Management of Sarcopenia in Elderlies

Abstract

Improvement in living conditions, science and technology has enabled the management of several diseases. However, in elderly people new medical condition, which cannot be explained by other definitions of disease are evolving. These are called geriatric syndromes. Sarcopenia might be one of these syndromes. Commonly it is defined as loss of muscle mass and functionality due to aging. Changes of the body composition, significant decline of the muscle mass and functions due to aging leads to decrease of physical performance, loss of strength, immobility, falls, and physical disability. An interdisciplinary approach is needed for the diagnosis and management of frailty. The diagnosis is based on the evaluation of the muscle mass, muscle strength, and physical performance of the patients by different methods and tests. The management process begins with the diagnosis and could be divided into two parts: non-pharmacological (physical activity and nutritional support) and/ or pharmacological management. Potential drugs, which are under development do not fulfill our expectations, because they are lacking any scientific evidence. Data on mechanism, effectivity, and safety are still missing. Therefore, non-pharmacological methods like sports and nutrition are sustaining their importance.  Management approaches to sarcopenia should develop and facilitate sportive exercise and nutritional support programs. Family physicians play an important role during the care of this specific risk group. They might play an important at the early diagnosis, the follow-up and coordination of the care of this condition.

Yaşam koşullarının iyileşmesi ile bilim ve teknolojideki gelişmeler, birçok hastalığın yönetimini olanaklı kılmaktadır. Bu çerçevede, yaşlı bireylerin sayıları artmaktadır. Yaşlı hastada, çoğunlukla atipik semptomlarla kendini gösteren ve hastalık tanımı ile açıklanamayan klinik durumları tanımlamak için, geriatrik sendrom terimi kullanılmaktadır. Bu terim, yaşlı hastalarda sık görülen, yaşam kalitesini bozup, morbidite ve mortaliteyi arttırabilen klinik durumları ifade etmektedir. Bu sendromlar arasında sarkopeniyi de saymak mümkündür. Yaygın tanımı ile sarkopeni, yaşlılığa bağlı kas kütlesi ve fonksiyon kaybını ifade eder. Yaşlanmayla beden bileşiminde oluşan değişiklikler, kas kütlesi ve işlevlerindeki anlamlı kayıplar ile bedensel verimde azalmalara, güç kaybına, bedensel bağımlılığa, düşmelere ve bedensel engelliliğe neden olmaktadır. Sarkopeni’nin tanısı ve tedavisi interdisipliner yaklaşım gerektirmektedir.Tedavi süreci tanının konulması ile başlamaktadır. Tanı kas kütlesinin, kas gücünün ve fiziksel performansın değişik yöntem ve testlerle değerlendirilmesi sonucu konulmaktadır.Sarkopeni’nin yönetimini non-farmakolojik (Bedensel Etkinlik ve Nütrisyonel Destek) ya/ ya da ilaç tedavileri olarak iki gruba ayırmak mümkündür. Geliştirilmeye başlanan potansiyel ilaçların kanıt eksiklikleri nedeniyle, henüz beklentilerimizi karşılayabilecek nitelikte olmadıkları anlaşılmaktadır. İlaç tedavilerinin mekanizması, etkinliği ve güvenliği ile ilgili veriler henüz yeterli değildir. Bu nedenle, spor ve nütrisyonel destek gibi non-farmakolojik tedavilerin önemi sürmektedir. Yaklaşımında ise, planlama ve uygulama bakımından sarkopenili bireye özel sporsal alıştırma ve beslenme destek planları geliştirilmeli ve uygulamaya konulmalıdır. Aile hekimlerinin, bu risk grubunun bakımında önemli rolü bulunmaktadır. Sorunun erken tespitinde rol alabileceği gibi, bakımın takibinde ve koordinasyonunda ilgili uzmanlık dallarına desteği mümkündür. 

Keywords

• Geriatric syndrome,frailty,sarcopenia

References

1. 1. Şahin S, Cankurtaran M. Geriatrik sendromlar. Ege Tıp Dergisi / Ege Journal of Medicine 2010;49(3):31-37
2. 2. Inouye SK et al. Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. J Am Geriatr Soc 2007;55(5):780–791.
3. 3. Roseberg IH. Sarcopenia: origins and clinical relevance. J Nutr 1997; 127:990S–991S.
4. 4. Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. J Lab Clin Med 2001; 137:231-43.
5. 5. Cesar M, Leeuwenburgh C, Lauretani F, Onder G, Bandinelli S, Maraldi C. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr 2006; 83:1142-8.
6. 6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definiti- on and diagnosis: Report of the European Working Group on Sarcopenia in Older People. European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39:412- 23.
7. 7. Rolland Y, Abellan van Kan GA, Gillette-Guyonnet S, Vellas B. Cachexia vs sarcopenia. Curr Opin Clin Nutr Metab Care 2011; 14:15-21.
8. 8. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle sizeand strength; a quantitative review. Front Physiol 2012; 3:260.

