Treatment of sarcopenia: the road to the future

• Published in: Journal of cachexia, sarcopenia and muscle Vol. 9; no. 7; pp. 1196 - 1199
• Main Author: Morley, John E.
• Format: Journal Article
• Language: English
• Published: Germany John Wiley & Sons, Inc 01.12.2018; John Wiley and Sons Inc; Wiley
• Subjects: Amino acids; Anorexia; Chronic obstructive pulmonary disease; Diabetes; Disease Management; Disease prevention; Humans; Immunoglobulins; Metabolism; muscle; Patient-Centered Care; Proteins; Sarcopenia; Sarcopenia - diagnosis; Sarcopenia - therapy; Testosterone; treatment; Sarcopenia; treatment; muscle
• DOI: 10.1002/jcsm.12386
• ISSN: 2190-5991; 2190-6009

While age‐related sarcopenia is considered to be primary sarcopenia, a number of disease states, for example, diabetes mellitus, male hypogonadism, and chronic obstructive pulmonary disease can produce secondary sarcopenia. Abnormalities in these pathways can be due to insulin growth factor‐1/insulin receptors, activin (myostatin) receptors, tropomysin receptor, kinase C receptors (neurotrophin and G‐protein receptors), a variety of cytokines, and testosterone through activation of β‐catenin. [...]in the long run, the ideal treatment of sarcopenia will involve identification of the aberrant molecular pathway and the possible hormone causing this imbalance. Patient‐centred approach to management of sarcopenia Early identification Primary prevention Secondary prevention Tertiary prevention SARC‐F or ISHII screening test Exercise Resistance exercise Physical therapy Adequate protein diet Low‐protein diet: leucine‐enriched essential amino acids or methyl hydroxy butyrate supplementation Occupational therapy In ALL hospitalized: aggressive resistance exercise (include intensive care unit) Male hypogonadism: testosterone If dysphagia: speech therapy If falling: use CDC STEADI or F3ALLS approach Provide adequate protein intake If low 25(OH) vitamin D—1000 IU vitamin D Optimal treatment of COPD; CHF and diabetes mellitus Exclude cachexia: elevated CRP + low protein Exclude protein energy malnutrition (anorexia or malabsorption) ‐Look for treatable causes ‐Caloric supplement ‐Future: anamorelin Future: antibodies to myostatin At present, the treatment of sarcopenia is focused on resistance exercise.