Sarkopenia

When talking about sarcopenia, usually refer to the degenerative processes in the muscles, when a person gradually loses muscle mass. Sarcopenia is not a disease. It is rather a peculiar condition characterized by other pathologies or age-related changes in the body.

Sarcopenia has only relatively recently attracted the attention of scientific experts. To date, there is not much information about this problem, as the investigation of the disease is still ongoing.

Epidemiology

According to medical experts, the initial processes of sarcopenia can be observed after 26-30 years: the muscle loss is less than 1% per year.

Degenerative changes in muscle tissue related to sarcopenia are diagnosed in 14% of the male population and in 13% of the female population in the age group from 65 to 75 years, and in 56% of men and 53% of women in the age group of 80 years and older.

[1], [2], [3], [4], [5], [6], [7], [8],

Causes of the sarcopenia

Virtually all cases of sarcopenia are associated with age-related changes within the body. It is for this reason that sarcopenia is diagnosed primarily in old age.

The loss of muscle mass can occur in different ways. This causes the subdivision of this problem into such types:

• primary sarcopenia;
• secondary sarcopenia.

The development of primary sarcopenia can be affected by such risk factors associated with age processes:

• hormonal changes (lowering the level of sex hormones and growth hormone, increasing the level of cortisol, lowering the total amount of vitamin D and worsening of receptor sensitivity to it);
• accelerated process of cell death, disturbance of mitochondrial function, differentiation of mesenchymal stem cell into adipocyte;
• replacement of muscles with fat tissue;
• degenerative changes in the nervous system, violation of nervous messages in the muscles, denervation.

The primary variant is an irreversible sarcopenia with an increase and aggravation of symptoms.

Secondary sarcopenia does not appear due to age, but as a result of exposure to other negative factors:

• protein deficiency in nutrition;
• hypodynamia;
• presence of malignant formations;
• HIV infection;
• general exhaustion of the body;
• starvation;
• severe form of kidney failure;
• severe chronic obstructive bronchitis, etc.

In addition, sarcopenia can develop against a background of other diseases - for example, with inflammatory changes in the digestive organs, with stroke, osteoporosis, osteoarthritis, etc.

[9], [10], [11], [12], [13], [14], [15],

Pathogenesis

For normal high-grade functioning, the muscles require proteins produced in the body from amino acids. Even with age changes, the human body does not lose the ability to assimilate proteins from food - of course, if there are no chronic problems in the intestine, or the protein simply does not come in sufficient quantities with food.

As for the internal production of protein, over the years this process can be slowed down. This is due, first of all, to the deterioration of the endocrine system, as with the age, the production of most hormones, for example, insulin-like growth hormone and testosterone, is reduced.

These processes lead to a decrease in the quality of muscle tissue, to muscle weakness, to conduction disorders of nerve fibers and even to damage to nerve cells. As a consequence - a possible violation of muscle recovery and coordination of movements.

[16], [17], [18], [19], [20], [21], [22], [23]

Symptoms of the sarcopenia

Sarcopenia occurs with a gradual, increasing, generalized decrease in muscle mass, which sooner or later leads to a reduced functionality of the limbs and the progression of muscle weakness.

The processes associated with sarcopenia increase the risk of domestic injuries due to loss of muscle tonus and impaired motor coordination, which leads to inconsistent vestibular apparatus, to falls, bruises, sprains, fractures (which is aggravated by osteoporosis). As a result, difficulties arise with self-service, the quality of life deteriorates, mortality increases.

The first signs of sarcopenia can be identified with the following symptoms:

• deterioration of appetite;
• slowing of gait;
• periodic or frequent falls of a random type;
• a decrease in vital activity;
• violation of thermoregulation;
• slowing of the basic metabolism;
• osteoporosis;
• problems with maintaining balance.

Sarcopenia in the elderly is exacerbated by the increasing tendency to overweight and obesity. Often the pathology occurs with a decrease in albumin level in the serum, as well as with the increase of depressive symptoms.

Stages

Specialists have identified three main stages of development of sarcopenia:

1. The first stage (prescaropenia) is characterized by a decrease in muscular mass, with the preservation of strength and functionality of the muscles.
2. The second stage proceeds with a decrease in muscular mass, with the appearance of muscle weakness and a violation of the functionality of skeletal muscles.
3. The third stage is accompanied by a pronounced decrease in all three parameters.

[24], [25], [26], [27], [28], [29], [30],

Complications and consequences

First of all, sarcopenia precedes the reduction of skeletal musculature function, responsible for the preservation of balance when changing the position of the body and shifting the center of gravity. At the same time, the risk of sudden falls considerably increases. So, in the elderly, the frequency of injuries increases by about 10% every 8-10 years.

Falls can cause both minor injuries and serious fractures (mainly with damage to the proximal parts of the femur). Such injuries sometimes lead to disability, and even to death.

