Sarcopenia: A Time for Action. An SCWD Position Paper

Abstract

The term sarcopenia was introduced in 1988. The original definition was a “muscle loss” of the appendicular muscle mass in the older people as measured by dual energy x‐ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC‐F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease‐related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age‐related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age‐related and disease‐related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life‐long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

“…However, numerous tools are at the clinician's disposal for both osteoporosis and sarcopenia. The SARC‐F is a 5‐point sarcopenia questionnaire recommended in the most recent international consensus guidelines . Owing to its moderate sensitivity and high specificity, the SARC‐F is most accurate in detecting those with severe sarcopenia.…”

“…Owing to its moderate sensitivity and high specificity, the SARC‐F is most accurate in detecting those with severe sarcopenia. The SARC‐F has been validated in international and multiethnic populations . In contrast, there is clear consensus on osteoporosis screening and when investigations with BMD testing via DXA should be undertaken.…”

“…Physical assessments are considered as either measures of muscle strength (grip strength, sit to stand test) or functional capacity (gait speed, short physical performance battery, timed up and go test, 400 m walk test). The two most widely used and validated assessments are grip strength and gait speed . Clinicians must apply caution when using these measures interchangeably; different strength and performance measures result in markedly different classifications of sarcopenia within populations and individuals …”

Frailty and Seasonality

“…Individuals with frailty are also very unlikely to partake in physical activity in colder weather (22). A lack of physical activity reduces muscle strength and physical function (22)(23)(24) and it is therefore reasonable to propose that frailty develops and progresses the longer the colder weather goes for (22). Physical performance is also lower in older adults in colder houses during winter (25).…”

Influence of combined vitamin D3supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial

“…Resistance exercise training (RET) is the most promising intervention for improving 20 and also reversing sarcopenia. 21 It is the position of the Society on Sarcopenia, Cachexia and Wasting Disorders that RET should be implemented in the management of sarcopenia, 22 since it is known to improve muscle mass, strength and function. 21 23 24 Although and others have shown that even in very old adults (>75 years), RET improves muscle strength and functional outcomes, the hypertrophic ability of older muscle is blunted compared with younger adults.…”