Pitfalls in the measurement of muscle mass: a need for a reference standard

Fanny Buckinx*, Francesco Landi, Matteo Cesari, Roger A. Fielding, Marjolein Visser, Klaus Engelke, Stefania Maggi, Elaine Dennison, Nasser M. Al-Daghri, Sophie Allepaerts, Jurgen Bauer, Ivan Bautmans, Maria Luisa Brandi, Olivier Bruyère, Tommy Cederholm, Francesca Cerreta, Antonio Cherubini, Cyrus Cooper, Alphonso Cruz-Jentoft, Eugene McCloskeyBess Dawson-Hughes, Jean Marc Kaufman, Andrea Laslop, Jean Petermans, Jean Yves Reginster, René Rizzoli, Sian Robinson, Yves Rolland, Ricardo Rueda, Bruno Vellas, John A. Kanis

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: All proposed definitions of sarcopenia include the measurement of muscle mass, but the techniques and threshold values used vary. Indeed, the literature does not establish consensus on the best technique for measuring lean body mass. Thus, the objective measurement of sarcopenia is hampered by limitations intrinsic to assessment tools. The aim of this study was to review the methods to assess muscle mass and to reach consensus on the development of a reference standard.

METHODS: Literature reviews were performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis working group on frailty and sarcopenia. Face-to-face meetings were organized for the whole group to make amendments and discuss further recommendations.

RESULTS: A wide range of techniques can be used to assess muscle mass. Cost, availability, and ease of use can determine whether the techniques are better suited to clinical practice or are more useful for research. No one technique subserves all requirements but dual energy X-ray absorptiometry could be considered as a reference standard (but not a gold standard) for measuring muscle lean body mass.

CONCLUSIONS: Based on the feasibility, accuracy, safety, and low cost, dual energy X-ray absorptiometry can be considered as the reference standard for measuring muscle mass.

Original languageEnglish
Pages (from-to)269-278
Number of pages10
JournalJournal of Cachexia, Sarcopenia and Muscle
Issue number2
Early online date19 Jan 2018
Publication statusPublished - Apr 2018


1Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; 2Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart Rome, Milan, Italy; 3Gérontopôle, University Hospital of Toulouse, Toulouse, France; 4INSERM UMR1027, University of Toulouse III Paul Sabatier, Toulouse, France; 5Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA02111, USA; 6Department of Health Sciences, VU University Amsterdam, Amsterdam, Netherlands; 7Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, Netherlands; 8Institute of Medical Physics, University of Erlangen, Erlangen, Germany; 9National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; 10MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England, UK; 11Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh11451, Saudi Arabia; 12Department of Geriatrics, CHU-Liège, Liège, Belgium; 13Department of Geriatric Medicine, Klinikum, Carl von Ossietzky University, Oldenburg, Germany; 14Gerontology and Frailty in Ageing Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium; 15Department of Surgery and Translational Medicine, University of Florence, viale Pieraccini 659139, Florence, Italy; 16Human Medicines Research and Development Support Division, Scientific Advice, London, UK; 17Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy; 18NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; 19Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis), Madrid, Spain; 20Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; 21MRC and Arthritis Research UK Centre for Integrated research in Musculoskeletal Ageing (CIMA), London, UK; 22Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; 23Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium; 24Scientific Office, Austrian Agency for Health and Food Safety, Vienna, Austria; 25Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 26National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton NHS Foundation Trust, Southampton, UK; 27Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse); UMR INSERM 1027, University of Toulouse III, Toulouse, France; 28Abbott Nutrition R&D, Granada, Spain; 29Centre for Metabolic Bone Diseases, University of Sheffield, UK and Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia

FundersFunder number
Medical Research CouncilMR/P020941/1, MC_UP_A620_1014, MC_UU_12011/2, G0400491, MC_U147585824, MC_UP_A620_1015, MC_UU_12011/1


    • Lean body mass
    • Lean mass
    • Muscle mass
    • Reference standard


    Dive into the research topics of 'Pitfalls in the measurement of muscle mass: a need for a reference standard'. Together they form a unique fingerprint.

    Cite this