In addition to domestic injuries, sarcopenia significantly worsens the quality of life, contributing to the development of type 2 diabetes, osteoporosis, heart and vascular diseases, the appearance of nocturia, etc.

[31], [32], [33], [34], [35]

Diagnostics of the sarcopenia

Diagnosis of sarcopenia is a difficult and time-consuming process. At the present time, many different methods are used to determine the strength and functionality of the musculature.

To estimate the amount of fat and lean mass, instrumental diagnostics is used:

• CT scan;
• Magnetic resonance imaging;
• two-photon X-ray absorptiometry (DRA).

CT and MRI are the most common procedures in the study of muscles. However, due to the relative high cost of these methods, preference is often given to DRA, as well as bioimpedance analysis - these procedures allow estimating the volume of fat and muscle components of the total mass.

Additionally, with sarcopenia, analyzes are performed to assess the release of potassium with urinary fluid, as well as manual dynamometry, isokinetic dynamometry, and ascending load testing.

[36], [37], [38], [39], [40]

Differential diagnosis

Differential diagnosis of age-related sarcopenia is carried out with myopenia - a significant loss of muscle as a result of the influence of various pathologies:

• in the diagnosis of myopia, the degree of muscle atrophy plays a large role for a fixed period of time (for example, 5% for six months);
• in the diagnosis of sarcopenia, a decisive role is played by a combination of two criteria: a decrease in the number of muscles and the loss of their strength.

For differential diagnosis, it is important to measure the speed when walking, as well as other dynamic tests.

[41], [42], [43], [44], [45], [46]

Treatment of the sarcopenia

The main way to treat sarcopenia is to increase physical activity. Topical are aerobic exercises that benefit the cardiovascular system and respiratory organs, and also positively affect the percentage of fat and muscle tissue. The force variants of the loads significantly influence not only the state of the muscles, but also the health of the bone system, preventing the development of sarcopenia and osteoporosis. The course of exercises usually lasts up to 10-12 weeks, half an hour once every two to three days. In terms of its effectiveness, the physical load is superior to other types of treatment - for example, hormone replacement therapy,

The second no less important way to resist sarcopenia is diet. In the diet should be added more protein food, so that its daily amount is not less than 1.2-1.5 g per kg.

Medications

Scientists have confirmed the fact that in the treatment of sarcopenia, vitamin D deficiency must necessarily be filled. Vitamin can be prescribed in the form of complex preparations, as well as in monopreparations - but necessarily in combination with calcium.

The use of vitamin D in sarcopenia is based on the fact that its deficiency is present in all forms of the disease. Patients with sarcopenia are prescribed vitamins in large doses, several times exceeding prophylactic.

At the moment, pharmacists have developed a large number of various medications on the basis of vitamin D. These are Tachysteen, Alfa D ₃ -Teva, Vigantol, Oxidevit, Rockaltrol and others.

• Vigantol is used in an amount of up to 5 drops three times a day, with a liquid;
• Alpha D ₃ -Tev take 0.5-1 μg daily in the mornings;
• Rockaltrol is taken at 0.25 μg twice a day;
• Osteogenon take 1-2 tablets a day, and in neglected cases - 2-4 tablets twice a day.

Treatment with drugs should be combined with the intake of calcium salts. The duration of therapy is determined individually. To prevent the development of side effects, the above should be administered under the control of the quality of blood clotting and kidney function.

The effect of testosterone in the blood on the quality of muscular strength and functionality has been experimentally confirmed. The drop in the number of estrogens in age-old female patients has about the same effect. Thus, both estrogen and testosterone inhibit the synthesis of pro-inflammatory cytokines, which catabolically affect the quality of muscle fibers.

Nevertheless, the use of drugs based on testosterone and estrogens did not have the expected positive effect on the course of sarcopenia. For example, some patients did have some positive dynamics, but many patients did not help such treatment. And, in addition, testosterone therapy increases the risk of prostate cancer in men.

Interesting information was obtained when trying to use growth hormone in sarcopenia. Growth hormone has an indirect anabolic effect on muscles, stimulating the production of insulin-like growth factor by the liver, the level of which decreases with age. The use of such treatment allowed to increase muscular strength, however, the condition of muscle mass and its functionality did not affect therapy in any way.

In the future, it is proposed to use for the treatment of sarcopenia such drugs as myostatin inhibitors and selective androgen receptor modulators.

Currently, scientists continue to search for effective drugs for the treatment of sarcopenia. Now pharmacological tests of fundamentally new drugs are being actively carried out, which already demonstrate excellent results in animals.

Physiotherapeutic treatment

When sarcopenia, physiotherapy is performed along with exercise therapy and massage of the extremities.