9. 9. Halil M, Ülger Z, Arıoğlu S. Sarkopeniye yaklaşım. Hacettepe Tıp Dergisi 2011; 42:123-132.
10. 10. Erim Z, Beg MF, Burke DT, de Luca CJ. Effects of aging on motor-unit control properties. J Neurophysiol 1999; 82:2081-91.
11. 11. Thornell LE, Lindstrom M, Renault V, Mouly V, Butler- Browne GS. Satellite cells and training in the elderly. Scand J Med Sci Sports 2003; 13:48-55.
12. 12. Brink M, Wellen J, Delafontaine P. Angiotensin II causes weight loss and decreases circulating insulin-like growth factor I in rats through a pressor-independent mechanism. J Clin Invest 1996; 97:2509-16.
13. 13. Schaap LA, Pluijm SMF, Deeg DJH, Visser M. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. Am J Med 2006; 119:9-17.
14. 14. Landi F, Abbatecola AM, Provinciali M, et al. Moving against frailty: does physical activity matter? Biogerontology 2010; 11:537-45.
15. 15. Frontera WR, Bigard X. The benefits of strength training in the elderly. Sci Sports 2002; 17:109-116.
16. 16. Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG, Evans WJ. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol 1988; 64:1038-44.
17. 17. Landi F, Onder G, Carpenter I, Cesari M, Soldato M, Bernabei R. Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study. J Clin Epidemiol 2007; 60:518-24.
18. 18. Landi F, Russo A, Cesari M, et al. Walking one hour or more per day prevented mortality among older persons: results from ilSI- RENTE study. Prev Med 2008;47: 422-6
19. 19. 2008 Physical Activity Guidelines for Americans. Erişim: http://www.health.gov/paguidelines/pdf/paguide.pdf. Erişim tarihi: 01.05.2016.
20. 20. Sundell J. Resistance training is an effective tool against meta- bolic and frailty syndromes. Adv Prev Med 2011:984683. http://dx.doi.org/10.4061/2011/984683
21. 21. Russell B, Motlagh D, Ashley WW. Form follows function: how muscle shape is regulated by work. J Appl Physiol 2000; 88:1127- 32.
22. 22. Borst, SE Interventions for sarcopenia and muscle weakness in older people. Age Ageing 2004; 33:548-55
23. 23. Fielding RA, LeBrasseur NK, Cuoco A, Bean J, Mizer K, Fiatarone Singh MA. High-velocity resistance training increases skeletal muscle peak power in older women. J Am Geriatr Soc 2002; 50:655-62.
24. 24. Global recommendation on physical activity for health. Erişim:http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf. Erişim tarihi: 21.06.2016.
25. 25. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39:1435-45.
26. 26. Chodzko-zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Salem GJ, Skinner JS. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exer 2009; 41:1510-30.
27. 27. Morley JE. Weight loss in older persons: New therapeutic approaches. Curr Pharm Des 2007; 13:3637–3647.
28. 28. Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009;(2):CD003288.
29. 29. Stratton RJ, Elia M. Are oral nutritional supplements of benefit to patients in the community? Findings from a systematic review. Curr Opin Clin Nutr Metab Care 2000;(3):311–315.
30. 30. Short KR, Nair KS. The effect of age on protein metabolism. Curr Opin Clin Nutr Metab Care 2000; 8:89-94.
31. 31. Brass EP, Sietsema KE. Considerations in the development of drugs to treat sarcopenia. J Am Geriatr Soc 2011; 59:530-5.
32. 32. Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids. Am J Clin Nutr 2005; 82:1065-73.
33. 33. Martone AM, Lattanzio F, Abbatecola AM, et al. Treating sarcopenia in older and oldest old. Current Pharmaceutical Design 2015;21(13) 1715-1722
34. 34. Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Am J Physiol Endocrinol Metab 2006;291: E381-7
35. 35. Eley HL, Russell ST, Tisdale MJ. Mechanism of attenuation of muscle protein degradation induced by tumor necrosis factor-alpha and angiotensin II by beta-hydroxy-beta-methylbutyrate. Am J Physiol Endocrinol Metab 2008;295: E1417-26
