Diagnostic criteria for sarcopenia in patients undergoing vertebroplasty and kyphoplasty: a systematic review

Objectives: Sarcopenia increases adverse outcomes in elderly patients with osteoporotic vertebral compression fractures (OVCFs). Diagnostic methods vary widely, limiting risk stratification. This systematic review aims to describe the diagnostic criteria used to define sarcopenia in studies involving vertebroplasty (PVP) and kyphoplasty (PKP). Materials and methods: A systematic review was conducted in PubMed, Embase and Scopus through June 2025. Included studies assessed sarcopenia in OVCF patients treated with PVP or PKP. Extracted data included diagnostic methods: CT, MRI, dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis; anatomical landmarks; muscle indices: skeletal muscle index, psoas muscle index, psoas-to-lumbar vertebral index and appendicular muscle index; and functional parameters such as handgrip strength and gait speed. Results: Among 18 studies included (total 3531 patients; sarcopenic 1357), CT was the most used diagnostic modality: CT only was used in 11 studies (11/18, 61%); MRI in 2 (2/18, 11%) studies; DXA only in 1 (1/18, 5%) and BIA in 1 (1/18, 5%). Three studies employed more than one imaging modality: two studies used either CT or MRI (2/18, 11%) and one study used either DXA or MRI (1/18, 5%). L3 (5/18, 28%) and T12 (5/18, 28%) were the most used anatomical landmarks for skeletal muscle assessment. Skeletal muscle index was reported in 7 studies (7/18, 38%): cutoff values 36–42.6 cm2/m2 for males and 29–30.6 cm2/m2 for females. Only 6 studies (33%) included functional parameters; just 3 (17%) fully followed EWGSOP2 criteria with both quantitative and functional measures. Conclusions: A standardized approach combining low muscle mass measured in CT at T12/L3 level with the skeletal muscle index, low strength (handgrip) and low physical performance (gait speed) may be recommended.