Sarcopenia & Its Costs
Sarcopenia is the progressive loss of skeletal muscle that comes with aging. Most people begin to lose modest amounts of muscle mass after age 30, but the resulting loss of strength increases exponentially with age. Sarcopenia is thought to play a major role in the increased frailty and functional impairment that comes with age.
Possible effects of sarcopenia include decreased muscle strength, problems with mobility, frailty, weak bones (osteoporosis), falls and fractures, decreased activity levels, diabetes, middle‐age weight gain and a loss of physical function and independence.
The Human Costs of Sarcopenia:
- Recent estimates indicate that approximately 45% of the older U.S. population is affected by sarcopenia. That equates to 18 million people in 2010, a number that will only continue to rise.
- The risk of disability is 1.5 to 4.6 times higher in older persons with sarcopenia than in older persons with normal muscle.
Stats from: Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The Healthcare Costs of Sarcopenia in the United States. Journal of the American Geriatric Society 52:80–85, 2004.)
The Economic Costs of Sarcopenia:
- The estimated direct healthcare cost attributable to sarcopenia in the United States in 2000 was $18.5 billion ($10.8 billion in men, $7.7 billion in women), which represented about 1.5% of total healthcare expenditures for that year. (Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The Healthcare Costs of Sarcopenia in the United States. Journal of the American Geriatric Society 52:80–85, 2004.)
- People with chronic illnesses and activity limitations caused by conditions like sarcopenia have more physician visits and fill more prescriptions than those individuals with no activity limitations, all of which presents a greater burden on our health care system. These individuals also have more health visits.The United States spends more than $26 billion annually on additional health care costs for people over 65 who lose their ability to live independently over the course of a single year.(Alliance for Aging Research , Silver Book: Chronic Disease and Medical Innovation in an Aging Nation http://silverbook.org/fact/31 28 September 2011)
Why we need to act:
- A 10% reduction in the sarcopenic population would save $1.1 billion. (Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The Healthcare Costs of Sarcopenia in the United States. Journal of the American Geriatric Society 52:80–85, 2004.)
- Though sarcopenia contributes to numerous other health problems and accounts for a similar percentage of healthcare costs as osteoporosis, no public health campaigns are directly aimed at reducing the prevalence of sarcopenia. (Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The Healthcare Costs of Sarcopenia in the United States. Journal of the American Geriatric Society 52:80–85, 2004.)
Current Sarcopenia Management Strategies
Exercise & Nutrition
While pharmaceutical options will expand with further research, resistance training proves to be the safest and most effective strategy to combat sarcopenia, to preserve physical strength and function, and to maintain mobility and independence. Studies confirm that resistance training of the appropriate intensity produces significant gains in strength and muscle mass in older people, with effects similar to those exhibited by younger counter parts. This form of exercise stimulates muscle synthesis and promotes bone health, preventing both falls and fractures.
Diet also plays an important role in the prevention of sarcopenia. Adults tend to consume fewer calories with age and often do not meet their recommended daily allowance of dietary protein, which may contribute to the slowing of muscle protein synthesis. Research suggests that older adults should increase their protein consumption, especially individuals who continue to be active, in order to augment the results of resistance training.
Where the Promise Lies: Current Research
With more than 18 million older Americans living with sarcopenia, age related muscle wasting, and functional decline, it is imperative that the research community and policymakers devote greater resources toward this often overlooked chronic health care challenge.
Though there is a lack of solid medical consensus on causes and exact symptoms of sarcopenia, alongside a lack of regulatory recognition of the condition, there are several areas of research that show great promise. However, while basic research suggests success, the overarching theme for many of these therapies is that they still are largely unexplored or problematic. These research possibilities underscore the need for greater regulatory and research channels to help translate the findings into real management solutions for sarcopenia and functional decline.
Some of the initial research being explored includes:
Men with low testosterone levels frequently exhibit low muscle mass. While basic research suggests testosterone therapy may improve strength in elderly male subjects, testosterone therapy has demonstrated limited clinical success. While subjects did exhibit increased muscle mass, most studies fail to link the hormone to improved functional performance and reduced risk of mortality. The safety of testosterone therapy also remains undetermined; the risks of testosterone therapy include cardiac complications and prostate cancer.
Though initial research shows promise, further research and development is needed for testosterone therapy to become a viable strategy for the management of sarcopenia or functional decline.
