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What is sarcopenia (muscle wasting with age)?

by Josephine Andrews
Published: Last Updated on 389 views

People with sarcopenia lose muscle mass and muscle strength as they age. Those affected are less efficient as a result, which means that they fall more often and injure themselves. 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 valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

M62

quick overview

  • Description: Excessive loss of muscle mass 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 (like walking slowly, stumbling). This often leads to falls and injuries (e.g. broken bones).
  • Causes: How sarcopenia develops has not yet been fully clarified. Doctors suspect that multiple factors (such as diet, exercise, hormones , medical conditions) play a role in its development.
  • Diagnosis: discussion with the doctor, physical examination (e.g. measuring muscle mass, measuring hand pressure, measuring walking speed)
  • Course: With early treatment, it is usually possible to slow down muscle breakdown.
  • Prevention: Getting enough exercise, eating a healthy diet and leading an active lifestyle reduces the risk of sarcopenia.

What is sarcopenia?

The loss of muscle mass and thus 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 fat and connective tissue. As a result, the muscles of older people are generally smaller, weaker and tire more easily.

In the case of sarcopenia, this process is amplified by factors such as chronic diseases, inflammation, too little exercise or being overweight . The muscles continue to deteriorate with age, which means that those affected quickly lose strength.

Sarcopenia (colloquially also “muscle wasting in old age”) describes a progressive reduction 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.

How severe the sarcopenia is depends on various factors, such as insufficient exercise, malnutrition or illnesses. For this reason, older people are affected differently by sarcopenia.

How common is sarcopenia?

The risk of sarcopenia increases with age. In up to 50 percent of men and women over the age of 80, the musculature is increasingly reduced. However, sarcopenia sometimes also affects younger people if they suffer from certain diseases (e.g. vascular diseases or tumors) or do not move enough.

What can you do about sarcopenia?

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

strength training and sports

Regular strength training makes it possible to build up and maintain muscles. Doctors therefore recommend that older people in particular exercise and exercise regularly. Which sport is suitable and to what extent depends on the individual state of health. Have a health check done by a doctor and get advice.

Physiotherapy and occupational therapy

If someone already has sarcopenia and is physically challenged, it is important to slow down further muscle breakdown. Physiotherapy and ergotherapy , for example, are suitable for this . Under the guidance of trained therapists, those affected learn how 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), hold on to a table or chair if necessary.
  • Take long, regular walks through your home.
  • Sit in a chair and slowly raise and lower your heels. The toes stay on the ground.
  • Stand up from a chair several times without using your arms.
  • Lie on the floor and pull your legs towards your stomach several times.
  • Sit in a chair, hold a 2-liter water bottle in both hands, and stretch your arms up over your head several times, then lower them back down.
  • Use the stairs instead of the elevator.
  • Walk short distances or ride a bike.

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

Balanced nutrition

In addition, it is important that people with sarcopenia get enough energy and nutrients (especially proteins, vitamin D and unsaturated fatty acids). In some cases, the doctor prescribes additional food or liquid food to cover daily needs. However, diet alone is not enough to stop the premature breakdown of the muscles. What is more important is a combination of healthy nutrition, sufficient exercise and strength training.

medication

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

How do you recognize muscle loss with 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 those affected falling and injuring themselves.

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

On the one hand, this contributes to the fact that the muscles continue to break down. 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 going shopping. The refrigerator remains empty, which increases the risk that those affected do not eat enough.

Malnutrition weakens the immune system, which usually disrupts wound healing and causes chronic wounds. All of these factors ultimately lead to those affected moving too little and the muscles breaking down further.

A sarcopenia usually develops from a “vicious circle” of several different causes, which is often difficult to break.

If you or a loved one notice one or more symptoms, consult a doctor to prevent possible consequences of sarcopenia early on.

What other consequences does sarcopenia have?

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

Sarcopenia therefore often leads to the condition 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 kinds.

