Association Between Lifetime Cumulative Surgical Exposure and Total Body Bone and Muscle Mass in Older Adults

Keywords:

Total body bone mass, total body lean mass, recurrent surgeries, older adults.


Published online: Oct 08 2026

https://doi.org/10.52628/92.3.15693

ASHOUR L.1,2, ALSHOLI M.3, NASAR H. B.4, SADAQA I.5, ZAITA M.5, ZAQOUT A. M.4, ALSARKHI A.6, OKASHA A.5, HAMMAD A.7, ABUISSA H.6

1Public Health Institute, Liverpool John Moored University, Liverpool, UK
2King Hussein Cancer Center, Amman, Jordan
3Al Hussein New As-Salt Hospital, Ministry of Health, As-Salt, Jordan
4Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
5Jordan University Hospital, The University of Jordan, Amman, Jordan
6Al-Basheer Hospital, Ministry of Health, Amman, Jordan
7Department of Internal Medicine, Specialty Hospital, Amman, Jordan

Abstract

| laithashour100@gmail.com The relationship between recurrent surgical exposure and musculoskeletal health in older adults remains insufficiently characterized. This study aimed to investigate the association between the cumulative number of surgical procedures and total body bone mass (TBBM) and total body lean mass (TBLM) in an older adult population. Data were analyzed from the 2017-2022 biomarker wave of the Midlife in the United States (MIDUS 3) study. TBBM and TBLM were measured using dual-energy X-ray absorptiometry (DXA) with Lunar systems. The number of prior surgeries (minor or major) was retrospectively obtained through structured medical history interviews. Multiple linear regression models were used to evaluate associations between surgical history and body composition measures. Models were adjusted for age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), triglyceride levels, smoking history, dietary habits, medication use, physical activity, and serum creatinine levels. The final analytic sample included 327 participants (41% male) with a mean age of 64.5 ± 9.3 years. Regression analyses showed that a higher number of prior surgeries was significantly associated with lower TBBM (β = −0.094; 95% CI: −0.175 to −0.013; P = 0.021). Further sensitivity analyses including participants with higher threshold of cumulative major surgeries supported this association with a higher effect size. No significant association was observed between number of surgeries and TBLM (P = 0.33), even after conducting sensitivity analysis on cohort who underwent major recurrent surgeries. Healthier dietary habits were significantly associated with higher TBLM (β = 0.073; 95% CI: 0.017 to 0.129; P = 0.011), but not with TBBM (P = 0.507). In conclusion, recurrent surgical exposure was associated with lower total body bone mass but not lean mass in older adults. However, further longitudinal research is needed to fully adjust for potentially-related underlying morbidities.

ActaOrthopBelg-92-1-cover

About this issue

Volume 92, issue 3.

Autumn 2026.

Open access journal

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