Associations of components of sarcopenic obesity with bone health and balance in older adults

•Higher muscle mass is a consistent independent predictor of better bone health in community-dwelling older men and women.•Higher body fat percentage does not appear to be beneficial for bone health.•Reduced lower-leg muscle density is independently associated with lower cortical density and area in obese older women.•Reduced lower-leg muscle density is associated with poorer balance in both sexes. To determine characteristics of sarcopenic obesity that are independently associated with bone health and balance in older adults. Cross-sectional study of 168 community-dwelling older adults (mean age 67.7 ± 8.4 years; 55% women). Appendicular lean mass (ALM), whole-body areal BMD (aBMD) and body fat percentage were assessed by dual-energy X-ray absorptiometry. Peripheral quantitative computed tomography assessed muscle density and cortical volumetric BMD (vBMD), area, thickness, and strength-strain index (SSI) at 66% tibial length. Hand grip strength (dynamometry) and balance path length (computerised posturography) were assessed. Obesity was defined as high body fat percentage. Greater lower-leg muscle density was associated with lower balance path length in men (r = −0.36; P