Sarcopenia among Older Adults with Knee Osteoarthritis: A Cross-Sectional Study of Prevalence and Its Associated Factors

Main Article Content

Pongsak Dharmakulsakti
Inthira Roopsawang
Suparb Aree-Ue


                Sarcopenia is a common health problem in older adults associated with age-related loss of muscle mass and strength. Sarcopenia can cause low activity of daily living, increased risk of falls, and low quality of life. This cross-sectional study investigated the prevalence of sarcopenia and the association among personal factors, health factors, and sarcopenia in older adults with knee osteoarthritis. Data were collected in 180 older adults with knee osteoarthritis in a tertiary care hospital in Bangkok using the demographic questionnaire, the Thai version of the 15-item Geriatric Depression Scale, the Knee and Osteoarthritis Outcome Score-Activities of Daily Living Thai version, and the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls questionnaire. Data were analyzed using descriptive statistics and logistic regression.
              Results revealed that the prevalence of sarcopenia in older adults with knee osteoarthritis was relatively high (41.7%). The univariate logistic regression indicated that age, depression, physical ability, and body mass index (BMI) were significantly associated with sarcopenia. After controlling other factors, the multivariate analysis demonstrated that depression, poor physical ability, and increased BMI significantly predicted sarcopenia; these three variables together explained 56.2% of the total variance in sarcopenia. Gerontological nurse practitioners and other healthcare professionals should focus on early screening and evaluating sarcopenia in older adults with knee osteoarthritis. An intervention is imperative to manage, prevent, and minimize sarcopenia and knee osteoarthritis severity by promoting physical activity, managing depressive symptoms, and controlling body weight.

Article Details

How to Cite
Dharmakulsakti P, Roopsawang I, Aree-Ue S. Sarcopenia among Older Adults with Knee Osteoarthritis: A Cross-Sectional Study of Prevalence and Its Associated Factors. PRIJNR [Internet]. 2021 Dec. 9 [cited 2022 Sep. 28];26(1):121-34. Available from:
Original paper


1. World Health Organization (WHO). Musculoskeletal conditions [Internet]; 2021 [cited 2021 Aug 22]. Available from:

2. Morley JE. The new geriatric giants. Clin Geriatr Med. 2017;33(3):xi–xii. doi:

3. Papadopoulou SK. Sarcopenia: a contemporary health problem among older adult populations. Nutrients. 2020;12(5):1293. doi: 10.3390/nu12051293.

4. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4): 412-23.

5. Tournadre A, Vial G, Capel F, Soubrier M, Boirie Y. Sarcopenia. J Bone Spine. 2019;86(3):309–14.

6. Amirthalingam H, Cicuttini FM, Wang Y, Chou L, Wluka AE, Hussain S. Association between sarcopenia and osteoarthritis-related knee structural changes: a systematic review. Osteoarthr Cartil. 2019;27(suppl 1):S472. doi:

7. Godzik K, Prado CM, Woodhouse LJ, Forhan M. The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review. BMC Musculoskelet Disord. 2018;19(1):271.doi:

8. Godzik K, Prado C, Woodhouse L, Forhan M. Prevalence of sarcopenic obesity in adults with end-stage knee osteoarthritis.Osteoarthritis Cartilage. 2019; 27(12): 1735-45.

9. Blom AW, Donovan RL, Beswick AD, Whitehouse MR, Kunutsor SK. Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1evidence. BMJ. 2021;374:n1511. doi:

10. Hamilton DF, Beard DJ, Barker KL, Macfarlane GJ, Tuck CE, Stoddart A, et al. Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial. BMJ. 2020; 371:m3576. doi:

11. Misra D, Fielding RA, Felson DT, Niu J, Brown C, Nevitt M, et al. risk of knee osteoarthritis with obesity, sarcopenic obesity, and sarcopenia. Arthritis Rheumatol. 2019; 71(2):232-7.

12. Pickering ME, Chapurlat R. Where two common conditions of aging meet: osteoarthritis and sarcopenia. Calcif. Tissue Int. 2020; 107: 203-11.

13. Yu SCY, Khow KSF, Jadczak AD, Visvanathan R. Clinical screening tools for sarcopenia and its management. Curr Gerontol Geriatr Res. 2016;2016:5978523. doi:10.1155/2016/5978523.

14. Pongchaiyakul C, Limpawattana P, Kotruchin P, Rajatanavin R. Prevalence of sarcopenia and associated factors among Thai population. J Bone Miner Metab. 2013; 31(3):346-50.

15. Khongsri N, Tongsuntud S, Limampai P, Kuptniratsaikul V. The prevalence of sarcopenia and related factors in a community-dwelling elders Thai population. Osteoporosis Sarcopenia. 2016; 2(2): 110-5.

16. Therakomen V, Petchlorlian A, Lakananurak N. Prevalence and risk factors of age-related sarcopenia in Thai elderly. Chula Med J. 2020; 30(1): 17-32 (in Thai).

17. Tieland M, Trouwborst I, Clark BC. Skeletal muscle performance and ageing. J. Cachexia Sarcopenia Muscle. 2018; 9(1): 3-19.

18. Whaikit P, Kittipimpanon K, Piaseu N. Prevalence and predictors of sarcopenia among older Buddhist monks in Thailand. Pacific Rim Int J Nurs R. 2020; 24(3): 363-75.

