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Original Article Differences in Type 2 Fiber Composition in the Vastus Lateralis and Gluteus Maximus of Patients with Hip Fractures
Jingwen Tian1,2*orcid , Minchul Song3*orcid , Kyu Jeong Cho1, Ho Yeop Lee1,2, Sang Hyeon Ju3, Jung Ryul Lim3, Ha Thi Nga1,2, Thi Linh Nguyen1,2, Ji Sun Moon1, Hyo Ju Jang1,2, Jung-Mo Hwang4orcid , Hyon-Seung Yi1,2,3orcid

DOI: https://doi.org/10.3803/EnM.2024.1935 [Epub ahead of print]
Published online: June 11, 2024
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1Laboratory of Endocrinology and Immune System, Chungnam National University College of Medicine, Daejeon, Korea
2Department of Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
3Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
4Department of Orthopedics, Chungnam National University Hospital, Daejeon, Korea
Corresponding author:  Jung-Mo Hwang, Tel: +82-42-280-6801, Fax: +82-42-338-2482, 
Email: tea06@hanmail.net
Hyon-Seung Yi, Tel: +82-42-280-6801, Fax: +82-42-280-6990, 
Email: jmpbooks@cnu.ac.kr
*These authors contributed equally to this work.
Received: 13 January 2024   • Revised: 15 March 2024   • Accepted: 21 March 2024
contributed equally to this study as co-first authors.

Background
Aging leads to sarcopenia, which is characterized by reduced muscle mass and strength. Many factors, including altered muscle protein turnover, diminished neuromuscular function, hormonal changes, systemic inflammation, and the structure and composition of muscle fibers, play a crucial role in age-related muscle decline. This study explored differences in muscle fiber types contributing to overall muscle function decline in aging, focusing on individuals with hip fractures from falls.
Methods
A pilot study at Chungnam National University Hospital collected muscle biopsies from hip fracture patients aged 20 to 80 undergoing surgical treatment. Muscle biopsies from the vastus lateralis and gluteus maximus were obtained during hip arthroplasty or internal fixation. Handgrip strength, calf and thigh circumference, and bone mineral density were evaluated in individuals with hip fractures from falls. We analyzed the relationships between each clinical characteristic and muscle fiber type.
Results
In total, 26 participants (mean age 67.9 years, 69.2% male) were included in this study. The prevalence of sarcopenia was 53.8%, and that of femoral and lumbar osteoporosis was 19.2% and 11.5%, respectively. Vastus lateralis analysis revealed an age-related decrease in type IIx fibers, a higher proportion of type IIa fibers in women, and an association between handgrip strength and type IIx fibers in men. The gluteus maximus showed no significant correlations with clinical parameters.
Conclusion
This study identified complex associations between age, sex, handgrip strength, and muscle fiber composition in hip fracture patients, offering insights crucial for targeted interventions combating age-related muscle decline and improving musculoskeletal health.

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