sarcopenia
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[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]
Introduction
- diminished muscle mass, muscle atrophy.
- also see age-associated changes in skeletal muscle
Etiology
- andropause
- androgen-deprivation therapy[8]
- bedrest
- chronic illness*
- lack of exercise*
- protein-calorie malnutrition
- vitamin D deficiency?[18]
- old age
* chronic illness & lack of exercise best explains sarcopenia & osteopenia associated with advanced age
Epidemiology
- 45% of elderly with 20% functionally disabled
- health cost estimate as $18.5 billion/year in USA
- begins with 6th decade of life
Pathology
- see age-associated changes in skeletal muscle
- neuronal alterations
- decrease in number &/or function of motor neurons
- alterations in axonal function
- loss of motor endplates
- decrease in neurotransmitter release
- decreased number of motor units
- fast-twitch (type II) white fibers affected more than slow-twitch (type I) red fibers[22]
- increase in cytokines, IL1-beta, IL6, TNF-alpha
- decreased testosterone, DHEA, growth hormone
- insulin resistance
- decreased IGF-1
- upregulation of FBXO32 (atrogin-1), MuRF1
- oxidative stress & damage postulated
- senescence-associated secretory phenotype
- strongly associated with sarcopenia
- drives chronic inflammation & muscle degeneration [25-28]
- not associated with sarcopenia[23][24]
Genetics
- genetically predicted serum 25-OH vitamin D concentration < 20 ng/mL associated with risk of sarcopenia[18]
Clinical manifestations
Laboratory
- low serum creatinine is associated with sarcopenia & frailty[17]
- serum cystatin C/creatine ratio more accurately assesses renal function (not directly affected by muscle mass)[19]
* also see frailty
Complications
- increased risk of falls[21]
- increased risk & morbidity of infections
- diminished glucose tolerance, increase risk of type 2 diabetes[4]
- muscle dysfunction, not diminished lean muscle mass, associated with late-life cognitive impairment
Management
- increase exercise, resistance training[1]
- increase calories, if protein-calorie malnutrition
- treat intercurrent disease
- testosterone, DHEA, vitamin D, & leucine of benefit[11]
- Vitamin D supplementation is not recommended unless deficient[11]
- no improvements in measures of physical function with DHEA[11]
- vitamin C & vitamin E without proven benefit[11]
- in healthy elderly >= 70 years, vitamin D3 2000 IU/day, marine omega-3 fatty acids 1 gram/day, &/or home exercise 3 times/week, alone or in combination, did not improve incidence of sarcopenia or appendicular lean muscle mass index at 3 years[20]
- men:
- testosterone replacement if indicated
- a trial of recombinant growth hormone
- women
- a trial of recombinant growth hormone, with or without DHEA
- 25-30 g of high-quality protein/meal recommended[10][11][16]
- if pressure ulcers, add arginine, zinc & antioxidants or arginine/glutamine/zinc[11]
Comparative biology
- p16ink4A silencing by RNA interference restores regenerative capacity of satellite cells in old mice[9]
More general terms
- sign/symptom
- muscular disease; myopathy
- chronic musculoskeletal disease
- geriatric disorder; disease of old age; geriatric syndrome
More specific terms
Additional terms
- age-associated changes in skeletal muscle
- andropause
- frailty
- testosterone (Delatestryl Testopel, Striant, Intrinsa, Xyosted)
References
- ↑ 1.0 1.1 Fiatarone MA, O'Neill EF, Ryan ND et al Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994 Jun 23;330(25):1769-75. PMID: https://pubmed.ncbi.nlm.nih.gov/8190152 Free article. Clinical Trial.