Sometimes even a simple flu infection or a negative social experience (e.g. when a family member dies) throws the organism out of balance. As a result, patients are more susceptible to illnesses, fall more often and are therefore treated more often in hospital.

In many cases, frailty syndrome also leads 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 favor the development of sarcopenia. These include, among others:

malnutrition

Older people tend to be less hungry and feel full sooner, causing them to eat less. Illnesses such as diabetes mellitus , dementia or depression as well as side effects of medicines (e.g. nausea) often mean that those affected do not eat according to their needs.

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

Too little movement

In order to prevent muscle atrophy in old age, it is important to get enough exercise. People who do not exercise enough are therefore at an increased risk of sarcopenia.

hormones

As we age, levels of hormones such as testosterone , estrogen, insulin , and other hormones that build muscle decrease. This also favors the development of sarcopenia.

chronic diseases

Heart failure ( heart failure ), kidney failure ( kidney failure ), diabetes mellitus, chronic obstructive pulmonary disease ( COPD ) or rheumatoid arthritis (RA) also contribute to muscle breakdown.

taking medication

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

How does the doctor make a diagnosis?

Diagnosing sarcopenia is difficult. If muscle atrophy is suspected, the first point of contact is the family doctor. If necessary, he or she will refer you to a specialist in geriatric medicine for further examinations.

conversation with 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 indications of how strong the patient is and whether he has problems walking. For example, the doctor asks the person concerned whether they are able to get up from a chair or climb stairs on their own and how often they have fallen in the past year.

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

These are:

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

Sarcopenia is present when criterion 1 is present in combination 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:

muscular strength

To check muscle strength, the doctor measures the patient’s hand pressure strength using a hand strength meter. Sarcopenia is suspected when grip strength is less than 50 pounds in men over the age of 65 or less than 30 pounds in women. The examination allows reliable conclusions to be drawn as to whether the person concerned is able to carry out everyday activities independently.

muscle mass

In order to measure muscle mass, doctors usually use 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 body of the person concerned and thus estimate the muscle mass.

walking speed

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

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

Further investigations

In order to assess the strength and coordination of the muscles, the doctor uses functional tests such as the chair-stand test or the stair-climb test. In the chair-stand test, for example, the patient has to get up from a chair five times as quickly as possible without using his arms (arms crossed in front of his chest ). In the stair climb test, the patient is asked to climb and descend a number of steps on a flight of stairs as quickly as possible.

Imaging procedures such as computed tomography (CT), magnetic resonance imaging (MRI) or an 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) distinguish three stages of sarcopenia:

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

This subdivision is helpful for the doctor to set therapy goals and select the appropriate treatment.

Which diagnoses should sarcopenia be distinguished from?

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

malnutrition

People who are malnourished usually lose a lot of weight, whereby the body’s fat mass in particular is broken down. The musculature remains unchanged or is only slightly reduced. Unlike sarcopenia, malnutrition can be reversed with nutritional therapy.

cachexia

People with cachexia are severely underweight due to side effects associated with chronic disease or cancer (tumor cachexia). Both fat and muscle mass are excessively broken down in them. 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 (possibly artificial nutrition) is an option.

In the case of both malnutrition and cachexia, those affected lose weight to a greater or lesser extent. In addition, their body composition (fat and muscle mass) is changed.

Is sarcopenia curable?

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

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

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

How to prevent muscle loss in old age?

A few measures will help you to prevent your muscles from breaking down prematurely and prevent sarcopenia. These include, among others:

Movement

Get enough exercise. This is how 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 correspond to your health and fitness level. Don’t overdo it.

nutrition

Eat a balanced, varied and needs-based diet. This is especially important in old age to maintain good health. Therefore, it is best to consume the following every day:

  • At least 1.5 liters of water, herbal or fruit tea or diluted fruit juices
  • Five servings of vegetables, fruit and legumes
  • Four servings of complex carbohydrates such as potatoes, rice, pasta, bread
  • Three servings of dairy products, preferably low-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 before quantity!

Adequate 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 every day.

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