Tools in the Assessment of Sarcopenia
- 1.6k Downloads
This review provides a framework for the development of an operational definition of sarcopenia and of the potential end points that might be adopted in clinical trials among older adults. While the clinical relevance of sarcopenia is widely recognized, there is currently no universally accepted definition of the disorder. The development of interventions to alter the natural history of sarcopenia also requires consensus on the most appropriate end points for determining outcomes of clinical importance which might be utilized in intervention studies. We review current approaches to the definition of sarcopenia and the methods used for the assessment of various aspects of physical function in older people. The potential end points of muscle mass, muscle strength, muscle power, and muscle fatigue, as well as the relationships between them, are explored with reference to the availability and practicality of the available methods for measuring these end points in clinical trials. Based on current evidence, none of the four potential outcomes in question is sufficiently comprehensive to recommend as a uniform single outcome in randomized clinical trials. We propose that sarcopenia may be optimally defined (for the purposes of clinical trial inclusion criteria as well as epidemiological studies) using a combination of measures of muscle mass and physical performance. The choice of outcome measures for clinical trials in sarcopenia is more difficult; co-primary outcomes, tailored to the specific intervention in question, may be the best way forward in this difficult but clinically important area.
KeywordsSarcopenia Muscle mass Muscle strength Muscle power Muscle fatigue Older adults
This review was based on a workshop supported by the European Society for the Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF). We are grateful to the NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, and NIHR Nutrition Biomedical Research Unit, University of Southampton, UK.
C. C. has received consultancy fees/honoraria from Servier, Eli Lilly, Merck, Amgen, Novartis, GSK, Alliance, Medtronic; W. D. is an employee and stockholder of Amgen; W. E. is an employee of GlaxoSmithKline; B. M. is an employee and shareholder of Eli Lilly and Company; Y. T. is an employee of Servier. Y. R. has spoken for and prepared an education module with Nutricia and is on the expert board of Cheisi and Lactalis. S. B. was senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium, and holder of the Leuven University Chair in Gerontology and Geriatrics.
- 3.Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M et al, Health ABC Study Investigators (2003) Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 51:1602–1609Google Scholar
- 6.Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc 12:249–256PubMedCrossRefGoogle Scholar
- 8.World Health Organisation (1998) Guidelines for preclinical evaluation and clinical trials in osteoporosis. WHO, GenevaGoogle Scholar
- 12.Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G et al (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by special interest groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 29:154–159PubMedCrossRefGoogle Scholar
- 15.Cooper R, Kuh D, Hardy R; Mortality Review Group; FALCon and HALCyon Study Teams (2010) Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 341:c4467Google Scholar
- 18.National Institute on Aging (2012) Assessing physical performance in the older patient. www.grc.nia.nih.gov/branches/ledb/sppb. Accessed 21 Feb 2012
- 19.Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94PubMedCrossRefGoogle Scholar
- 21.Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV et al (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55:M221–M231PubMedCrossRefGoogle Scholar