- ↑ Geenlund LJ & Nair KS, Sarcopenia--consequences, mechanisms, and potential therapies. Mech Ageing Dev. 2003 Mar;124(3):287-99. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/12663126
- ↑ Janssen I et al, J AM Ger Soc (JAGS) 52:80, 2004
- ↑ 4.0 4.1 Fiatarone Singh MA & Rosenberg IH, Nutrition and Aging, In: Principles of Geriatric Medicine, 4th ed,, Hazzard et al (eds), McGraw-Hill, NY, 1999, pg 81-84
- ↑ Loeser RF & Delbono O, Aging and the Musculoskeletal System, In: Principles of Geriatric Medicine, 4th ed,, Hazzard et al (eds), McGraw-Hill, NY, 1999, pg 81-84
- ↑ Borst SE Interventions for sarcopenia and muscle weakness in older people. Age Ageing. 2004 Nov;33(6):548-55. Epub 2004 Sep 22. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/15385272
- ↑ Chin A et al The functional effects of physical exercise training in frail older people : a systematic review. Sports Med. 2008;38(9):781-93. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/18712944
- ↑ 8.0 8.1 Smith MR et al. Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol 2012 Sep 10; 30:3271 PMID: https://pubmed.ncbi.nlm.nih.gov/22649143
- ↑ 9.0 9.1 Sousa-Victor P et al. Geriatric muscle stem cells switch reversible quiescence into senescence. Nature 2014 Feb 20; 506:316. PMID: https://pubmed.ncbi.nlm.nih.gov/24522534
- ↑ 10.0 10.1 Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009 PMID: https://pubmed.ncbi.nlm.nih.gov/19057193
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Kim JS, Wilson JM, Lee SR. Dietary implications on mechanisms of sarcopenia: roles of protein, amino acids and antioxidants. J Nutr Biochem. 2010 Jan;21(1):1-13. PMID: https://pubmed.ncbi.nlm.nih.gov/19800212
- ↑ Rolland Y, Onder G, Morley JE et al Current and future pharmacologic treatment of sarcopenia. Clin Geriatr Med. 2011 Aug;27(3):423-47. PMID: https://pubmed.ncbi.nlm.nih.gov/21824556
- ↑ Volpi E, Ferrando AA, Yeckel CW, Tipton KD, Wolfe RR. Exogenous amino acids stimulate net muscle protein synthesis in the elderly. J Clin Invest. 1998 May 1;101(9):2000-7. PMID: https://pubmed.ncbi.nlm.nih.gov/9576765
- ↑ Beeri MS, Leugrans SE, Delbono O et al Sarcopenia Is Associated With Incident Alzheimer's Dementia, Mild Cognitive Impairment, and Cognitive Decline. J Am Geriatr Soc. 2021;69(7):1826-1835. PMID: https://pubmed.ncbi.nlm.nih.gov/33954985 PMCID: PMC8286176 (available on 2022-07-01) https://www.medscape.com/viewarticle/954738
- ↑ 16.0 16.1 Liao CD, Chen HC, Huang SW et al. The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: a systematic review and meta-regression analysis of randomized trials. Nutrients. 2019 Jul 25;11(8):1713 PMID: https://pubmed.ncbi.nlm.nih.gov/31349606 PMCID: PMC6723070 Free PMC article https://www.mdpi.com/2072-6643/11/8/1713
- ↑ 17.0 17.1 Loria A et al. Low preoperative serum creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. Ann Surg 2023 Feb; 277:246. PMID: https://pubmed.ncbi.nlm.nih.gov/36448909 https://journals.lww.com/annalsofsurgery/Abstract/2023/02000/Low_Preoperative_Serum_Creatinine_is_Common_and.12.aspx
- ↑ 18.0 18.1 18.2 Sha T, Wang Y, Zhang Y, Lane NE, Li C, Wei J, Zeng C, Lei G. Genetic Variants, Serum 25-Hydroxyvitamin D Levels, and Sarcopenia: A Mendelian Randomization Analysis. JAMA Netw Open. 2023 Aug 1;6(8):e2331558. PMID: https://pubmed.ncbi.nlm.nih.gov/37647062 FPMCID: PMC10469287 Free PMC article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808925
- ↑ 19.0 19.1 An JN, Kim JK, Lee HS, Kim SG, Kim HJ, Song YR. Serum cystatin C to creatinine ratio is associated with sarcopenia in non-dialysis-dependent chronic kidney disease. Kidney Res Clin Pract. 2022 Sep;41(5):580-590. PMID: https://pubmed.ncbi.nlm.nih.gov/35791742 PMCID: PMC9576455 Free PMC article.
