Sarcopenia in the elderly: from clinical aspects to therapeutic options

Sarcopenia is a major contributor to the risk of physical frailty, functional decline, poor health-related quality of life and premature death in older people. Sarcopenia can be considered a geriatric syndrome. The term sarcopenia indicates the loss of muscle mass that accompanies aging. Muscle mass declines with aging process with differences between subjects in relation to the presence of chronic diseases, to lifestyles habits (mainly diet and physical activity), to cognitive status. Sarcopenia in the elderly is associated with poor health outcomes, such as falls, disability, loss of independence, and mortality; however, it is potentially treatable if recognized and intervened early. The prevalence of sarcopenia rates between 5% and 13% in community-dwelling older people aged 65 years and over, and is higher in those 80 years and older (20-25%). The cause of sarcopenia is generally thought to be multifactorial, with environmental causes, disease triggers, inflammatory pathway activation, and a large number of cellular and biochemical abnormalities. Resistance training and amino acid supplementation are a recommended practice for the prevention of sarcopenia. The essential elements for the management of the sarcopenic patient are the recognition of a condition of frailty, an accurate multidimensional geriatric assessment, with attention to cognitive problems, mood, functional problems, living conditions, using standardized instruments. Combining exercise with some pharmacological compounds such as β- Hydroxy-β-methylbutyrate (HMB) and dietary supplements (including proteins, aminoacids and vitamin D) may exert a beneficial effect on older adults thus influencing the progress to sarcopenia. The recommended daily amount of protein is greater for older people. Vitamin D and leucine enrichment seems mandatory in order to improve muscle mass and lowerextremity function among sarcopenic older adults. There are some evidences that collagen peptides in this setting might be even superior to whey protein in promoting muscle growth and increasing the mobility.