What do we already know about this topic?

• The increasing number of older adults with obesity is a growing public health problem because of increased risk of fractures especially at the ankle and upper leg despite normal or high bone mineral density.^1,2
• Among the contributory factors for fracture risk in this population may be aging- and obesity-associated physical frailty and impaired bone quality.^1,2
• However, how the adverse changes in physical function and body composition in this aging and obese population contribute to bone quality as assessed by finite element analyses (FEA) of bone strength has not been determined.
• This study evaluated sarcopenic obesity as a determinant of bone strength in obese, elderly adults.

How was this study conducted?

• One-hundred sixty-nine older (age ≥65 years) adults with obesity (BMI ≥30 kg/m²) were recruited to participate in lifestyle intervention trials.
• Steroid, androgen, and estrogen use was among the exclusion criteria for this study.
• All patients underwent baseline measurements of bone strength (failure load [N] and stiffness [N.mm^-1]) as estimated using FEA from high-resolution peripheral quantitative tomography (HR-pQCT) of the distal radius and tibia.
• In addition, body composition (appendicular lean mass/BMI [ALM_BMI], fat mass/height² [FMI]) was assessed by dual-energy x-ray absorptiometry (DXA) and physical function by the modified physical performance test (PPT), knee extension strength (isokinetic dynamometry), hand grip strength, and 4-meter gait speed.