Sarcopenia: A new geriatric giant and focus of intense research
Sarcopenia, a condition previously underrecognized in clinical practice, has now become a focus of intense research.
“Sarcopenia is a new ‘geriatric giant’. It matters because it is associated with increased falls as well as disability, hospitalization and mortality,” said Professor Avan Aihie Sayer of the Newcastle Biomedical Research Centre, Newcastle, UK.
In 2019, the European Working Group on Sarcopenia in Older People (EWGSOP) published an updated consensus report on sarcopenia, recommending the pathway of “Find cases, Assess, Confirm, Severity” in the screening and diagnosis of sarcopenia. [Age Ageing 2019;48:16-31]
“According to the consensus report, clinicians should proceed with further assessment of sarcopenia if there is clinical suspicion or if the patient has a SARC-F questionnaire score of ≥4. Initial assessment of sarcopenia should include grip strength [cut-off, 27 kg for men and 16 kg for women] or the chair-stand test [cut-off, 15 seconds for five chair rises], followed by confirmatory tests such as bone densitometry, MRI and CT to measure muscle quantity and quality. Severity can be evaluated by physical performance tests, such as gait speed or short physical performance battery test,” said Sayer.
“Diagnosis of sarcopenia is important because the condition is associated with incident disability, hospitalization and death. Importantly, sarcopenia was found to be the most significant risk factor for falls, but not other well-known factors such as a history of falls,” she noted. [J Gerontol A Biol Sci Med Sci 2016;71:259-264; J Am Geriatr Soc 2001;49:664-672; BMC Geriatr 2018;18:116; Exp Aging Res 2018;44:258-269]
According to Sayer, several studies have shown that exercise and diet may play a role in the prevention and management of sarcopenia, but most of these studies are observational. In addition, implementation of exercise programmes in elderly individuals with sarcopenia is faced with challenges, such as low uptake and variable response.
“While no pharmacological interventions have been approved by the US FDA for the treatment of sarcopenia to date, several drugs are currently being investigated. These include selective androgen receptor modulators, myostatin inhibitors and leucine,” she highlighted.
For example, the combination of perindopril and leucine is being investigated in the LACE trial. “LACE is the first major academic-led, government-funded multicentre trial on sarcopenia in the UK. In the study, patients with sarcopenia are randomized to receive perindopril plus leucine, either therapy alone, or placebo for 1 year,” Sayer said. [www.lacetrial.org.uk] “The initial recruitment process of this trial was challenging because most patients were not fit enough to be enrolled. The situation improved when recruitment sites were changed from geriatric medicine hospitals to primary care clinics.”
“It is now timely to consider how emerging research findings on sarcopenia can be translated into improved care for the elderly,” she concluded. “Future research directions include a focus on the underlying mechanisms of sarcopenia that can potentially translate into advances in the prevention, diagnosis and management of the disease.”