{"doi":"10.1002/jcsm.12521","title":"The authors reply: Letter on: “ Sarcopenia and its association with falls and fracturesin older adults: A systematic review andmeta‐analysis” by Zhang et al.","abstract":"Thank you for the comments to our recent article “Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis”.1 Firstly, as mentioned in our article, studies were excluded from the meta-analysis if an odds ratio (OR) could not be calculated because of insufficient data, or confidence intervals were not presented. Therefore, we were not able to include the studies of Cawthon,2 Schaap,3 and Henwood,4 as hazard ratios2, 3 or risk ratios4 were reported. These measures are not interchangeable with ORs5, 6 but can be converted if information about the baseline risk is available.7 We agree that the above-mentioned studies are valuable; therefore, we contacted the authors to obtain the data needed to compute ORs. Two authors of the three studies responded, which allowed us to include those studies in the meta-analysis.2, 3 Both were prospective studies examining the association between sarcopenia with falls and fractures. ORs reported in our original article1 did not change significantly after inclusion of these studies (falls prospective studies: pooled OR 1.91, 95% CI 1.52–2.40, P < 0.001, I2 = 36%; fractures prospective studies: pooled OR 1.73, 95% CI 1.14–2.64, P = 0.011, I2 = 6%) (Figures 1 and 2). Secondly, Zhang et al. suggested to take the types of fracture into consideration when conducting the meta-analysis of the association between sarcopenia and fractures. We agree with the authors that fracture sites vary significantly in their risk profiles8 and appreciate the subgroup analysis performed by them. However, we have updated the subgroup analysis because (i) some studies reported the association between sarcopenia with more than one type of fracture, and (ii) we obtained additional data from Cawthon2 and Schaap3 to compute ORs. Our subgroup analysis showed a significant association between sarcopenia and hip fractures (OR 2.06, 95% CI 1.35–3.14, P = 0.001, I2 = 94%) and incident fractures (OR 1.63, 95% CI 1.13–2.35, P = 0.009, I2 = 25%), but the association was insignificant for non-vertebral fractures (two studies) (OR 1.66, 95% CI 0.78–3.56, P = 0.190, I2 = 0%) and vertebral fractures (two studies) (OR 1.41, 95% CI 0.66–3.01, P = 0.373, I2 = 82%) among older adults (Figure 3). Finally, Zhang et al. raised an important point regarding the number of falls. As each fall is associated with a risk of injury, functional decline, and loss of autonomy, the risk profile of recurrent fallers is not equivalent to that of single fallers.9, 10 Of the 22 studies included in our meta-analysis, 20 studies reported at least one fall (≥1) as outcome, and two studies reported recurrent falls (≥2) as outcome.2, 3 We acknowledge the limitation of our article that a subgroup analysis regarding the number of falls cannot be performed owing to insufficient data. The authors certify that they comply with the ethical guidelines for authorship and publishing of the Journal of Cachexia, Sarcopenia and Muscle.11 This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie-Sklodowska-Curie (H2020 Marie Sklodowska-Curie Actions) grant agreement no. 675003 (PANINI programme) and no. 689238 (PreventIT). We are grateful to Cawthon P. M. and Schaap L. A. for providing information on their studies. The Osteoporotic Fractures in Men (MrOS) Study is supported by the National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and National Institutes of Health (NIH) Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The funders had no role in the design and conduct of the study, data collection and analy","journal":"Journal of Cachexia Sarcopenia and Muscle","year":2020,"id":128671,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9462,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":49127,"name":"Martijn W. Heymans","orcid":"0000-0002-3889-0921","position":1,"is_corresponding":false},{"id":264262,"name":"Andrea B. Maier","orcid":"0000-0001-7206-1724","position":2,"is_corresponding":false},{"id":337755,"name":"Suey S.Y. Yeung","orcid":"0000-0002-1926-2962","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-18T23:15:42.522809Z","pmid":"31903717","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}