36. 36. Sakuma K, Yamaguchi A. Novel intriguing strategies attenuating to sarcopenia. J Aging Res 2012:251217. doi: 10.1155/2012/251217.
37. 37. Robinson SM, Jameson KA, Batelaan SF, et al. Diet and its relationship with grip strength in community-dwelling older men and women: the Hertfordshire cohort study. Hertfordshire Cohort Study Group. J Am Geriatr Soc 2008;56(1):84-90
38. 38. Visser M, Deeg DJ, Lips P. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): The longitudinal aging study Amsterdam. J Clin Endocrinol Metab 2003; 88:5766–5772.
39. 39. Montero-Odasso M, Duque G. Vitamin D in the aging musculoskeletal system: An authentic strength preserving hormone. Mol Aspects Med 2005; 26:203–219.
40. 40. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: A meta- analysis. JAMA 2004; 291:1999–2006.
41. 41. Autier P, Gandini S. Vitamin D supplementation and total mortality: A meta-analysis of randomized controlled trials. Arch Intern Med 2007; 167:1730–1737.
42. 42. Onder G, Penninx BWJH, Balkrishnan R et al. Relation between use of angiotensin-converting enzyme inhibitors and muscle strength and physical function in older women: an observational study. Lancet 2002;359(9310):926–93.
43. 43. Sumukadas D, Witham MD, Struthers AD, McMurdo ME. Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. CMAJ 2007; 177:867-74.
44. 44. Aoki C, Nakano A, Tanaka S, et al. Fluvastatin upregulates endothelial nitric oxide synthase activity via enhancement of its phosphorylation and expression and via an increase in tetrahydrobiopterin in vascular endothelial cells. Int J Cardiol 2012; 156:55-6193.
45. 45. Armitage J, Bowman L, Collins R, Parish S, Tobert J. MRC/BHF Heart Protection Study Collaborative Group. Effects of simvastatin 40 mg daily on muscle and liver adverse effects in a 5-year ran- domized placebo-controlled trial in 20, 536 high-risk people. BMC Clin Pharmacol 2009; 31:9-6. doi: 10.1186/14726904-9-6.
46. 46. Ferrando AA, Sheffield-Moore M, Paddon-Jones D, Wolfe RR, Urban RJ. Differential anabolic effects of testosterone and amino acid feeding in older men. J Clin Endocrinol Metab 2003; 88:358-62
47. 47. Borst SE, Yarrow JF, Conover CF, et al. Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial. Am J Physiol Endocrinol Metab 2014;15(306): E433-42.
48. 48. Siparsky PN, Kirkendall DT, Garrett WE. Muscle changes in aging: understanding sarcopenia. Sports Health. 2014 Jan;6(1):36-40.
49. 49. Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000; 97:4279-84.
50. 50. Morley JE, Argiles JM, Evans WJ, et al; Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010; 11:391-6.
51. 51. Aguiar AF, Januário RS, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol 2013; 113: 987-96.
52. 52. Cooke MB, Brabham B, Buford TW, S et al. Creatine supplementation post-exercise does not enhance training-induced adaptations in middle to older aged males. Eur J Appl Physiol 2014; 114:1321-32.
53. 53. Onder G, Della Vedova C, Landi F. Validated treatments and therapeutics prospectives regarding pharmacological products for sarcopenia. J Nutr Health Aging 2009; 13:746-56.
54. 54. Mohler ML, Bohl CE, Jones A, et al. Nonsteroidal selective androgen receptor modulators (SARMs): dissociating the anabolic and androgenic activities of the androgen receptor for therapeutic benefit. J Med Chem 2009; 52:3597-617.
55. 55. Cesari M, Fielding R, Bénichou O, Bernabei R, Bhasin S, Guralnik JM, et al. Pharmacological Intreventions in frailty and sarcopenia: Report by the international conference on frailty and sarcopenia research task force. J Frailty Aging 2015;4(3):114-120.
56. 56. Sakuma K, Yamaguchi A. Novel intriguing strategies attenuating to sarcopenia. J Aging Res 2012:251217. doi: 10.1155/2012/251217.
57. 57. Burton LA, Sumukadas D. Optimal management of sarcopenia. Clin Interv Aging 2010 Sep 7; 5:217-28.