Sarcopenia

Tanja Unterberger studied journalism and communication science in Vienna. In 2015 she started her work as a medical editor at in Austria. In addition to writing specialist texts, magazine articles and news, the journalist also has experience in podcasting and video production.

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People with sarcopenia lose muscle mass and strength as they age. Affected people are less productive as a result, which means they fall and injure themselves more often. A balanced diet and sufficient exercise are important to prevent sarcopenia in old age. Read more about causes, symptoms and treatment here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M62

Brief overview

• Description: Excessive breakdown of muscles and muscle strength in old age
• Treatment: strength training to strengthen the muscles, balanced diet (especially protein intake), physiotherapy
• Symptoms: Common symptoms are weakness and unsteady gait (such as walking slowly, stumbling).This often leads to falls and injuries (such as broken bones).
• Causes: How sarcopenia develops is not yet fully understood. Doctors suspect that several factors (such as diet, exercise, hormones, diseases) play a role in the development.
• Diagnosis: Talk to the doctor, physical examination (e.g. measuring muscle mass, measuring hand pressure, measuring walking pace)
• Course: With early treatment, it is usually possible to slow down muscle breakdown.
• Prevention: Those who exercise enough, eat healthily and lead an active lifestyle reduce the risk of sarcopenia.

What is sarcopenia?

The loss of muscle mass and therefore muscle strength is part of the normal aging process: between the ages of 45 and 90, a healthy person loses around half of their muscle mass. With age, the muscle fibers become smaller and fewer and are replaced by adipose and connective tissue. As a result, the muscles of older people are generally smaller, weaker and tire more quickly.

In sarcopenia, this process is intensified by factors such as chronic illnesses, inflammation, too little exercise or being overweight. The muscles continue to degrade with age, causing those affected to lose strength quickly.

Sarcopenia (also known colloquially as "muscle wasting in old age") denotes a progressive decline in muscle mass, muscle strength and muscle function.

This increases the risk of those affected falling and injuring themselves. They are often restricted in their everyday life and dependent on the help of others, which significantly reduces their quality of life.

The severity of the sarcopenia depends on various factors, such as too little exercise, malnutrition or illnesses. For this reason, the elderly are affected by sarcopenia to different degrees.

How common is sarcopenia?

The risk of sarcopenia increases with age. For example, up to 50 percent of men and women over 80 years of age have more muscle breakdowns. However, sarcopenia sometimes also affects younger people if they suffer from certain diseases (for example vascular diseases or tumors) or if they do not move enough.

What can you do about sarcopenia?

In order to treat sarcopenia, it is important to counteract any breakdown of the muscles as early as possible. This is achieved, for example, by:

Weight training and sports

With regular strength training it is possible to build up or maintain the muscles. Doctors therefore recommend that older people, in particular, participate in sports and exercise regularly. Which sport is suitable and to what extent depends on the individual state of health. Let the doctor do a health check beforehand and get advice.

Physiotherapy and occupational therapy

If someone is already affected by sarcopenia and has physical limitations, it is important to slow down the further breakdown of the muscles. Physiotherapy and occupational therapy, for example, are suitable for this purpose. Under the guidance of trained therapists, those affected learn to improve their mobility and strengthen their muscles through appropriate strength training.

Exercises

The following exercises will help you to strengthen your muscles in everyday life:

• Do squats regularly (e.g. while watching your favorite show), holding onto a table or chair if necessary.
• Take long strides through your home on a regular basis.
• Sit in a chair and slowly raise and lower your heels. The tips of your toes remain on the ground.
• Get up from a chair several times in a row without using your arms.
• Lie on the floor and pull your legs towards your stomach several times.
• Sit on a chair, take a two-liter water bottle in both hands and stretch your arms up over your head several times and then lower them back down again.
• Use the stairs instead of the elevator.
• Walk shorter distances or ride a bike.

Have a trained physiotherapist or movement trainer show you the exercises beforehand in order to avoid mistakes and injuries.

Balanced nutrition

In addition, it is important that people with sarcopenia consume sufficient energy and nutrients (especially proteins, vitamin D and unsaturated fatty acids). In some cases, the doctor will prescribe additional food or drink to meet your daily needs. However, diet alone is not enough to stop the early breakdown of muscles. What is more important is a combination of a healthy diet, sufficient exercise and strength training.