19. Han P, Kang L, Guo Q, Wang J, Zhang W, Shen S, et al. Prevalence and factors associated with sarcopenia in suburb-dwelling older Chinese using the Asian Working Group for Sarcopenia definition. J Gerontol A Biol Sci Med Sci. 2016; 71(4): 529-35.

20. Yang L, Smith L, Hamer M. Gender-specific risk factors for incident sarcopenia: 8-year follow-up of the English longitudinal study of ageing. J Epidemiol Community Health. 2019; 73(1): 86-8.

21. Limpawattana P, Putraveephong S. Frailty and sarcopenia. KKU Journal of Medicine. 2015; 1(4): 10-6. (in Thai).

22. Ishii S, Chang C, Tanaka T, Kuroda A, Tsuji T, Akita M, et al. The association between sarcopenic obesity and depressive symptoms in older Japanese adults. PLoS One.2016; 11(9): e0162898. doi: 10.1371/journal.pone.0162898.

23. Tyrovolas S, Koyanagi A, Olaya B, Ayuso‐Mateos JL, Miret M, Chatterji S, et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi‐continent study. J. Cachexia Sarcopenia Muscle. 2016; 7(3): 312-21.

24. Hiligsmann M, Beaudart C, Bruyère O, Biver E, Bauer J, Cruz-Jentoft AJ, et al. Outcome priorities for older persons with sarcopenia. J Am Med Dir Assoc. 2020;21(2):267-71.

25. Distefano G, Standley RA, Zhang X, Carnero EA, Yi F, Cornnell HH, et al. Physical activity unveils the relationship between mitochondrial energetics, muscle quality, and physical function in older adults. J Cachexia Sarcopenia Muscle. 2018; 9(2): 279-94.

26. Gianoudis J, Bailey C, Daly R. Associations between sedentary behaviour and body composition, muscle function and sarcopenia in community-dwelling older adults. Osteoporos Int. 2015; 26(2): 571-9.

27. Zembron-Lacny A, Dziubek W, Rogowski L, Skorupka E, Dabrowska G, et al. Sarcopenia: monitoring, molecular mechanisms, and physical intervention. Physiol Res. 2014; 63(6): 683-91.

28. Li CI, Li TC, Lin WY, Liu CS, Hsu CC, Hsiung CA, et al. Combined association of chronic disease and low skeletal muscle mass with physical performance in older adults in the Sarcopenia and Translational Aging Research in Taiwan (START) study. BMC Geriatrics. 2015;15(1):11. doi:10.1186/s12877-015-0011-6.

29. Tanimoto Y, Watanabe M, Sun W, Sugiura Y, Hayashida I, Kusabiraki T. Sarcopenia and falls in community-dwelling elderly subjects in Japan: defining sarcopenia according to criteria of the European Working Group on Sarcopenia in Older People. Arch Gerontol Great. 2014; 59(2):295-9.

30. Tsonga T, Michalopoulou M, Kapetanakis S, Giovannopoulou E, Malliou P, Godolias G, et al. Risk factors for fear of falling in elderly patients with severe knee osteoarthritis before and one year after total knee arthroplasty. J Orthop Surg. 2016; 24(3): 302-6.

31. Yeung SS, Reijnierse EM, Pham VK, Trappenburg MC, Lim WK, Meskers CG, et al. Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta‐analysis. J Cachexia Sarcopenia Muscle. 2019;10(3): 485-500.

32. Trajanoska K, Schoufour JD, Darweesh SK, Benz E, Medina‐Gomez C, Alferink LJ, et al. sarcopenia and its clinical correlates in the general population: the Rotterdam study. J Bone Miner Res. 2018; 33(7): 1209-18.

33. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9. doi: 10.1016/j.jclinepi.2007.11.008.

34. Burmeister E, Aitken LM. Sample size: how many is enough? Aust Crit Care. 2012; 25(4): 271-4.

35. Aree-Ue S, Youngcharoen P. The 6 Item Cognitive Function Test-Thai Version: psychometric property testing. Rama Nurs J. 2020;26(2):188-202 (in Thai).

36. Wongpakaran N, Wongpakaran T, Van Reekum R. The use of GDS-15 in detecting MDD: a comparison between residents in a Thai long-term care home and geriatric outpatients. J Clin Med Res. 2013; 5(2): 101-11.

37. Chaipinyo K. Test-retest reliability and construct validity of Thai version of Knee Osteoarthritis Outcome Score (KOOS). Thai J Phys Ther. 2009; 31:67-76.

38. Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc.2013; 14(8): 531-2.

39. Mohd Nawi SN, Khow KS, Lim WS, Yu SC. Screening tools for sarcopenia in community-dwellers: a scoping review. Ann Acad Med Singap. 2019;48(7):201-16.

40. Roopsawang I, Thompson H, Zaslavsky O, Belza B. Predicting hospital outcomes with the reported Edmonton frail scale-Thai version in orthopaedic older patients. J Clin Nurs. 2020;29(23-24):4708-19. doi: 10.1111/jocn.15512.

41. Wang H, Hai S, Liu Y, Cao L, Liu Y, Liu P. Association between depressive symptoms and sarcopenia in older Chinese community-dwelling individuals. Clin Interv Aging. 2018; 13: 1605-11.

Most read articles by the same author(s)