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Sarcopenia and Osteoporosis are two prevalent conditions in the older population and are defined by low strength, muscle quality/volume and low Bone Mineral Density, respectively. When there is a concomitant presence of both, there is a novel musculoskeletal condition called Osteosarcopenia. These conditions adversely affect quality of life and elevate the risk of fractures, disability, and mortality among older individuals. Dysbiosis of the gut microbiota is the impairment of the mutualistic relationship between microorganisms, metabolic products and the host's immune system. Gut microbiota dysbiosis could be intricately linked to sarcopenia and osteoporosis, shedding light on the complex microbiota-gut-bone-muscle axis. Furthermore, the intestinal microbiota experiences a notable decline in beneficial microorganisms as part of the aging process. The relationship between dysbiosis of the intestinal microbiota in older people and sarcopenia, osteoporosis or osteosarcopenia is still unclear. This review protocol aims to systematically review the literature and compile evidence on the influence of gut microbiota dysbiosis on musculoskeletal function in older people with sarcopenia, osteoporosis or osteosarcopenia. This systematic review will analyze observational studies that have investigated the relationship between the effects of gut microbiota dysbiosis and sarcopenia, osteoporosis and osteosarcopenia in older people aged 65 and over. Studies will be retrieved from PubMed/MEDLINE, EMBASE, Scopus, Web of Science and the Cochrane Library. Outcome measures will include body composition for diagnosing osteoporosis and screening for sarcopenia/osteosarcopenia by any criteria. Data synthesis will involve quantitative analysis using summary measures. If sufficient studies, homogeneity and heterogeneity analysis will be performed to conduct Meta-analysis and pooled OR, RR and HR measures will be provided.

IntroductionSarcopenia, osteoporosis and osteosarcopenia are conditions prevalent in ageing that impair muscle strength and bone density, increasing the risks of fractures, falls, disability and mortality. Recent studies highlight the benefits of milk protein supplementation (MPS) combined with exercises to improve musculoskeletal health in the older population. This systematic review protocol will enable the production of a compilation of evidence that will elucidate the effects of MPS combined with aerobic exercise, resistance exercise or both on the musculoskeletal function of older individuals with these three conditions.Methods/analysisStudies will be selected from electronic databases, including PubMed/MEDLINE, EMBASE, Scopus, Web of Science and the Cochrane Library, without restrictions on language or publication date. The outcomes evaluated will include muscle mass, muscle strength, BMD and physical performance after combined interventions of MPS and physical exercise of any type. The risk of bias will be assessed using the Cochrane Risk of Bias 2 tool. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to classify the certainty of the evidence into four levels: high, moderate, low and very low. Meta-analysis will be performed given the homogeneity of the studies, using random effects methods in the face of the expected heterogeneity. The standardised mean difference (SMD) will be used for continuous data, and the I² index will assess heterogeneity (I² > 50%). Sensitivity analysis, ‘leave one out’ and a strategy for dealing with missing data will be carried out. Statistical analysis will be conducted using the STATA 18 software with a 95% CI and p<0.05. The searches will be carried out from inception until August 2025.Ethics and disseminationFormal ethical approval will not be required as primary data collection will not be performed. The results will be disseminated through peer-reviewed publications and presentations at conferences dedicated to the relevant field of study.PROSPERO registration numberCRD42024555933.

Key summary points Aim To analyze the associations between pain and physical performance in different aging contexts. Findings Lower limbs Pain or Back Pain were associated with poor physical performance in older people. Message Pain symptoms are associated with reduced physical performance in older people, even with interference from clinical and sociodemographic factors. Purpose To analyze the associations between pain and physical performance in different aging contexts. Methods Data from 1725 older adults from Canada, Brazil, Colombia, and Albania from the 2014 wave of the IMIAS were used to assess the associations between Back Pain (BP) or Lower Limb Pain (LLP) and physical performance by the Short Physical Performance Battery (SPPB). Three binary logistic regression models adjusted for sex, age, study site, education, income sufficiency, BMI, depressive symptoms, and chronic conditions were used to estimate the associations between LLP or BP and SPPB. The SPPB was classified into good performance (8 points or more) and poor physical performance (< 8 points). Results The mean age of the older men was 71.2 (± 3.0) and the mean age of the women was 71.2 (± 2.8) years. Older men (72.8%, p  < 0.05) and women (86.1%, p -value < 0.05) from Albania had the highest frequencies of self-reported general pain. Older women in Colombia had the highest frequencies of LLP or BP (33.5%, p -value < 0.05). In the fully adjusted logistic regression model, LLP or BP was significantly associated with poor SPPB (OR = 0.48, 0.35 to 0.66 95% CI, p  < 0.01). Conclusions Pain symptoms are associated with reduced physical performance in older people, even when adjusted for other clinical and sociodemographic factors. Protocols for aiming to increase the level of physical activity to manage pain should be incorporated into health care strategies.