Sarcopenia is a progressive loss of skeletal muscle mass and strength that contributes to adverse outcomes such as falls, fractures, and mortality in aging populations. Its prevalence varies widely across studies, influenced by intrinsic factors (eg, age, comorbidities, lifestyle), environmental conditions (eg, urban-rural differences, institutionalization), and the diagnostic criteria applied. This review synthesizes evidence mainly from systematic reviews and meta-analyses to examine how these factors shape the epidemiology of sarcopenia. The use of different definitions, such as EWGSOP 1/2, AWGS 2014/2019, IWGS, and FNIH, leads to large variations in prevalence estimates. This limits regional comparisons and hampers surveillance. The review also highlights key risk factors such as physical inactivity, malnutrition, smoking, irregular sleep, and cognitive impairment, although the overall certainty of evidence remains low to moderate. These findings emphasize the need for harmonized diagnostic standards and greater methodological consistency in future studies. Clinically, integrating sarcopenia screening into routine care and implementing targeted lifestyle interventions may help reduce disease burden. Future longitudinal and interventional research is essential to clarify causal pathways and guide effective public health strategies for sarcopenia prevention and management.

Osteoporosis increases the fracture and mortality risk of patients and has a higher disease burden than some cancers. Therefore, global concerns regarding the prevention and treatment of osteoporosis have been raised. However, fast-aging Taiwan lacks national epidemiological data on osteoporosis in recent years. We aimed to establish and update epidemiological data on osteoporosis by analyzing national data from 2008 to 2019. We estimated the prevalence and incidence of osteoporosis in patients aged ≥50 years based on claims data from Taiwan's National Health Insurance database from 2008 to 2019. We also analyzed the key parameters of fracture care (anti-osteoporosis medication use, bone mineral density examination rate, and length of hospital stay) to understand the secular trend of management and related clinical outcomes (imminent refracture rate and mortality). The number of prevalent osteoporosis increased from 2008 to 2015 and remained constant until 2019; however, the age-standardized prevalence and incidence rates declined from 2008 to 2019 (3.77%-2.91% and 2.08%-1.02%, respectively). The overall incidence rates of hip and spine fractures decreased significantly by 34% and 27%, respectively. For patients with hip and spine fractures, the immanent refracture rates were 8.5% and 12.9% and the 1-year mortality rate remained stable at approximately 15% and 6%, respectively. The age-standardized prevalence and incidence rates decreased remarkably from 2008 to 2019, while the number of prevalent osteoporosis remained steady. Patients with hip fractures encountered a high 1-year mortality rate, while the risk of imminent refracture was notable for patients with spine fractures.

Aims: The objective of this study was to estimate the nationwide annual incidence, healthcare utilization, and mortality among hospitalized heart failure (HF) patients in Taiwan. Methods and results: People aged 20 years or older and having been newly admitted for HF between 2010 and 2015 were identified from Taiwan's National Health Insurance Research Database. For 124 816 patients with incident HF hospitalizations between 2010 and 2012, we further analysed their treatment patterns, healthcare utilizations, and mortality during index hospitalization and within 3 years following discharge from the index hospitalization. The age-stratified incidences were declined by 10–20% in people aged 55 years or older, but increased by ~4% among people younger than 44 years old between 2010 and 2015. For all incident hospitalized HF patients, the percentages of patients visiting the emergency room, were rehospitalized, and treated with guideline-directed medical therapy were highest in the first year. Approximately two-thirds of subsequent hospitalizations were due to non-HF and non-cardiovascular causes. The all-cause mortality rate during index hospitalization was 8.5%, whereas the mortality rates at 30 days, 90 days, 180 days, 1 year, 2 years, and 3 years following discharge were 3.5%, 8.9%, 14.4%, 22.5%, 33.9%, and 42.8%, respectively, for those surviving index HF hospitalization. Non-cardiovascular disease-related deaths accounted for nearly 60% of all deaths. Conclusions: Our study reveals that, in contemporary Taiwan, the >10% annual mortality following the first year of hospitalization, 30% deaths occurring outside the hospital, and 60% non-cardiovascular-related deaths, along with the decreasing use of guideline-directed medical therapy, highlight sectors requiring more attention.

