The Rising Burden of Osteosarcopenia in Older Adults: A Narrative Review of Pathophysiology, Diagnostic Challenges, and Therapeutic Perspectives.

<h4>Background and aims</h4>Osteosarcopenia, defined as the coexistence of osteoporosis and sarcopenia, is an emerging geriatric syndrome linked to the musculoskeletal decline associated with aging. It is correlated with an increased risk of falls, fractures, disability, and mortality. This review aims to synthesize the emerging concepts, underlying mechanisms, epidemiology, diagnostic challenges, and current therapeutic strategies for osteosarcopenia.<h4>Methods</h4>A narrative review was conducted using the PubMed, Scopus, and Google Scholar databases. The keywords used were: osteosarcopenia, sarcopenia, osteoporosis, frailty, and related terms. Relevant peer-reviewed studies and reports from international organizations were included. The selected articles, addressing definitions, pathophysiology, epidemiology, diagnosis, and management, underwent thematic analysis.<h4>Results</h4>Osteosarcopenia affects approximately 18% to 20% of older adults. Its prevalence increases with age and is higher in women. Osteosarcopenia results from mechanisms common to both bones and muscles, including chronic inflammation, hormonal decline, genetic and epigenetic factors, dysregulated signaling pathways, and the interplay between muscles and bones. Risk factors include age, sedentary lifestyle, malnutrition, chronic diseases, and endocrine disorders. Diagnosis remains complex due to the lack of standardized criteria and relies on separate assessments such as bone densitometry (DXA) for bone density and functional tests for muscle strength. The emergence of biomarkers and composite indices holds promise for improved detection. Management primarily involves resistance training, nutritional optimization (protein, calcium, vitamin D), and anti-osteoporosis medications. However, no treatment simultaneously targets both components, and pharmacological options remain limited.<h4>Conclusion</h4>Osteosarcopenia represents a major and growing public health problem in aging populations. Despite progress in understanding its pathophysiology, gaps persist in standardized diagnosis and integrated treatment. Multidisciplinary approaches combining physical exercise, nutrition, and pharmacotherapy, as well as future research on unified diagnostic criteria and targeted therapies, are essential to reduce its impact and improve the functional abilities of older adults.