Medication

No drugs for sarcopenia are currently approved. However, drugs such as certain antihypertensive agents or biologics (bioengineered drugs) that promote muscle growth are currently in development.

How do you recognize muscle wasting in old age?

People with sarcopenia usually feel weak and have difficulty walking (unsteady gait). Many stumble more often, walk very slowly and lean their upper body forward. This often leads to people falling and injuring themselves.

Older, frail people in particular often suffer complicated injuries such as femoral neck fractures or head injuries as a result. As a result, they are often bedridden and dependent on the help of others. Such accidents, but also the mere fear of falling, often lead to people with sarcopenia moving less.

On the one hand, this contributes to the fact that the muscles continue to degrade. On the other hand, it leads to those affected losing their independence. People with sarcopenia are often no longer able to take care of themselves and do everyday activities such as shopping. The refrigerator stays empty, which increases the risk that people will not be able to eat properly.

Malnutrition weakens the immune system, which usually disrupts wound healing and causes chronic wounds. Ultimately, all of these factors mean that those affected move too little and the muscles continue to lose weight.

Sarcopenia usually develops from a "vicious circle" of several different causes, which is often difficult to break.

If you notice one or more symptoms in yourself or a loved one, consult a doctor in order to prevent possible consequences of sarcopenia at an early stage.

What other consequences does sarcopenia have?

Often people with sarcopenia are restricted in their movement and are unable to cope with everyday life independently. This usually severely affects their quality of life.

Sarcopenia therefore often leads to a state of so-called frailty ("frailty"). This syndrome is characterized, among other things, by the fact that those affected are less resilient to stress factors of various types.

For example, a simple flu-like infection or a negative social experience (such as when a family member dies) can throw the organism out of balance. As a result, patients are more prone to illness, fall more often and are therefore treated more often in hospital.

Frailty syndrome also leads in many cases to those affected becoming bedridden and no longer moving. They are therefore often in need of care and have an increased risk of dying.

Frailty syndrome is dependent on many factors. The most common cause is sarcopenia.

What causes sarcopenia?

How sarcopenia develops has not yet been fully clarified. However, doctors suspect that several factors promote the development of sarcopenia. These include:

Malnutrition

Older people tend to be less hungry and feel full sooner, which means they eat less. Diseases such as diabetes mellitus, dementia or depression as well as side effects of drugs (such as nausea) often lead to those affected not eating in accordance with their needs.

The body breaks down muscles, especially when older people consume too few proteins. This in turn encourages the sarcopenia to progress.

Too little movement

To prevent muscle wasting in old age, it is important to get enough exercise. People who exercise too little are therefore at increased risk of sarcopenia.

Hormones

With age, the levels of hormones such as testosterone, estrogen, insulin and other hormones that build muscles decrease. This, too, favors sarcopenia.

Chronic illnesses

Heart failure (heart failure), kidney failure (kidney failure), diabetes mellitus, chronic obstructive pulmonary disease (COPD) or rheumatoid arthritis (RA) also contribute to the loss of muscles.

taking medication

Certain drugs, such as glucocorticoids (cortisone), encourage or increase the loss of muscle mass.

How does the doctor make a diagnosis?

Diagnosing sarcopenia is difficult. If you suspect muscle atrophy, your first point of contact is your family doctor. If necessary, the doctor will refer you to a geriatric specialist for further examinations.

Talk to the doctor

First, the doctor conducts a detailed discussion with the person concerned (anamnesis). To do this, he often uses questionnaires such as the SARC-F screening questionnaire (Simple Five-Item Questionnaire). This consists of five questions that give the doctor an indication of how strong the patient is and whether he has any problems walking. The doctor asks the person concerned, for example, whether he is able to get up from a chair or climb stairs and how often he has fallen in the past year.

The European Working Group on Sarcopenia in Older People (EWGSOP) has also established criteria for determining sarcopenia.

These are:

1. Low muscle strength
2. Low muscle mass
3. Low physical performance (walking speed)

Sarcopenia is present if criterion 1 is combined with criterion 2 or criterion 3. A reduced muscle mass alone is not enough. In addition, the strength or performance of the person concerned must be impaired.

The following examinations are used to determine the individual diagnostic criteria:

Muscle strength

To check muscle strength, the doctor measures the patient's hand pressure strength using a hand strength meter. Sarcopenia is suspected if the grip strength is less than 27 kg in men over 65 years of age or less than 16 kg in women. The investigation allows reliable conclusions to be drawn as to whether the person affected is able to carry out everyday activities independently.

