As we grow older, our muscles tend to weaken and decrease in size and strength. This natural age-related loss of skeletal muscle mass and function is known as sarcopenia. Sarcopenia has become a major health concern, with serious physical, functional, psychosocial, and economic implications. In this article, we will take a comprehensive look at sarcopenia - what causes it, its effects, and available treatment options.

What is Sarcopenia?

Sarcopenia refers to the involuntary loss of skeletal muscle mass and strength associated with aging. It is estimated that adults lose about 5-15% of their muscle mass every decade after age 30. The two main characteristics of sarcopenia are:

- Reduction in muscle mass: By the age of 80, the average person loses about 40% of their muscle mass. This loss accelerates after age 60.

- Decrease in muscle strength and performance: As muscles get smaller, they also become weaker and less efficient. This leads to a decline in functional ability and increased risk of falls and injuries.

The decrease in muscle mass due to sarcopenia is primarily due to the loss of type II muscle fibers, which are the fast-twitch fibers responsible for bursts of strength and power. The precise causes are multi-factorial including reduced physical activity, decreased protein intake, hormonal changes, chronic diseases and inflammation.

Impact of Sarcopenia

Sarcopenia has wide-ranging health implications as it contributes to physical frailty and disability in older adults. Some key effects include:

- Mobility issues: Loss of leg strength from sarcopenia makes activities like walking, stairs climbing and rising from chairs very difficult. This increases fall risks.

- Poor balance: Weaker lower limb muscles impair postural stability leading to balance issues and falls. Over 30% of older adults with sarcopenia experience falls each year.

- Functional limitations: Daily tasks like carrying groceries or getting dressed become challenging with reduced grip strength and overall weakness.

- Increased mortality risk: Sarcopenia is associated with significantly higher risks of death from any cause as well as death specifically due to infections.

- Poor quality of life: Physical decline and disability associated with muscle loss negatively affect mental health as well as independence and social interaction in the elderly.

- Economic burden: Sarcopenia results in more medical costs especially related to hospitalization, nursing home stays and home healthcare services. It also reduces productivity in aging populations.

Assessment and Diagnosis of Sarcopenia

There are no definitive diagnostic labs for sarcopenia. The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed standardized diagnostic criteria based on low muscle mass, muscle strength and physical performance:

- Low muscle mass is assessed using dual energy X-ray absorptiometry (DEXA) scan to measure lumbar skeletal muscle mass index.

- Weakness is evaluated using handgrip dynamometry to measure maximum isometric strength.

- Poor physical performance is indicated by slow gait speed, short sitting-rising test or stair climbing power test.

Sarcopenia is diagnosed if low muscle mass plus low muscle strength or physical performance are present. Secondary causes like malnutrition, chronic diseases, medications and lifestyle factors must also be ruled out.

Treatment and Management of Sarcopenia

At present there is no cure for Sarcopenia Treatment but a multi-pronged approach can help slow its progression and improve functionality:

Exercise and Resistance Training

- Strength training 2-3 times a week focusing on large muscle groups is the cornerstone of sarcopenia treatment. It stimulates muscle protein synthesis.

Nutritional Support

- Adequate protein intake of at least 1-1.2 grams of high quality protein per kg body weight daily along with vitamin D and other nutrients support muscle health.

Medications

- Testosterone supplementation may benefit some hypogonadal men. Further research is being done on myostatin inhibitors and other anabolic agents.

Fall Prevention Strategies

- Exercises to improve balance, core strength and gait training can help prevent falls often seen in sarcopenic individuals.

Disease Management

- Treating underlying illnesses like diabetes, cancers optimizes general health and muscle mass stability.

Early intervention with a customized plan incorporating exercise, nutrition and lifestyle modifications tailored to the individual’s needs, abilities and risks is key to getting the best results from sarcopenia therapy. With proper care and management, much of the muscle loss and subsequent disability seen in aging can be counteracted.

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