Considerations concerning the definition of sarcopenia
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In this commentary, we describe the sarcopenia spectrum that results in frailty and consider the impact of several components of the frailty definition on its global prevalence. We review proposed operational definitions of sarcopenia and the extent to which they have been shown to predict hard clinical outcomes, such as hip fracture, falls, and mortality. A head-to-head comparison of nine proposed operational definitions of sarcopenia as predictors of falls revealed that the definition involving appendicular lean mass (ALM)/ht2 alone was a significant predictor; the prevalence of sarcopenia by this definition was 11 %. We consider the strengths and limitations of definitions that include functional measurements, such as gait speed and grip strength, along with measures of lean tissue mass. The functional assessments are harder to standardize than the more objective ALM measurements. The prevalence of sarcopenia by definitions that include functional and lean mass measurements tends to be lower than the prevalence by definitions that include lean mass alone. A low prevalence limits opportunity for early identification and application of prevention strategies. For these and other reasons, it seems advantageous to base the operational definition of sarcopenia on ALM/ht2 alone. This commentary addresses the importance of a globally applicable operational definition of sarcopenia and both desirable and undesirable features of such a definition.
KeywordsFalls Fractures Frailty Mortality Sarcopenia Sarcopenia definition
B D-H is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR060261-01A1), the National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098245), and the US Department of Agriculture under agreement No. 58-1950-7-707. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author and do not necessarily reflect the view of the US Department of Agriculture. B D-H is a member of the scientific advisory boards of OPKO, Eli Lilly, and Pfizer Inc. and has received funding for investigator-initiated research from Pfizer, Inc. and DSM. H B-F is a member of scientific advisory boards of Sandoz, Pfizer, and Sanofi. She received research funding from DSM Nutritional Products, Nestlé, MSD, and WILD.
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