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Sarcopenia: Causes, Symptoms and Treatment

Sarcopenia is the age-related progressive loss of muscle mass and strength. It increases fall risk and reduces quality of life in older adults.

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Things worth knowing about "Sarcopenia"

Sarcopenia is the age-related progressive loss of muscle mass and strength. It increases fall risk and reduces quality of life in older adults.

What is Sarcopenia?

Sarcopenia is a progressive skeletal muscle disease characterised by the loss of muscle mass, muscle strength, and physical performance. The term derives from the Greek words sarx (flesh) and penia (lack). Sarcopenia primarily affects older adults and has been officially recognised as a distinct disease since 2016, with its own ICD-10 code (M62.84). It is a major risk factor for falls, fractures, dependency, and increased mortality.

Causes

The development of sarcopenia is multifactorial. Key contributing factors include:

Ageing: From around the age of 40, adults lose approximately 0.5–1% of muscle mass per year, with this rate accelerating after the age of 70.
Physical inactivity: Sedentary behaviour and prolonged bed rest significantly accelerate muscle loss.
Nutritional deficits: Inadequate protein and calorie intake, common in older adults, impairs muscle maintenance and regeneration.
Hormonal changes: Age-related declines in testosterone, oestrogen, and growth hormone reduce muscle repair capacity.
Chronic inflammation: Elevated levels of pro-inflammatory cytokines (e.g., interleukin-6, TNF-alpha) accelerate muscle breakdown.
Neurological changes: Loss of motor neurons impairs muscle innervation and function.
Chronic diseases: Conditions such as cardiovascular disease, diabetes mellitus, chronic kidney disease, and cancer can contribute to or worsen sarcopenia.

Symptoms

Sarcopenia develops gradually and is often recognised late. Common signs include:

Declining muscle strength, such as difficulty opening bottles or carrying objects
Slower walking speed and unsteady gait
Increased risk of falls
General weakness and rapid fatigue
Unintentional weight loss due to muscle wasting
Difficulty with daily activities such as climbing stairs or rising from a chair

Diagnosis

The diagnosis of sarcopenia is based on internationally recognised criteria, particularly those of the European Working Group on Sarcopenia in Older People (EWGSOP2). Commonly used assessments include:

Handgrip strength: Measured with a dynamometer; a simple screening tool for muscle strength.
Gait speed: Measured over a set distance (e.g., 4-metre walk test).
Chair stand test: Time required to rise from a chair five times without using the arms.
DXA scan (dual-energy X-ray absorptiometry): The gold standard for measuring muscle mass.
Bioelectrical impedance analysis (BIA): A simpler alternative for estimating body composition.
SARC-F questionnaire: A short self-reported screening tool for sarcopenia-related symptoms.

Treatment

There is currently no curative treatment for sarcopenia. Management aims to slow muscle loss and improve physical function.

Resistance Training and Physical Activity

Resistance training (strength training) is the most effective intervention for sarcopenia. Even two to three sessions per week can meaningfully improve muscle mass and strength. Balance training and aerobic exercise are recommended as complementary approaches.

Nutritional Therapy

Optimising protein intake is essential. For older adults, the following are recommended:

Protein intake: 1.0–1.2 g per kg body weight per day; up to 1.5 g/kg/day in the presence of illness.
Leucine-rich protein sources: Whey protein, meat, fish, legumes.
Vitamin D: Adequate supplementation (800–2000 IU/day) to support muscle function.
Omega-3 fatty acids: May positively influence muscle protein synthesis.
Total caloric intake: Sufficient energy to prevent malnutrition.

Pharmacological Approaches

No medication is currently approved specifically for sarcopenia. In certain cases, treating vitamin D deficiency or considering hormone replacement therapy may be appropriate. Various agents, including selective androgen receptor modulators and myostatin inhibitors, are currently under clinical investigation.

Prevention

Sarcopenia can be delayed or mitigated through an active lifestyle, a balanced diet, and regular strength training throughout life. Promoting muscle health from middle age onwards is particularly important.

References

Cruz-Jentoft AJ et al. - Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing, 2019; 48(1): 16–31. (EWGSOP2)
Deutz NEP et al. - Protein intake and exercise for optimal muscle function with aging. Clinical Nutrition, 2017; 36(6): 1457–1464.
World Health Organization (WHO) - Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care, 2019.

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