Sarcopenia

When people talk about sarcopenia, they usually mean degenerative processes in muscles, when a person gradually loses muscle mass. Sarcopenia is not a disease. It is rather a specific condition that characterizes other pathologies or age-related changes in the body.

Sarcopenia has only recently attracted the attention of scientific experts. To date, there is not much information about this problem, since research into the disease is still ongoing.

Epidemiology

According to medical experts, the initial processes of sarcopenia can be observed after 26-30 years: muscle loss is less than 1% annually.

Degenerative changes in muscle tissue related to sarcopenia are diagnosed in 14% of the male population and 13% of the female population in the age category from 65 to 75 years, and in 56% of men and 53% of women in the age category from 80 years and older.

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Causes sarcopenia

Almost all cases of sarcopenia are associated with age-related changes in the body. This is the reason why sarcopenia is diagnosed mainly in old age.

Loss of muscle mass can occur in different ways. This causes the division of this problem into the following types:

• primary sarcopenia;
• secondary sarcopenia.

The development of primary sarcopenia can be influenced by the following age-related risk factors:

• hormonal changes (decreased levels of sex hormones and somatotropic hormone, increased levels of cortisol, decreased total vitamin D levels and deterioration of receptor sensitivity to it);
• accelerated process of cell death, disruption of mitochondrial function, differentiation of mesenchyme stem cells into adipocytes;
• replacement of muscles with adipose tissue;
• degenerative changes in the nervous system, disruption of nerve communications in muscles, denervation.

The primary variant is irreversible sarcopenia with increasing and worsening symptoms.

Secondary sarcopenia does not appear due to age, but as a result of exposure to other negative factors:

• protein deficiency in the diet;
• physical inactivity;
• presence of malignant tumors;
• HIV infections;
• general exhaustion of the body;
• starvation;
• severe renal failure;
• severe chronic obstructive bronchitis, etc.

In addition, sarcopenia can develop against the background of other diseases - for example, with inflammatory changes in the digestive organs, stroke, osteoporosis, osteoarthritis, etc.

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Pathogenesis

For normal, full functioning, muscles need proteins produced in the body from amino acids. The human body, even taking into account age-related changes, does not lose the ability to absorb proteins from food - of course, if there are no chronic problems in the intestines, or protein is simply not supplied in sufficient quantities with food.

As for internal protein production, this process may slow down over the years. This is primarily due to the deterioration of the endocrine system, since with age, the production of most hormones usually decreases - for example, insulin-like growth hormone and testosterone.

The listed processes lead to a decrease in the quality of muscle tissue, muscle weakness, nerve fiber conduction disorders, and even damage to nerve cells. As a consequence, there is a possible disruption of muscle recovery and movement coordination.

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Symptoms sarcopenia

Sarcopenia occurs with a gradual, increasing, generalized decrease in muscle mass, which sooner or later leads to decreased functionality of the limbs and progression of muscle weakness.

Processes associated with sarcopenia increase the risk of household injuries due to loss of muscle tone and deterioration of motor coordination, which leads to instability of the vestibular apparatus, falls, bruises, sprains, fractures (which is aggravated by osteoporosis). As a result, difficulties with self-care arise, the quality of life deteriorates, and mortality increases.

The first signs of sarcopenia can be identified with the following symptoms:

• loss of appetite;
• slowing of gait;
• periodic or frequent falls of a random nature;
• decreased vital activity;
• violation of thermoregulation;
• slowing down of the basal metabolic rate;
• osteoporosis;
• problems maintaining balance.

Sarcopenia in the elderly is aggravated by an increasing tendency to overweight and obesity. The pathology often occurs with a decrease in serum albumin levels, as well as an increase in depressive symptoms.

Stages

Experts have identified three main stages in the development of sarcopenia:

1. The first stage (presarcopenia) is characterized by a decrease in muscle mass, while maintaining muscle strength and functionality.
2. The second stage occurs with a decrease in muscle mass, with the appearance of muscle weakness and a disruption in the functionality of skeletal muscles.
3. The third stage is accompanied by a marked decrease in all three parameters.

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Complications and consequences

First of all, sarcopenia precedes the decline in the function of skeletal muscles responsible for maintaining balance when changing body position and shifting the center of gravity. At the same time, the risk of sudden falls increases significantly. Thus, in old age, every 8-10 years, the frequency of injuries increases by about 10%.

Falls can cause both minor bruises and serious fractures (mainly with damage to the proximal femur). Such injuries sometimes lead to disability and even death.

In addition to domestic injuries, sarcopenia significantly worsens the quality of life, contributing to the development of type 2 diabetes, osteoporosis, heart and vascular diseases, the appearance of nocturia, etc.

