Mixed
Skeletal muscle mass measured via D3-creatine dilution is a strong predictor of functional capacity, mobility limitations, and injurious falls in older adults, whereas lean body mass measured by DXA is only weakly or not associated with these outcomes.
If you are assessing muscle health in older adults, standard DXA scans may underestimate the risk of falls and disability because they include non-muscle tissue in 'lean mass'. Accurate assessment of functional muscle mass (via D3-creatine dilution in research settings) reveals that muscle mass is a critical driver of mobility. For clinical practice, this implies that relying solely on DXA lean mass may miss high-risk individuals who have low functional muscle mass despite normal lean mass readings.
In a recent study in older men (MrOS cohort), D3-Cr muscle mass was associated with functional capacity and risk of injurious falls and disability, while assessments of LBM or appendicular lean mass by DXA were only weakly or not associated with these outcomes.
Why this rating
Based on a large prospective cohort (MrOS) with side-by-side comparison of measurement methods, though it is an observational study.
Source
D<sub>3</sub>‐Creatine dilution and the importance of accuracy in the assessment of skeletal muscle mass
William J. Evans et al. · Journal of Cachexia Sarcopenia and Muscle · 2019
DOI 10.1002/jcsm.12390
Related findings · Mixed
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