Sarcopenia is one of the most important health issues in today's ageing society. As an evaluation method, computed tomography (CT) is an effective means of assessing not only the quantity but also the quality of skeletal muscle. We aimed to examine the relationship between sarcopenia severity and muscle/fat area, and osteoporosis.

321 patients (116 men and 205 women, mean age 77.2 ± 7.1 years, age range 53–96 years) who visited the Integrated Healthy Aging Clinic from 2016 to 2017 were included in this study.

Based on the Asia Working Group for Sarcopenia2019 criteria, patients were divided into four groups:​ normal group, low-functional group (with normal skeletal muscle mass, but reduced muscle strength or physical function), sarcopenia group, and severe sarcopenia group.

We measured the skeletal muscle (SM), intermuscular adipose tissue (IMAT), and subcutaneous adipose tissue (SAT) areas and the CT attenuation values (CTV) using cross sections of the mid-thigh CT. We also measured bone mineral density. Then, we compared each result among the four groups.

We found a significant decrease in SM area in both men and women with sarcopenia (p < 0.001 for both sexes). In women, a decrease in SAT area was observed in the sarcopenia group (p < 0.001), and an increase in IMAT was observed in the low functional group (p < 0.001). The CTV decreased in men with sarcopenia and severe sarcopenia;​ similarly, women in the low functional and severe sarcopenia groups had decreased CTV (p < 0.001 for both sexes). An association between sarcopenia and osteoporosis in men was detected (p = 0.004).

By using not only muscle mass but also fat mass and CTV, we were able to better examine the pathogenesis of sarcopenia and differences between men and women in Japanese middle-aged and older adults.