- ↑ 20.0 20.1 Eggimann AK, de Godoi Rezende Costa Molino C, Freystaetter G, et al. Effect of vitamin D, omega-3 supplementation, or a home exercise program on muscle mass and sarcopenia: DO-HEALTH trial. J Am Geriatr Soc. 2024 Nov 20. PMID: https://pubmed.ncbi.nlm.nih.gov/39565152 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19266
- ↑ 21.0 21.1 Yeung SSY, Reijnierse EM, Pham VK et al Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019 Jun;10(3):485-500. PMID: https://pubmed.ncbi.nlm.nih.gov/30993881 PMCID: PMC6596401 Free PMC article. https://onlinelibrary.wiley.com/doi/10.1002/jcsm.12411
- ↑ 22.0 22.1 Horwath O, Moberg M, Edman S, Philp A, Apro W. Ageing Leads to Selective Type II Myofibre Deterioration and Denervation Independent of Reinnervative Capacity in Human Skeletal Muscle. Experimental Physiology. 2025;110(2):277-292. PMID: https://pubmed.ncbi.nlm.nih.gov/39466960 PMCID: PMC11782179
- ↑ 23.0 23.1 Aslam MA, Ma EB, Huh JY. Pathophysiology of sarcopenia: Genetic factors and their interplay with environmental factors. Metabolism. 2023 Dec;149:155711. doi:http://dx.doi.org/ 10.1016/j.metabol.2023.155711. Epub 2023 Oct 21. PMID: https://pubmed.ncbi.nlm.nih.gov/37871831 Review.
- ↑ 24.0 24.1 Chen LK, Woo J, Assantachai P et al Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020 Mar;21(3):300-307.e2. PMID: https://pubmed.ncbi.nlm.nih.gov/32033882
- ↑ He Y, Xie W, Li H, Jin H, Zhang Y, Li Y. Cellular Senescence in Sarcopenia: Possible Mechanisms and Therapeutic Potential. Front Cell Dev Biol. 2022 Jan 10;9:793088. doi:http://dx.doi.org/ 10.3389/fcell.2021.793088. eCollection 2021. PMID: https://pubmed.ncbi.nlm.nih.gov/35083219 PMCID: PMC8784872 Free PMC article. Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC8784872/
- ↑ Huang Y, Wang C, Cui H, Sun G, Qi X, Yao X. Mitochondrial dysfunction in age-related sarcopenia: mechanistic insights, diagnostic advances, and therapeutic prospects. Front Cell Dev Biol. 2025 Oct 3;13:1590524. PMID: https://pubmed.ncbi.nlm.nih.gov/41113460 PMCID: PMC12531180 Free PMC article. Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC12531180/
- ↑ Forman DE, Kuchel GA, Newman JC et al Impact of Geroscience on Therapeutic Strategies for Older Adults With Cardiovascular Disease: JACC Scientific Statement. J Am Coll Cardiol. 2023 Aug 15;82(7):631-647. doi:http://dx.doi.org/ 10.1016/j.jacc.2023.05.038. Epub 2023 Jun 28. PMID: https://pubmed.ncbi.nlm.nih.gov/37389519 PMCID: PMC10414756 Free PMC article. Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC10414756/
- ↑ Ishii KA, Hashimoto R, Umeda C, Hosoyama T, Watanabe K. An in vitro model to study molecular pathogenesis of sarcopenia established by a SASP-dependent human myotube culture. PLoS One. 2025 Jul 7;20(7):e0326968. PMID: https://pubmed.ncbi.nlm.nih.gov/40623060 PMCID: PMC12233260 Free PMC article. https://pmc.ncbi.nlm.nih.gov/articles/PMC12233260/