Coexisting Sarcopenia and Osteoporosis in COPD: Integrated Identification, Risk-Oriented Assessment, and Comprehensive Management-A Structured Narrative Review.

Sarcopenia and osteoporosis are common but underrecognized extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD). When they coexist, functional limitation, falls, fractures, hospitalization, and mortality may be amplified. This structured narrative review synthesizes evidence available through April 1, 2026, focusing on shared mechanisms, clinical identification, diagnostic interpretation, and management. Coexisting muscle-bone impairment is plausibly driven by systemic inflammation, hypoxia and oxidative stress, physical inactivity, malnutrition, exacerbation-related catabolism, and systemic glucocorticoid exposure, with additional but incompletely validated myokine-osteokine signaling. Integrated assessment is most relevant for patients with systemic wasting, recurrent exacerbations or substantial systemic glucocorticoid exposure, marked activity limitation, falls or fragility fractures, or planned pulmonary rehabilitation. A stepwise pathway links low-burden functional screening with consensus-based muscle assessment and formal bone evaluation; opportunistic computed tomography (CT) and musculoskeletal ultrasound may add complementary information but lack universal COPD-specific thresholds. Management should combine individualized endurance, resistance, and balance training with nutritional support, fracture-risk management, and serial reassessment. Prospective multicenter studies are needed to determine whether this approach reduces fractures, rehospitalization, or mortality.