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Diagnostics sarcopenia

Diagnosis of sarcopenia is a complex and lengthy process. Currently, many different methods are used to determine muscle strength and functionality.

To assess the amount of fat and lean mass, instrumental diagnostics are used:

• computed tomography;
• magnetic resonance imaging;
• dual-photon X-ray absorptiometry (DXA).

CT and MRI are the most common procedures for muscle examination. However, due to the relative high cost of these methods, preference is often given to DXA, as well as bioimpedance analysis - these procedures allow us to estimate the volume of fat and muscle components of the total mass.

Additionally, in case of sarcopenia, tests are performed to assess the excretion of potassium with urine, as well as manual dynamometry, isokinetic dynamometry, and ascending load testing.

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Differential diagnosis

Differential diagnosis of age-related sarcopenia is carried out with myopenia – significant muscle loss as a result of the influence of various pathologies:

• in the diagnosis of myopenia, the degree of muscle atrophy over a fixed period of time (for example, 5% over six months) plays a major role;
• In the diagnosis of sarcopenia, the decisive role belongs to the combination of two criteria: a decrease in the number of muscles and a loss of their strength.

For differential diagnosis, it is important to measure walking speed and perform other dynamic tests.

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Treatment sarcopenia

The main method of treating sarcopenia is considered to be increasing physical activity. Aerobic exercises are relevant, which benefit the cardiovascular system and respiratory organs, and also have a positive effect on the percentage of fat and muscle tissue. Strength training options significantly affect not only the condition of the muscles, but also the health of the skeletal system, preventing the development of sarcopenia and osteoporosis. The course of exercises usually lasts up to 10-12 weeks, for half an hour once every two or three days. In its effectiveness, physical activity surpasses other types of treatment - for example, hormone replacement therapy, etc.

The second equally important way to combat sarcopenia is diet. More protein foods should be added to the diet so that its daily amount is at least 1.2-1.5 g per kg.

Medicines

Scientists have confirmed the fact that when treating sarcopenia, vitamin D deficiency must be replenished. The vitamin can be prescribed in the form of complex preparations, as well as in the form of monodrugs - but always in combination with calcium.

The use of vitamin D in sarcopenia is based on the fact that its deficiency is present in any form of the disease. Patients with sarcopenia are prescribed vitamins in large doses, several times higher than prophylactic ones.

At the moment, pharmacists have developed a large number of various medications based on vitamin D. These are Takhistin, Alpha D ₃ -Teva, Vigantol, Oxidevit, Rocaltrol, etc.

• Vigantol is used in quantities of up to 5 drops three times a day, with liquid;
• Alpha D ₃ -Teva is taken 0.5-1 mcg daily in the morning;
• Rocaltrol is taken at 0.25 mcg twice daily;
• Osteogenon is taken 1-2 tablets per day, and in advanced cases - 2-4 tablets twice a day.

Treatment with drugs should be combined with the intake of calcium salts. The duration of therapy is determined individually. To prevent the development of side effects, the intake of the above-mentioned drugs should be carried out under the control of the quality of blood clotting and kidney function.

The effect of testosterone levels in the blood on the quality of muscle strength and functionality has been experimentally confirmed. A drop in estrogen levels in older female patients has approximately the same effect. Thus, both estrogen and testosterone suppress the synthesis of proinflammatory cytokines, which have a catabolic effect on the quality of muscle fibers.

However, the use of testosterone and estrogen-based drugs did not have the expected positive effect on the course of sarcopenia. Thus, some patients did experience some positive dynamics, but many patients did not benefit from such treatment. And, in addition, testosterone therapy increases the risk of prostate cancer in men.

Interesting information was obtained when trying to use growth hormone in sarcopenia. Growth hormone has an indirect anabolic effect on muscles, stimulating the liver to produce insulin-like growth factor, the level of which in humans decreases with age. The use of such treatment allowed to increase muscle strength, but the therapy still did not affect the state of muscle mass and its functionality.

In the future, it is proposed to use drugs such as myostatin inhibitors and selective androgen receptor modulators for the treatment of sarcopenia.

Currently, scientists continue to search for effective drugs for the treatment of sarcopenia. Pharmacological tests of fundamentally new drugs are currently being actively conducted, which are already demonstrating excellent results on animals.

Physiotherapy treatment

In case of sarcopenia, physiotherapy procedures are carried out along with therapeutic exercise and massage of the extremities.