• Myostimulation is the transfer of nerve impulses to the muscle fibers, which allows you to create protection and raise the tone of the muscular apparatus. At the initial stages of development of sarcopenia, myostimulation strengthens the muscles of patients who are unable to perform even minor physical exertion (for example, in strict bed rest). The action of electrical impulses leads to a reduction in muscle fibers, which contributes to increased local circulation, improves metabolism and restorative processes in tissues.
• Magnetic resonance therapy involves signaling to damaged cells, which leads to the activation of restorative processes.
• Ozone therapy has a general strengthening effect, improves tissue nutrition and capillary circulation, stimulates immune defense. With sarcopenia, ozonotherapy helps to anesthetize and prevent inflammation.

With stiffness and lack of mobility, pain in joints, injection of an ozone-oxygen mixture can additionally be used. This treatment gives a lasting effect, restoring the joints and cartilage.

Alternative treatment

Treatment of sarcopenia with the help of alternative means can be considered effective if it is carried out simultaneously with conventional therapy. Positive effect on the condition of muscle tissue renders linseal. Since this plant is considered poisonous, it is important to adhere to the rules of preparation and dosage of the drug:

• 200 ml of boiling water pour 1 tsp. Dry grass;
• insist for 60 minutes, filtered;
• take 3-4 times a day before meals for 1 tbsp. L .;
• the duration of treatment is three weeks.

Another, no less effective means is a recipe: 500 ml of boiling water is poured into the thermos, 3 tbsp are covered. L. Field horsetail, leave for the night. In the morning, the infusion is filtered and taken three times a day for a third of the glass, half an hour before meals. Duration of treatment is 14 days, after which it should be a break for 10 days.

To maintain normal muscle functionality, it is recommended to take ascorbic acid in sufficient quantities. It is useful to prepare compotes and fruit drinks from berries, which are rich in this vitamin - it is dogrose, currant, raspberry, strawberry, blueberry. It is also recommended to eat kiwi, citrus, cabbage, radish, onion and garlic.

[47], [48], [49], [50], [51], [52], [53]

Herbal Treatment

As an aid to sarcopenia, you can use herbal treatment:

• Prepare an equal mixture of elder flowers, birch leaves, willow bark. One tablespoon of the mixture is brewed in 400 ml of boiling water, drink half the glass 4 times a day before meals.
• Prepare an equivalent mixture of elderberry blossoms, nettle leaves, rhizomes of parsley. One tablespoon of the mixture pour 400 ml of boiling water, insist under the lid. Take 100 ml 4 times a day before meals.
• Prepare a mixture of leaves of birch, nettle leaves, violet grass, boil (1 tablespoon per 500 ml of water). Infusion take 100 ml from 4 to 6 times a day before meals.

Daily it is recommended to drink tea from currant leaves, cranberries - at least 2 glasses a day, half an hour before meals.

Homeopathy

Homeopathic treatment of sarcopenia is considered possible, but the goal pursued by this treatment is equated with a slowing of the age-related changes in the muscles in the body. Reception of homeopathic preparations should be started as soon as possible. Medicines of choice are Calcium carbonicum, Gepar sulfuris, Silicea, Phosphorus, fluoride salts, as well as Lachezis, Pulsatilla and Sepia (affects the endocrine glands), Sulfuris (affects the quality of cartilage).

If there are bone injuries, Sulfuris treatment is added as a result of falls and bumps. With right-sided damage will help Ledum, Bryonia, Manganum muriatikum, Nikcolum, Osmium, Tellurium. For left-sided damage, Lachezis or Lithium carbonum are prescribed.

Dosages of these drugs are strictly individual and are prescribed by a doctor homeopath.

Surgery

Operative treatment for sarcopenia is usually not applied. Operation can become necessary only in case of complex fractures and dislocations, development of tumors or cysts.

Prevention

For the prevention of sarcopenia, it is very important to make a correct diet: the dishes should contain a sufficient amount of protein, and a little less - fats and carbohydrates.

Take food regularly, in small volumes, about 5-6 times a day. For a competent diet, it is advisable to seek help from a doctor, it is not a secret that the right combination of nutrition and exercise is the main warning and treatment of sarcopenia.

All people after 40 years should periodically take multivitamins, with the appropriate age-appropriate dosage.

Also, you should carefully coordinate the time of physical exertion and rest, as both are very important for the normal functioning of the human body. Pedestrian and bicycle walks in the fresh air, dosed therapeutic load are useful.

[54], [55], [56], [57], [58], [59], [60], [61]

Forecast

Sarcopenia is an irreversible geriatric phenomenon, which is often fixed in the elderly and senile. When sarcopenia deteriorate the physical performance of a person, the quality of life suffers, the degree of danger of falls increases, the risk of injury to the bone apparatus increases. If you ignore the first signs of sarcopenia and do not provide timely assistance, the forecast can be considered unfavorable.

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