Background: Monitoring and improving intrinsic capacity (IC) and well-being are essential for older adults to maintain functional abilities. However, evidence of effective interventions to improve IC and happiness is scarce. This study examined the effects of multicomponent interventions in the Healthy Longevity and Ageing in Place (HOPE) randomised controlled trial on IC and happiness among rural community-dwelling older adults. Methods: This cluster randomised trial was conducted in rural communities in Taiwan (NCT05104034). Participants aged ≥50 were enrolled from September 2021 to April 2022 and randomly assigned by community level to one of three groups: multicomponent integrated care (MIC), osteoporosis care (OC) and usual care (UC). MIC included osteoporosis, sarcopenia and polypharmacy care, along with exercise and nutritional support. OC was a resource-conservative, focusing on osteoporosis screening and treatment alone. IC and happiness were measured at baseline and 12 months after follow-up. IC was assessed across cognition, locomotion, vitality, sensory and psychological domains per World Health Organization Integrated Care for Older People (ICOPE) guidelines. Happiness was measured using the 10-item Chinese Happiness Inventory. Generalised estimating equations were used to estimate the effect of the intervention. Results: 567 residents were recruited from 30 congregate meal service centres. Mean IC score increased across all the groups, though the happiness score decreased. Compared to UC, the MIC group exhibited a significantly greater improvement in IC scores (adjusted estimate = 0.30, standard error (SE) = 0.11, P = .01), whereas OC did not show significant effects. Smaller reductions in happiness scores were observed in both the MIC (adjusted estimate = 1.46, SE = 0.48, P = .003) and OC groups (adjusted estimate = 0.95, SE = 0.48, P = .05). Conclusion: MIC, including osteoporosis and pharmaceutical care, along with exercise and nutritional support, is an effective strategy to enhance IC and happiness compared to osteoporosis treatment alone and UC. This underscores the importance of comprehensive strategies for promoting healthy ageing in rural communities.

Previous epidemiological researchers have used various algorithms to identify a second hip fracture; however, there has been no validation of these algorithms to date. This study aimed to verify existing algorithms for identifying second hip fracture under the International Classification of Diseases diagnostic coding systems. Furthermore, we examined the validity of two newly proposed algorithms that integrated the concept of periprosthetic fractures and laterality of the ICD-10 coding system. Claims data of patients hospitalized for hip fracture from National Taiwan University Hospitals between 2007 and 2020 were retrieved. Hip fracture was confirmed by 2 orthopaedic surgeons with medical records and imaging data as gold standards. The validity of 9 existing and 2 newly proposed algorithms for identifying second hip fracture was evaluated. The positive predictive value (PPV) range between 84% and 90% in existing algorithms for identifying second hip fractures. Noteworthy, the longer time interval for discrimination resulted in slightly increased PPV (from 87% to 90%), while decreased sensitivity noticeably (from 87% to 72%). When considering the information about periprosthetic fracture, the PPV increased to 91% without diminished sensitivity. The PPV of the newly proposed ICD-10-specific algorithm was 100%. Algorithms integrated clinical insights of periprosthetic fractures and laterality concept of ICD-10 coding system provided satisfactory validity and help precisely define second hip fracture in future database research.

Therapeutic drug monitoring (TDM) is recommended during treatment with valproic acid (VPA), as is the measurement of free VPA concentration (MfVPA). However, MfVPA is unavailable in many institutions. Based on the highly protein-bound characteristics of VPA, an albumin-adjusted formula has been proposed to predict free VPA concentration (PfVPA). Nevertheless, the factors affecting the accuracy of this formula remain unknown, as does the concordance between MfVPA and PfVPA. Adult patients receiving VPA and undergoing TDM were enrolled. Free and total serum concentration (TVPA) were categorized as subtherapeutic, therapeutic, or supratherapeutic based on the reference range of 5-15 and 50-100 μg/mL, respectively. Concordance was defined as MfVPA and PfVPA, or MfVPA and TVPA, falling within the same category. Multivariate logistic regression with generalized estimating equation was adopted to identify factors affecting concordance, and the receiver operating characteristic curve was applied to determine the cutoff values of predictors. A total of 98 data points from 51 participants were included for analysis. The concordance of MfVPA and PfVPA, and MfVPA and TVPA, was 72% and 44%, respectively. Blood urea nitrogen (BUN) (0.97 [0.95-0.99], P = 0.01) and TVPA (0.97 [0.95-0.99], P = 0.02) had a significant influence on the concordance of MfVPA and PfVPA. The cutoff values of TVPA and BUN for the accuracy of the albumin-adjusted formula were 56.4 μg/mL and 51.05 mg/dL, respectively. If MfVPA is not available, the albumin-adjusted formula should be applied before VPA dosage adjustment when TVPA is < 56.4 μg/mL and BUN is < 51.05 mg/dL.