Muscle mass

To measure muscle mass, the doctor usually uses technical methods such as DXA measurement (dual X-ray absorptiometry) or bioimpedance analysis. With the help of both examinations, the doctor is able to differentiate between fat tissue and fat-free tissue in the person's body and thus estimate the muscle mass.

Walking speed

The quickest indication of reduced performance due to sarcopenia gives the doctor the measurement of the individual walking pace. It should be over 0.8 meters per second for people over 65 years of age. If the value is below this, this indicates reduced performance and thus sarcopenia.

The EWGSOP recommends measuring walking speed as a routine screening examination for patients over 65 years of age.

Further investigations

To assess the strength and coordination of the muscles, the doctor uses, among other things, functional tests such as the chair stand test or stair climb test. During the chair stand test, the person concerned should get up from a chair five times as quickly as possible without using their arms (arms crossed in front of their chest). In the stair climb test, the patient is asked to climb and descend a number of steps as quickly as possible.

Imaging methods such as computed tomography (CT), magnetic resonance imaging (MRT) or ultrasound examination (sonography) can also be used to diagnose sarcopenia.

Stages of sarcopenia

The guidelines of the European Working Group on Sarcopenia in the Elderly (EWGSOP) differentiate between three stages of sarcopenia:

• Pre-sarcopenia: muscle mass is reduced, but strength and performance are normal.
• Sarcopenia: The muscle mass is reduced, in addition the strength or the performance is reduced.
• Severe sarcopenia: muscle mass, strength and performance are reduced.

This subdivision is helpful for the doctor in determining therapy goals and selecting the appropriate treatment.

From which diagnoses should sarcopenia be differentiated?

There are some diseases that cause symptoms similar to sarcopenia, but must be clearly differentiated from sarcopenia as a diagnosis. These have different causes and must therefore be treated differently. This includes:

Malnutrition

People who are malnourished usually lose a lot of weight, with the fat mass in the body being broken down in particular. The muscles remain unchanged or are only slightly reduced. In contrast to sarcopenia, malnutrition can be reversed with nutritional therapy.

Cachexia

People with cachexia are severely underweight due to the side effects that occur with chronic illnesses or cancer (tumor cachexia). Both fat and muscle mass are excessively broken down in them. A cachexia can lead to sarcopenia. However, in the case of cachexia, the doctor treats the underlying disease. If the cause cannot be eliminated, nutritional therapy (artificial nutrition if necessary) can be considered.

Both with malnutrition and with cachexia, those affected lose weight to a greater or lesser extent. In addition, their body composition (fat and muscle mass) has changed.

Is Sarcopenia Curable?

With early treatment, it is often possible to slow down muscle breakdown. However, people with sarcopenia usually die earlier than their peers without age-related muscle wasting. Sarcopenia increases the risk of people falling and injuries such as broken bones or head injuries.

People with sarcopenia are therefore often restricted in their everyday life and their independence, which significantly reduces the quality of life for many of those affected.

Early diagnosis and treatment are therefore important in order to cope with everyday life as long as possible without restrictions.

How do you prevent muscle wasting in old age?

There are a few steps you can take to prevent your muscles from breaking down prematurely and to prevent sarcopenia. These include:

Move

Get enough exercise. In this way, you specifically prevent muscle breakdown. Not only strength training is suitable for this, regular, long walks in the fresh air also have a positive effect on your health.

You can also prevent sarcopenia with regular swimming, everyday exercise such as climbing stairs and light gymnastics. Discuss with your doctor which types of sport and exercise suit your state of health and training. Don't overwhelm yourself.

nourishment

Eat a balanced, varied and needs-based diet. This is especially important in old age in order to maintain health. It is therefore best to take the following daily:

• At least 1.5 liters of water, herbal or fruit tea or diluted fruit juices
• Five servings of vegetables, fruits and legumes
• Four servings of complex carbohydrates such as potatoes, rice, pasta, bread
• Three servings of dairy products, preferably reduced-fat
• Meat, fish and eggs twice a week - less is more!
• One to two tablespoons of high-quality fats and oils (e.g. rapeseed oil, olive oil, linseed oil) - quality over quantity!

Sufficient protein intake is important to prevent sarcopenia. You should therefore consume at least 0.8 g of protein (e.g. in the form of meat, fish, eggs, dairy products, legumes, soy products) per kilogram of body weight.

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