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In reply to “Small, however significant differences in the definition of physical frailty and sarcopenia”

Published:January 22, 2019DOI:https://doi.org/10.1016/j.ejim.2019.01.007
      We thank Dr. Yilmaz and colleagues [
      • Yilmaz O.
      • Aykent B.
      • Bahat G.
      Small, however significant differences in the definition of physical frailty, and sarcopenia.
      ] for their comment that allows us to further clarify a major strength of the BIOSPHERE study [
      • Calvani R.
      • Picca A.
      • Marini F.
      • Biancolillo A.
      • Cesari M.
      • Pesce V.
      • et al.
      The "BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons" (BIOSPHERE) study: Rationale, design and methods.
      ]. Many operational definitions of frailty exist, each of them describing specific aspects of the condition and capturing different risk profiles. The two constructs mentioned by the authors (i.e., the phenotype proposed by Fried et al. [
      • Fried L.P.
      • Tangen C.M.
      • Walston J.
      • Newman A.B.
      • Hirsch C.
      • Gottdiener J.
      • et al.
      Frailty in older adults: evidence for a phenotype.
      ] and the FRAIL criteria designed by Morley [
      • Morley J.E.
      Sarcopenia: diagnosis and treatment.
      ]) are not gold standards for the assessment of physical frailty, simply because no reference tool is recognized in this field. Furthermore, these instruments (as many other operational definitions of frailty) are unsuitable for use in clinical trials, especially those investigating biomarkers and/or testing pharmacological interventions. In fact, the wide and heterogeneous spectrum of confounders potentially biasing their results may affect the correct interpretation of an intervention effect or the identification of reliable biormakers. It is also noteworthy that the “traditional” models of frailty were not designed to focus on a specific “target organ” towards which drugs and biomarkers may be developed. For example, the frailty phenotype and/or the FRAIL scale include criteria measuring mood (i.e., fatigue), behavior (i.e., sedentariness), heterogeneous signs (i.e., weight loss), or nosological conditions (i.e., illnesses), which are only indirectly related with the skeletal muscle. It follow that, although designed to assess the physical domain of frailty, their defining criteria inevitably capture a syndromic and multidimensional entity.
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      Linked Article

      • Small, however significant differences in the definition of physical frailty, and sarcopenia
        European Journal of Internal MedicineVol. 61
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          We read the study of Calvania et al. with great interest titled “BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons” (BIOSPHERE): Rationale, design and methods” [1]. In this paper, the authors highlighted that sarcopenia was a major health issue in older adults given its high prevalence, and burdensome clinical implications. In addition to this unsolved debate, the complexity of musculoskeletal ageing represented a major challenge to the identification of clinically meaningful biomarkers.
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