We thank Dr. Yilmaz and colleagues [
[1]
] for their comment that allows us to further clarify a major strength of the BIOSPHERE
study [
- Yilmaz O.
- Aykent B.
- Bahat G.
Small, however significant differences in the definition of physical frailty, and
sarcopenia.
Eur J Intern Med. 2018; ([Epub ahead of print])https://doi.org/10.1016/j.ejim.2018.11.005
[2]
]. 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. [
[3]
] and the FRAIL criteria designed by Morley [
[4]
]) 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.To read this article in full you will need to make a payment
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References
- Small, however significant differences in the definition of physical frailty, and sarcopenia.Eur J Intern Med. 2018; ([Epub ahead of print])https://doi.org/10.1016/j.ejim.2018.11.005
- The "BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons" (BIOSPHERE) study: Rationale, design and methods.Eur J Intern Med. 2018; 56: 19-25https://doi.org/10.1016/j.ejim.2018.05.001
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- Reflection paper on physical frailty: Instruments for baseline characterisation of older population in clinical trials.(Available at:)https://www.ema.europa.eu/documents/scientific-guideline/reflection-paper-physical-frailty-instruments-baseline-characterisation-older-populations-clinical_en.pdfDate: 2018Date accessed: January 11, 2019
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Article info
Publication history
Published online: January 22, 2019
Accepted:
January 14,
2019
Received:
January 11,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Small, however significant differences in the definition of physical frailty, and sarcopeniaEuropean Journal of Internal MedicineVol. 61
- PreviewWe 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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