Elsevier

Maturitas

Volume 71, Issue 2, February 2012, Pages 109-114
Maturitas

Review
Sarcopenia in the elderly: Diagnosis, physiopathology and treatment

https://doi.org/10.1016/j.maturitas.2011.11.012Get rights and content

Abstract

Sarcopenia, defined as a syndrome rather than as a pathology, is the loss of muscle mass and function associated with age. Sarcopenia is an enigma for medicine, and despite the numerous publications available in the literature and the number of papers currently being published, there is no agreement about its definition, and even less about its root causes. One salient aspect that proves the lack of consensus is the fact that different working groups are still debating about the right name for this syndrome (which is associated with the loss of muscle mass and strength in the elderly).

In hospitalized patients, sarcopenia has been shown to raise the risk of complications such as infections, pressure ulcers, loss of autonomy, institutionalization and poor quality of life, as well as to increase mortality.

The factors that contribute to the development of sarcopenia in the elderly are: the state of chronic inflammation, atrophy of motoneurons, reduced protein intake (secondary among others to the condition defined as geriatric anorexia), and immobility. There is ongoing debate about the causes of sarcopenia, but the aspect that generates most interest today is the quest to achieve repeatable and clinically useful diagnostic criteria for its diagnosis, prevention and treatment.

The aim of this narrative review is to summarise the abundant information available in the literature and to draw useful conclusions.

Section snippets

Definition of sarcopenia

Sarcopenia is a subject of great interest for geriatricians, and the possibility of considering it as a geriatric syndrome has been in the air since 2010 [1]. The first author to speak of sarcopenia was Rosenberg, who wondered in 1989 why the loss of muscle mass seen in elderly subjects had not been given adequate attention [2]. It was he who first used the term of sarcopenia. The term sarcopenia derives from the Greek terms “sarx” (meat) and “penia” (loss) [3]. However, in the strong

Instrumental diagnosis of sarcopenia

Magnetic resonance imaging (MRI) allows us to calculate segmental and total muscle mass, and to assess muscle quality by calculating fat infiltration in muscle, which is a very interesting parameter. MRI has many advantages but is very expensive, is not easily accessible, and is not routinely indicated to study muscle mass, but has been used mainly for research purposes. It is a very complex test that requires highly specialized staff, specific software, and a relatively large amount of time.

Neuromuscular aging

Neuron loss is a progressive, irreversible process that increases with age.

Among the causes that contribute to strength loss observed in sarcopenia we must mention changes on nervous system due to age, which provoke the loss of motor units. A motor unit is made up of a single alpha motoneuron and all the muscle fibers connected with it. If alpha motoneuron is lost, denervated muscle fibers join to connect to surviving alpha motoneurons. This determines that a single alpha motoneuron must

Non-drug treatment

The practice of physical resistance exercise has been shown to improve muscle mass and strength, but is not always feasible in elderly subjects, and it is not yet known how long its effects last after it is discontinued [40]. It has also been shown that it is not sufficient to reverse the loss of muscle mass in elderly people.

Drug treatment

Pharmacological treatment of sarcopenia is a major area for research. Many drugs are being tested for their effects on muscle mass and strength, such as Ghrelin, GH

Conclusion

Despite the considerable volume of publications, there is no conclusive definition of sarcopenia and it is not recognized as a pathology. There is no clear association between the loss of muscle mass and strength, or the factors that contribute to their development. It would be logical to assume that there is a direct relationship between muscle mass and strength: the greater the mass the greater the strength, and vice versa. An active life style and diet seem to be associated protective

Contributors

All of authors contributed to the preparation of this manuscript equally.

Competing interests

None of the authors is currently receiving funds or grants for research of any kind. The conclusions reached reflect the thinking of the authors. The present study did not receive funding.

Provenance and peer review

Not commissioned, externally peer reviewed.

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