03.002
Tarantino U, et al. Sarcopenia and bone health: new acquisitions for a firm liaison. Ther Adv Musculoskelet Dis 2022; 14. https://doi.org/10.1177/1759720X221138354
Beckwée D, et al. Exercise Interventions for the Prevention and Treatment of Sarcopenia. A Systematic Umbrella Review. J Nutr Health Aging 2019; 23(6): 494-502. https://doi.org/10.1007/s12603-019-1196-8
de Liao C, Chen HC, Huang SW, Liou TH. 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. Nutrients 2019; 11(8). https://doi.org/10.3390/nu11081713
Rolland Y, Cesari M, Fielding RA, Reginster JY, Vellas B, Cruz-Jentoft AJ. Osteoporosis in Frail Older Adults: Recommendations for Research from the ICFSR Task Force 2020. J Frailty Aging 2021; 10(2): 168-175. https://doi.org/10.14283/jfa.2021.4
Mohseni R, Aliakbar S, Abdollahi A, Yekaninejad MS, Maghbooli Z, Mirzaei K. Relationship between major dietary patterns and sarcopenia among menopausal women. Aging Clin Exp Res 2017; 29(6): 1241-1248. https://doi.org/10.1007/s40520-016-0721-4
Steib S, Schoene D, Pfeifer K. Dose-response relationship of resistance training in older adults: a meta-analysis. Med Sci Sports Exerc 2010; 42(5): 902-914. https://doi.org/10.1249/MSS.0b013e3181c34465
Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev 2010; 9(3): 226-237. https://doi.org/10.1016/j.arr.2010.03.004
Zhao R, Zhang M, Zhang Q. The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2017; 47(4): 241-251. https://doi.org/10.2519/jospt.2017.6969
Devries MC, et al. Leucine, Not Total Protein, Content of a Supplement Is the Primary Determinant of Muscle Protein Anabolic Responses in Healthy Older Women. J Nutr 2018; 148(7): 1088-1095. https://doi.org/10.1093/jn/nxy091
Landi F, et al. The ‘Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies’ (SPRINTT) randomized controlled trial: design and methods. Aging Clin Exp Res 2017; 29(1): 89-100. https://doi.org/10.1007/s40520-016-0715-2
Papadopoulou SK, et al. Exercise and Nutrition Impact on Osteoporosis and Sarcopenia-The Incidence of Osteosarcopenia: A Narrative Review. Nutrients 2021; 13(12). https://doi.org/10.3390/nu13124499
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2023 Rosita Laurenti, Martina Fioretti, Luis Severino Martin, Francesca Tanzini, Daniela Marotto, Emanuela Gubinelli, Alberto Migliore