Dysmobility syndrome: current perspectives

Figures & data

Table 1 Proposed factors and cut point scores for classification of dysmobility syndrome (requires three or more of the factors to be present)

Factor	Recommended cut point for impairment
Osteoporosis	T-score of ≤−2.5 at lumbar spine, femoral neck, or total proximal femur
Falls in the preceding year	Self-report of one or more falls
Low lean mass	Appendicular lean mass ≤5.45 kg/m^2 (females) or ≤7.26 kg/m^2 (males)
Slow gait speed	<1.0 m/s (comfortable speed)
Low grip strength	Hand-held dynamometer: <30 kg (male); <20 kg (female)
Obesity/high fat mass	Total body % fat: >30 for males: >40 for females

Note: Data from Binkley et al.⁹

Table 2 Characteristics and main findings from studies identified in systematic review on dysmobility syndrome

Study reference (year)	Type of study	Aim of the study	Number of participants	Measurements used	Results	Future research
Binkley et al^Citation9 2013 Also includes review section	Cross-sectional	Evaluate the concept that a score-based approach, utilizing a combination of factors to estimate risk of future adverse health outcomes, is reasonable and timely for the diagnosis of dysmobility syndrome	97 Caucasian older adults (49 females and 48 males) 80.7 (70–95) years	Total body composition (DXA), self-selected gait speed (4 m walk), and grip strength (hand-held dynamometer). Self-reported falls and fracture histories. Dysmobility present if ≥3 factors: osteoporosis, low lean mass, history of falls within the past year, slow gait speed, low grip strength, and high fat mass	BMI: 25.6 (15–36) kg/m^2 Fall within the last year: n=24; prior fragility fracture(s): n=30. Individuals with dysmobility syndrome (34% of cohort), self-reported falls (36%), and prior fragility fracture (30%) were numerically more common than in those diagnosed with sarcopenia by any of the 3 approaches (appendicular lean mass/height,^Citation2 EWGSOP, and IWGS)	Linking a diagnosis of dysmobility syndrome to measureable adverse clinical outcomes. A similar approach could be evaluated in larger epidemiologic studies with multiple outcomes such as mobility disability, fractures, falls, and mortality to identify the combination of factors best able to predict adverse musculoskeletal outcomes in older adults
Clynes et al^Citation16 2015	Cross-sectional	Whether the EWGSOP, IWGS, and FNIH sarcopenia definitions and the criteria for dysmobility syndrome (from Binkley et al, 2013)^Citation9 are associated with previous falls and fracture in a cohort of community-dwelling older adults from the HCS^Citation32	298 Males: 156, 76 (2.54) years, BMI 27.2 (3.56) kg/m^2 Females: 142, 76.2 (2.60) years, BMI 27.6 (4.58) kg/m^2	Body composition and areal BMD (DXA), gait speed (3 m walk), and grip strength (hand-held dynamometer). Self-reported falls and fracture histories	Sarcopenia: EWGSOP 3.3%, IWGS 8.3%, more falls in the last year, prevalent fractures, and FNIH 2.0% Dysmobility syndrome: 24.8%, associated with more falls (last year and since the age of 45 years)
Iolascon et al^Citation17 2015	Case control	Investigate the role of previous fragility fractures as a risk factor in determining dysmobility syndrome and/or SMFD in postmenopausal females	121 post-menopausal females, age ≥50 years (mean age, 67.23 [SD: 8.47] years); BMI 25.35 (SD: 4.28) kg/m^2 Cases: previous fragility fracture (any site, > 12 months previous) Controls: no previous fragility fracture	BMD and body composition (DXA), handgrip strength (dynamometer), gait speed (4 m walk), fragility fracture, 12-month fall history, serum calcium, serum 25-OH vitamin D3, and serum parathyroid hormone (blood test)	77 (63.64%) had already sustained a fragility fracture at any site (cases) – this group was older and had higher risk of dysmobility syndrome. Dysmobility syndrome: cases 51 (66.23%) and controls 28 (38.64%)	Prospective studies are needed to confirm that dysmobility syndrome increases the risk of fractures
Lim and Noh^Citation18 2015	Cross-sectional	Examine the relationship between physical and cognitive functions and depressive symptoms in elderly females with dysmobility syndrome (high body fat, fall experience in the previous 2 years, and osteoporosis)	6,070 females 74.14 years (SD: 6.36) – from the Korean Elderly Adults Survey Dysmobility syndrome: n=43, 75.38±4.40 years Normal: n=6,027, 74.13±6.37 years	PF scale, MMSE-K, and the CES-D scale – short form	Physical function was significantly lower in the dysmobility syndrome than normal group. Depressive symptoms were significantly negatively correlated with physical function and each of its sub-categories in the dysmobility syndrome group	The validity of the diagnostic criteria of dysmobility syndrome according to gender, race, and region. The diagnosis and assessment of dysmobility syndrome may increase people’s interest in preventive programs and therapies
Looker^Citation19 2014	Longitudinal cohort	Assess the relationship between dysmobility syndrome and mortality in adults aged ≥50 years, gender, and race or ethnicity from the NHANES 1999–2002, with an average of 9.9 years follow-up	2,975 participants (50.4% male; aged ≥50 years at baseline – 34% aged ≥70 years)	Body composition and bone density (DXA), gait speed (6.15 m timed walk), muscle strength (isokinetic knee extension with dynamometer), and falls risk (self-reported balance problems in the past year)	22% had dysmobility syndrome at baseline, more prevalent in those 70+ years (also more likely to suffer from more dysmobility factors) Dysmobility syndrome associated with increased mortality (45% versus 15%), mortality risk attenuated with increased age Prevalence of individual factors of dysmobility syndrome (50–69 years; 70+ years): • Fall risk (reported balance problem) 18.2%; 29.0% •Low muscle strength 8.0%; 39.9% •Slow gait speed 28.0%; 61.8% •Low muscle mass 14.9%; 30.3% •Lumbar spine osteoporosis 4.7%; 9.9% •High percent body fat 56.8%; 59.8%	Evaluate the relationship between dysmobility syndrome and other adverse outcomes, such as mobility disability, falls, and fractures

Abbreviations: BMD, bone mineral density; BMI, body mass index; CES-D, Center for Epidemiological Studies Depression Scale; DXA, dual-energy X-ray absorptiometry; EWGSOP, European working group on sarcopenia in older people; FNIH, Foundation of the National Institute of Health; HCS, Hertfordshire cohort study; DXA,; IWGS, International working group on sarcopenia; MMSE-K, mini-mental state examination-Korean version; NHANES, National Health and Nutrition Examination Survey; PF, physical functioning; SD, standard deviation; SMFD, skeletal muscle function deficit.

Figure 1 Flow chart of search results.

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