• Myostimulation is the transmission of nerve impulses to muscle fibers, which allows for protection and increased muscle tone. At the initial stages of sarcopenia, myostimulation strengthens the muscles of patients who are unable to perform even minor physical activity (for example, with strict bed rest). The action of electrical impulses leads to contraction of muscle fibers, which helps to increase local blood circulation, improves metabolism and tissue recovery processes.
• Magnetic resonance therapy involves sending signals to damaged cells, which leads to the activation of restorative processes.
• Ozone therapy has a general strengthening effect, improves tissue nutrition and capillary circulation, stimulates immune defense. In sarcopenia, ozone therapy helps relieve pain and prevent inflammatory processes.

In case of stiffness and low mobility, pain in the joints, you can additionally use injection of ozone-oxygen mixture. Such treatment gives a long-term effect, restoring joints and cartilage.

Folk remedies

Treatment of sarcopenia with folk remedies can be considered effective if it is carried out simultaneously with conventional therapy. Common toadflax has a positive effect on the condition of muscle tissue. Since this plant is considered poisonous, it is important to strictly adhere to the rules for preparation and dosage of the medicine:

• 200 ml of boiling water is poured over 1 teaspoon of dry grass;
• Infuse for 60 minutes, filter;
• take 1 tbsp 3-4 times a day before meals;
• The duration of treatment is three weeks.

Another, no less effective remedy is considered to be the following recipe: pour 500 ml of boiling water into a thermos, add 3 tbsp. of horsetail, leave overnight. In the morning, filter the infusion and take a third of a glass three times a day, half an hour before meals. The duration of treatment is 14 days, after which you should take a break for 10 days.

To maintain normal muscle function, it is recommended to take ascorbic acid in sufficient quantities. It is useful to prepare compotes and fruit drinks from berries that are rich in this vitamin - rose hips, currants, raspberries, strawberries, blueberries. It is also recommended to eat kiwi, citrus fruits, cabbage, radishes, onions and garlic.

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Herbal treatment

Herbal treatments can be used as an adjunct to sarcopenia:

• Prepare an equal mixture of elder flowers, birch leaves, and willow bark. Brew one tablespoon of the mixture in 400 ml of boiling water and drink half a glass 4 times a day before meals.
• Prepare an equal mixture of elder flowers, nettle leaves, and parsley rhizomes. Pour 400 ml of boiling water over one tablespoon of the mixture and let it brew under a lid. Take 100 ml 4 times a day before meals.
• Prepare a mixture of birch leaves, nettle leaves, violet grass, brew with boiling water (1 tbsp. per 500 ml of water). Take the infusion 100 ml 4 to six times a day before meals.

It is recommended to drink tea from currant and lingonberry leaves daily – at least 2 glasses a day, half an hour before meals.

Homeopathy

Homeopathic treatment of sarcopenia is considered possible, but the goal pursued by this treatment is equal to slowing down age-related changes in the body's muscles. Taking homeopathic medicines should be started as early as possible. The medicines of choice are Calcium carbonicum, Hepar sulfuris, Silicea, Phosphorus, Fluoride salts, as well as Lachesis, Pulsatilla and Sepia (affects the endocrine glands), Sulfuris (affects the quality of cartilage).

In case of bone damage as a result of falls and blows, add Sulphuris treatment. In case of right-sided damage, Ledum, Bryonia, Manganum muriaticum, Niccolum, Osmium, Tellurium will help. In case of left-sided damage, Lachesis or Lithium carbonicum are prescribed.

The dosages of the listed drugs are strictly individual and are prescribed by a homeopathic doctor.

Surgical treatment

Surgical treatment for sarcopenia is usually not used. Surgery may become necessary only in the case of complex fractures and dislocations, the development of tumors or cysts.

Prevention

To prevent sarcopenia, it is very important to plan your diet correctly: meals should contain a sufficient amount of protein, and slightly less fat and carbohydrates.

You should eat regularly, in small amounts, about 5-6 times a day. For a competent diet, it is advisable to seek help from a doctor, because it is no secret that the correct combination of nutrition and exercise is the main prevention and treatment of sarcopenia.

All people over 40 years of age should periodically take multivitamins, with an age-appropriate dosage.

It is also necessary to carefully coordinate the time of physical activity and rest, since both are very important for the normal functioning of the human body. Walking and cycling in the fresh air, dosed therapeutic loads are useful.

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Forecast

Sarcopenia is an irreversible geriatric phenomenon that is often recorded in elderly and old people. With sarcopenia, a person's physical performance deteriorates, quality of life suffers, the degree of danger of falls increases, and the risk of bone injuries increases. If the first signs of sarcopenia are ignored and timely assistance is not provided, the prognosis can be considered unfavorable.

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