Sarcopenia

Sarcopenia is the gradual loss of muscle mass, strength and physical performance that happens with age. It affects your musculoskeletal system and can make everyday tasks — like climbing stairs or getting out of a chair — harder over time. As your muscles weaken, your risk of falls, fractures and loss of independence goes up.

The definition of sarcopenia (pronounced “sar-ko-PEE-nee-uh”) focuses on how muscle loss affects your strength and ability to function. Experts generally define it using one or more key features:

• Low muscle mass
• Low muscle strength
• Low physical performance

In some cases, sarcopenia occurs along with a higher body mass index (BMI). This combination, called sarcopenic obesity, can raise your risk of complications more than obesity or sarcopenia alone.

In 2016, sarcopenia was recognized as a specific disease with an ICD-10-CM code. This step helped distinguish sarcopenia from other conditions that cause muscle loss and made it a reportable diagnosis. As a result, awareness, research and treatment efforts have continued to grow.

Sarcopenia symptoms

The most common symptom of sarcopenia is muscle weakness. Other signs and symptoms may include:

• Loss of stamina
• Difficulty performing daily activities
• Walking slowly
• Trouble climbing stairs
• Poor balance and falls
• Decrease in muscle size

What is the main cause of sarcopenia?

The most common cause of sarcopenia is the natural aging process. As you age, your body goes through changes that affect your muscles. You don’t make protein as well, which your muscles need to grow and repair. Changes in hormones like testosterone and insulin-like growth factor (IGF-1) also play a role.

Over time, both the size and number of your muscle fibers decrease. This causes muscle atrophy (thinning), weakness and slower movement.

Intentional or unintentional weight loss may also lead to sarcopenia. This is especially true if you’re not doing weight, strength and resistance exercises on a regular basis. It’s also important to keep in mind if you’re considering taking a medication for weight loss.

What are the risk factors for sarcopenia?

Aging is the most common factor. You gradually begin losing muscle mass and strength in your 30s or 40s. This process picks up between the ages of 65 and 80. You may lose as much as 8% of your muscle mass each decade.

Your risk goes up as you age. But there are other possible risk factors. These include:

• Physical inactivity
• Overweight, obesity or underweight
• Chronic health conditions, like heart disease, diabetes and COPD
• Bone-related conditions, like osteoporosis and osteoarthritis
• Social factors, like having a lower income, being unmarried and living alone
• Trouble with activities of daily living
• Smoking
• Drinking alcohol

What are the complications of sarcopenia?

Sarcopenia can lead to:

• Falls
• Fractures
• Loss of independence
• Healthcare-associated infections (HAIs)
• Higher risk of complications after surgery

How doctors diagnose sarcopenia

Your healthcare provider will examine you and ask you about your symptoms. You may complete a questionnaire based on your self-reported symptoms. This is called the SARC-F. SARC-F stands for:

• S — Strength
• A — Assistance with walking
• R — Rising from a chair
• C — Climbing stairs
• F — Falls

You score each factor with a number between 0 and 2. The highest maximum SARC-F score is 10. If you get a SARC-F score of 4 or more, you need more testing.

Tests that are used

There’s no single test that can diagnose sarcopenia. Your healthcare provider may recommend several tests to diagnose the condition and figure out how severe it is.

Muscle strength tests

• Handgrip test: This test measures how strong your hand squeeze is. Your grip strength can show how strong your other muscles are, too. Providers use it to check for overall muscle weakness.
• Chair stand test: Providers use this test to measure your leg muscle strength, especially your quads. It measures the number of times you can stand and sit in a chair in 30 seconds without using your arms.
• Walking speed test: The walking (gait) speed test measures the time it takes for you to travel 4 meters (about 13 feet) at your usual walking pace.
• Timed-up and go test (TUG): The TUG test measures the time it takes for you to rise from a chair, walk 3 meters (about 10 feet) away from the chair, walk 3 meters back to the chair, and sit back down in the chair.

Imaging tests

• Dual-energy X-ray absorptiometry (DEXA or DXA): This test uses low-energy X-rays to measure your muscle mass, fat mass and bone density.
• Bioelectrical impedance analysis (BIA): This test is less expensive and more widely available than DEXA. It measures your body fat in relation to your lean body mass.

How is sarcopenia treated?

Sarcopenia treatment typically involves making changes to your diet and exercise routine. The goal is to keep your weight and muscle mass stable, as well as strengthen your muscles. These steps can help treat and reverse sarcopenia:

• Physical activity: Your healthcare provider may recommend resistance training. This form of exercise involves the use of resistance bands to stretch your muscles. It can help reverse muscle loss and improve your strength.
• Increase protein: Your provider may also suggest increasing your total protein intake through food and supplements. This can also help reverse the effects of sarcopenia. Try to aim for 20 to 35 grams of protein per meal.

Specific meds/procedures used

There aren’t currently any FDA-approved medications to treat sarcopenia. But if you take a proton pump inhibitor (PPI), your provider may recommend stopping it if possible. Studies show that long-term PPI use can lead to malabsorption of vitamin B12 and magnesium. This can lead to muscle weakness, poor balance and falls.

When should I see my healthcare provider?

Call your provider if you’ve experienced:

• Muscle weakness
• Loss of endurance
• Any other symptoms of sarcopenia

They can develop a treatment plan to help you reverse your muscle loss and manage the condition.

What is the prognosis for sarcopenia?

The prognosis (outlook) for sarcopenia depends on several factors, including:

• Your age
• Other health conditions
• Falls and fractures
• The need for surgery or other medical procedures

By adding resistance training and consuming more protein, you can help reverse the effects of the condition. Without making changes, sarcopenia will continue to weaken your muscles. Over time, you may need full-time care.

Can sarcopenia be prevented?

You can’t completely prevent sarcopenia since the condition happens as a natural part of aging. But you can take steps to slow the progression of the disease. These steps include:

• Eat nutritiously: Maintain a healthy diet for yourself that includes high-quality protein at each meal.
• Stay physically active: Keep your body moving with exercises like resistance training.
• Get routine physicals: See your healthcare provider regularly, and let them know about any changes in your health.

What’s the difference between muscle atrophy and sarcopenia?

Muscle atrophy is the loss of muscle tissue. Sarcopenia is a type of muscle atrophy that specifically affects you as you age. The two conditions share common features of muscle loss, but the processes behind them are different. A decrease in the size and number of your muscle fibers causes sarcopenia. With muscle atrophy, there’s a reduction in the size of the fibers, but the number of fibers stays the same.