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The Interconnection Between Muscle and Bone: A Common Clinical Management Pathway

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Abstract

Often observed with aging, the loss of skeletal muscle (sarcopenia) and bone (osteoporosis) mass, strength, and quality, is associated with reduced physical function contributing to falls and fractures. Such events can lead to a loss of independence and poorer quality of life. Physical inactivity (mechanical unloading), especially in older adults, has detrimental effects on the mass and quality of bone as well as muscle, while increases in activity (mechanical loading) have positive effects. Emerging evidence suggests that the relationship between bone and muscle is driven, at least in part, by bone–muscle crosstalk. Bone and muscle are closely linked anatomically, mechanically, and biochemically, and both have the capacity to function with paracrine and endocrine-like action. However, the exact mechanisms involved in this crosstalk remain only partially explored. Given older adults with lower bone mass are more likely to present with impaired muscle function, and vice versa, strategies capable of targeting both bone and muscle are critical. Exercise is the primary evidence-based prevention strategy capable of simultaneously improving muscle and bone health. Unfortunately, holistic treatment plans including exercise in conjunction with other allied health services to prevent or treat musculoskeletal disease remain underutilized. With a focus on sarcopenia and osteoporosis, the aim of this review is to (i) briefly describe the mechanical and biochemical interactions between bone and muscle; (ii) provide a summary of therapeutic strategies, specifically exercise, nutrition and pharmacological approaches; and (iii) highlight a holistic clinical pathway for the assessment and management of sarcopenia and osteoporosis.

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Funding

The salary of C.S. is supported by A/Prof Joshua Lewis’ National Heart Foundation of Australia Future Leader Fellowship (ID: 102817). The salary of M.S. is supported by a Royal Perth Hospital Career Advancement Fellowship and an Emerging Leader Fellowship from the Future Health Research and Innovation Fund (Department of Health, Western Australia). None of these funding agencies had any role in the conduct, collection, management, analysis or interpretation of the data, preparation, review or approval of the manuscript.

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Authors and Affiliations

  1. School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia

    Cassandra Smith, Marc Sim & Jack Dalla Via

  2. Medical School, The University of Western Australia, Perth, WA, Australia

    Cassandra Smith & Marc Sim

  3. Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia

    Itamar Levinger

  4. Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia

    Itamar Levinger

  5. Bone, Muscle & Geroscience Research Group, Research Institute of the MUHC, Montreal, QC, Canada

    Gustavo Duque

  6. Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada

    Gustavo Duque

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  1. Cassandra Smith
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  3. Jack Dalla Via
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Contributions

CS, MS, JDV, IL and GD contributed to the overall design of this review. CS, MS and JDV prepared the first draft. All authors revised the paper critically and approved the final version.

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Correspondence to Gustavo Duque.

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Cassandra Smith, Marc Sim, Jack Dalla Via, Itamar Levinger, and Gustavo Duque have no competing interests to declare.

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Smith, C., Sim, M., Dalla Via, J. et al. The Interconnection Between Muscle and Bone: A Common Clinical Management Pathway. Calcif Tissue Int 114, 24–37 (2024). https://doi.org/10.1007/s00223-023-01146-4

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