Sarcopenia: From definition to treatment

Sarcopenia prevalence and association with nutritional status in cohort of elderly patients affected by musculoskeletal concerns: a real-life analysis

Introduction

The progressive loss of skeletal muscle mass, strength, and function that frequently occurs as people get older is referred to as sarcopenia. Elderly musculoskeletal aging, sarcopenia, and obesity are all intimately connected. Our study's aim is to investigate the prevalence of sarcopenia in a real cohort of patients over 65 with musculoskeletal conditions referring to a Rehabilitation Unit. The secondary aim of our study is to investigate associations between sarcopenia and alterations in nutritional status and Body Mass Index (BMI). Finally, quality of life and global health has been investigated in our population.

Materials and methods

From January 2019 to January 2021, 247 patients over 65 years old with musculoskeletal concerns were enrolled and participated in an observational study. As outcome measures, the Mini Nutritional Assessment (MNA), the 12-Item Short Form Health Survey (SF-12), and the Cumulative Illness Rating Scale Severity Index (CIRS-SI) were used. Additionally, measurements of total skeletal muscle mass (SMM) and appendicular muscle mass (ASMM) using bioelectrical impedance analysis, as well as a hand grip strength test of the non-dominant hand were taken. The Mid Upper Arm Circumference (MUAC) and the Calf Circumference (CC) were measured and recorded as further indications of possible sarcopenia.

Results

A percentage of 46.1% of subjects with overt sarcopenia was found and 10.1% showed a severe sarcopenia. Patients with severe sarcopenia showed significantly lower values of BMI and MNA. Additionally, sarcopenic patients showed significantly lower values in MNA when compared to non-sarcopenic patients. Considering SF-12, only the physical score revealed slight significant differences. In particular, patients affected by probable or severe sarcopenia presented a lower value than non-sarcopenic patients. Concerning MUAC and CC, severe sarcopenic patients showed significant lower values for both the body parts.

Conclusion

Our study considers a cohort of real-life elderly subjects with musculoskeletal concerns and shows that these subjects are highly susceptible to sarcopenia. Therefore, rehabilitation for elderly patients with musculoskeletal concerns requires to be customized and multidisciplinary. Future research should further investigate these aspects in order to enable the early identification of sarcopenia and the formulation of customized rehabilitative programs. .

Improving functional outcomes and quality of life in an elderly woman with sarcopenia and spinal Tuberculosis: A case report

Background

Indonesia is the world's second-largest contributor to TB patients. According to prevalence by age, the elderly have the most diagnosed TB. In Indonesia, TB spondylitis affects approximately 5% of TB cases and is a common cause of non-traumatic spinal cord injury (NTSCI). Spinal cord injury (SCI) is a growing public health concern, particularly among the elderly, as many of its populations have sarcopenia. Due to the complete absence of voluntary muscle contraction, SCI is followed by a rapid loss of skeletal muscle mass. SCI has several physical, psychological, social, and economic consequences.

Case presentation

A 68-years-old woman presented with weakness and numbness of all four limbs. She also had sarcopenia, malnutrition, and dependency on activities of daily living (ADL). In addition, the patient was at a risk of SCI complications. Magnetic resonance imaging (MRI) showed destruction of the vertebral bodies at the level of the 5th and 6th cervical area, tuberculous abscesses of the paravertebral and longus colli muscles. The patient underwent debridement and spinal stabilization. However, the patient was at a risk of developing SCI complications. In these patients, the Physical Rehabilitation and Medicine (PRM) strategy focuses on improving medical conditions, including preventing secondary complications, promoting neurological recovery, and optimizing function.

Conclusion

This case highlights the importance of PRM intervention in assessing functional disorders in the elderly to improve their quality of life (QOL).

Sarcopenia in Hemiplegia

Sarcopenia is a disease characterized by quantitative and qualitative degeneration of the skeletal muscles and it primarily presents with a decline in the muscle strength. It frequently occurs in patients after a cerebrovascular accident due to a combination of various factors, such as the brain injury, structural adaptations, limited physical activity as long as malnutrition. Most of the articles and reviews concerning stroke-related sarcopenia are limited and usually are discussing about the factors and causes that may lead to the muscle wasting and the particular characteristics that distinguish it from age-related sarcopenia. As a result, even though sarcopenia is described as a medical entity, it appears to lack the attention that requires, limiting the maximum therapeutic effect a patient can obtain. Suggestions have been made concerning general treatment and management of sarcopenia, associated with exercise, diet and the use of medical preparations, lacking though disease-specific guidelines for management, treatment and possibly prevention of stroke-related sarcopenia. Nowadays, it is considered of major importance that the medical community should be properly informed and to raise awareness on this particular issue aiming to a better and holistic management of the patients after a cerebrovascular accident, in order to reduce morbidity and disability that both are sequelae that reduce quality of life.

Sarcopenia in the Elderly

In the 21st century, life expectancy has increased and consequently so has the number of elderly people. Sarcopenia is an emerging area in geriatric medicine. The European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength and/or physical performance, associated with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Sarcopenia requires diagnostic and interventional methods in order to initiate timely and appropriate treatment. Diagnosing sarcopenia requires assessments of muscle mass, muscle strength and physical performance. Management of sarcopenia involves a variety of approaches. Nutritional and exercise interventions are strongly supported.

Comparisons of different indices of low muscle mass in relationship with cardiometabolic disorder

This study aimed to evaluate the most valid index among various indices of low muscle mass in assessing cardiometabolic risks in a Korean population. Appendicular lean mass index (ALMI, kg/m2), fat mass index (FMI, kg/m2), FMI-adjusted ALMI (ALMfmi), ratio of ALM to weight index (ALMwt), ratio of ALM to body mass index (ALMbmi) and ratio of ALM to truncal fat index (ALMtrunkfat) were measured by dual energy X-ray absorptiometry in 17,870 participants from 2008 to 2011. We adopted all the aforementioned indices of low muscle mass expressed as sex- and age-specific standard deviation scores (Z-scores). Low muscle mass for age was defined as Z-score <-1. The prevalence of low muscle mass was approximately 16% across all indices. Low muscle mass defined by ALMI had low muscle mass and low fat mass, and ALMfmi had low muscle mass at the same FMI. However, low muscle mass defined by ALMwt, ALMbmi and ALMtrunkfat had similar muscle mass with high FMI. The receiver operating characteristic curve in metabolic syndrome showed that the ALMtrunkfat was 0.74 in male and 0.69 in female, indicating that ALMtrunkfat was the best discrimination index for metabolic syndrome. This study showed that ALMtrunkfat could be a useful indicator for screening cardiometabolic risk factors, particularly in normal or overweight Asian population.