Osteosarcopenia in older adults undergoing transcatheter aortic valve replacement: A narrative review of mortality and frailty implications

Abstract

This narrative review examines osteosarcopenia, characterized by the concurrent loss of muscle mass and bone density, as a pivotal marker of frailty in older adults. Its implications for patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis remain underexplored. This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR, with an emphasis on mortality. It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments. Contemporary studies were reviewed, focusing on older adults undergoing TAVR. Key parameters included pre-procedural assessments of muscle mass (psoas cross-sectional area) and bone density (lumbar trabecular attenuation) using computed tomography. Clinical correlations with frailty indices, nutritional deficiencies, functional disability and mortality were analyzed. Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality. Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications, prolonged hospitalizations, and worsening disability compared to isolated sarcopenia or osteoporosis (P < 0.05). Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes. Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations. Targeted interventions, such as resistance training and nutritional optimization, may mitigate its impact and improve clinical outcomes. Early identification facilitates personalized management strategies, enhancing survival and quality of life in this high-risk cohort.

Keywords: Osteosarcopenia; Frailty; Mortality; Transcatheter aortic valve replacement; Resistance training; Nutrition

Core Tip: Osteosarcopenia, the co-occurrence of muscle atrophy and bone density loss, is increasingly recognized as a potent marker of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. This review synthesizes evidence demonstrating that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality (P < 0.05). Compared to isolated sarcopenia or osteoporosis, osteosarcopenia correlates with higher risks of post-procedural complications, prolonged hospitalization, and functional decline. Key imaging biomarkers—psoas muscle cross-sectional area (muscle mass) and lumbar trabecular attenuation (bone density)—derived from pre-TAVR computed tomography scans provide objective frailty metrics. Integrating these parameters into risk stratification models (e.g., Society of Thoracic Surgeons Predicted Risk of Mortality) enhances predictive accuracy for adverse outcomes. Clinically, routine osteosarcopenia assessment could guide personalized interventions, such as resistance training and protein/vitamin D supplementation, to mitigate frailty-related risks. Early identification of osteosarcopenia bridges geriatric and cardiology care, offering a pathway to improve survival and quality of life in high-risk TAVR populations.