Association between osteosarcopenia and frailty in older adults: a systematic review and meta-analysis

BACKGROUND: Osteosarcopenia, the coexistence of sarcopenia and osteoporosis/osteopenia, is an emerging geriatric syndrome, but its relationship with frailty remains unclear. METHODS: Following PRISMA guidelines, we searched six databases (PubMed, Web of Science, Cochrane Library, Scopus, CINAHL, Embase) from inception to September 6, 2025. Observational studies on the association between osteosarcopenia and frailty were included. Meta-analysis was conducted using STATA 17.0, and subgroup analysis, sensitivity analysis, and assessment of publication bias were also performed. RESULTS: A total of 11 studies involving 9939 participants were included. Meta-analysis showed that osteosarcopenia was significantly associated with higher odds of frailty (OR = 5.27, 95% CI: 3.75-7.39). Among individuals with osteoporosis/osteopenia, the presence of sarcopenia was associated with 3.78-fold higher odds of frailty (95% CI: 2.95-4.85). Among those with sarcopenia, the presence of osteoporosis/osteopenia was associated with 1.57-fold higher odds of frailty (95% CI: 1.23-2.01). Subgroup analysis revealed that the association between osteosarcopenia and frailty remained consistent and significant across studies from different regions, populations, study designs, and diagnostic criteria. CONCLUSIONS: Osteosarcopenia is significantly associated with higher odds of frailty in older adults. However, most included studies were cross-sectional, limiting causal inference. Prospective studies with standardized diagnostic criteria are needed to establish causality and inform prevention strategies.