More information on testosterone therapy:
A new class of drugs known as selective androgen receptor modulators, or SARMs, show promise in initial research to promote greater muscle mass and strength by targeting specific areas with androgen, the primary male sex hormone. SARMs are similar in function to testosterone, but have been shown to have fewer negative effects on the prostate or cardiovascular system. As in other areas of research in muscle wasting and functional strength, though preliminary results of SARMs research show tremendous potential, the findings warrant further study and development to completely determine their safety and effectiveness.
More information on SARMs:
- PubMed: Drug Insight: testosterone and selective androgen receptor modulators as anabolic therapies for chronic illness and aging
- Journal of Clinical Endocrinology & Metabolism: Selective Androgen Receptor Modulators (SARMs): A Novel Approach to Androgen Therapy for the New Millennium
The administration of GH does not reverse the symptoms of sarcopenia despite the promise of early research and well documented benefits of GH on adolescent growth disorders. Sarcopenic patients treated with GH presented deleterious side effects more profound than any benefit from the therapy. This failure suggests the role of GH on muscle growth is more complex than previously conceived and scientists continue to study the effect of related hormones (I-GF1 and ghrelin) on muscle wasting.
Multiple factors place the elderly at risk for Vitamin D deficiency and low levels of the vitamin are linked to slowed muscle processes. Studies show the direct administration of Vitamin D3 reduces the risk of falls, the leading cause of death and disability in sarcopenic patients. This correlation adds compelling evidence to the hypothesis that Vitamin D improves muscle strength.
More information on Vitamin D and Sarcopenia:
- PubMed: Vitamin D deficiency is associated with sarcopenia in older Koreans
- British Medical Journal: Recent developments in vitamin D deficiency and muscle weakness among elderly people
- American Journal of Clinical Nutrition: Vitamin D deficiency, muscle function, and falls in elderly people
Another arising treatment evolves from the manipulation of the renin-angiotensin system. Angiotensin II-converting enzyme has a powerful impact on muscle atrophy as well as indirect effects on numerous mechanisms linked to the progression of sarcopenia, including inflammatory response. Scientists continue to explore the use of ACE inhibitors to treat sarcopenic patients and serves as noteworthy development.
More information on ACE Inhibitors:
Age and Ageing: ACE inhibitors for sarcopenia—as good as exercise training?
AIM Meeting Resources
On March 28, 2014, the AIM Coalition hosted a meeting with FDA, health and science experts on the latest advances in sarcopenia treatment. The links below offer information that is available for download.
More Patient Resources
Health & Aging Organizations
- National Association of Area Agencies on Aging
- Older Women’s League
- American Geriatrics Society
- The Gerontological Society of America
- Muscular Dystrophy Association
- Society for Women’s Health Research
- National Hispanic Council on Aging
- National Association for Hispanic Elderly
- Men’s Health Network
- Alliance for Aging Research
Agencies and Institutes
- National Institute on Aging
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Foundation for the National Institutes of Health
Exercise and Physical Activity
- Go4Life: An exercise and physical activity campaign from the National Institute on Aging at NIH, designed to help you fit exercise and physical activity into your daily life.
- The Journal of the American Medical Association: Fitness for Older Adults
- Medline Plus: Exercise for Seniors
- American Academy of Orthopaedic Surgeons: Seniors and Exercise
- International Osteoporosis Foundation: What is Sarcopenia, with info on prevention, diagnosis, and treatment
- National Association of Nutrition and Aging Services Programs
- USDA, Eat Smart, Live Strong: Nutrition Education for Older Adults
- Resistance Exercise for the Prevention of Age-related Sarcopenia (REPAiRS)(NCT01355861). The purpose of this study is to determine the benefits of negative work progressive resistance exercise (PRE) for the conservative management of sarcopenia in older male Veterans at the DC VAMC. Efficacy will be assessed by examining post-exercise changes in metabolic and inflammatory markers, muscle morphology, strength, and functional status.
- Blood Flow, Muscle Regeneration and Sarcopenia(NCT01035060): Reduced muscle blood flow in advanced age appears to be a significant factor in reducing skeletal muscle regenerative capacity, but few data exist to confirm this hypothesis. Thus to test this hypothesis we aim to conduct a translational pilot trial which examines regeneration in both young and old adults. Furthermore, we aim to determine if muscle blood flow and satellite cell number are associated with muscle function. The central hypothesis of this proposal is that age-related declines in skeletal muscle angiogenesis and perfusion are significant causal factors in age-related losses of skeletal muscle mass.