What are the newest advances in treating sarcopenia?
A reader wrote in with this one: “Could you explore new advances in treatment of sarcopenia? Frailty is a major problem in our aging population and even doctors don’t know much about this.”
The word itself is only a few decades old. Irwin Rosenberg, a nutrition scientist at Tufts University, coined it in 1989, from the Greek sarx, “flesh,” and penia, “loss.” He wanted a name for a common problem that was barely being studied.
Below: what the evidence supports today, what’s been tried in clinical trials, and what’s worth raising at an appointment. One fact up front: no drug is approved for sarcopenia yet.
This article is for general information only and isn’t medical advice. If you’re concerned about muscle loss, frailty, or falls, talk with a doctor before changing exercise, diet, or supplements.
“Even doctors don’t know much about this”
The reader has a point, and for good reason. Sarcopenia only got its own diagnostic code, ICD-10-CM M62.84, on October 1, 2016. It has been an independent disease entity for less than a decade, even though it affects an estimated 10 to 16 percent of older adults worldwide. A common condition went without a billing code until 2016.
Stand up five times, arms folded
The clinic version of a sarcopenia check is less dramatic than it sounds. It starts with SARC-F, a five-question form, and a score of 4 or higher earns a closer look.
Then comes the chair test. A person stands up from a chair five times as fast as possible, arms folded across the chest; taking more than 15 seconds indicates low strength. A grip test and a short walk make up the rest, and a walking speed of 0.8 meters per second or slower indicates severe cases. Those are tools for clinicians, not for self-diagnosis.
Maria Fiatarone put frail 90-year-olds on strength machines
In 1990, Fiatarone’s team at Tufts published a study of ten frail nursing-home volunteers, ages 87 to 96, who did eight weeks of high-intensity resistance training. Before they started, the weaker a person’s thighs, the longer it took them to walk. After nine weeks, their strength rose by an average of 174 percent. Tandem walking speed improved 48 percent.
More than three decades later, strength training plus nutrition is still the frontline treatment. One narrative review puts protein requirements for older adults with sarcopenia at 1.0 to 1.5 grams per kilogram of body weight per day, which works out to 70 to 105 grams for someone weighing 70 kilograms (about 154 pounds). It also found that creatine at 3 grams a day helped when paired with lifting.
The hard part is sticking with it. In a feasibility study of older adults leaving a geriatric rehab unit, about a third stopped treatment early.
The drug that raised muscle and still didn’t beat a good diet
In 2017, Daniel Rooks and colleagues at Novartis reported that bimagrumab, an antibody that blocks the activin receptors muscle uses to hold itself back, improved walking in older adults with sarcopenia who started out slow, adding 0.15 meters per second to their gait speed. It looked like the breakthrough everyone had been waiting for.
The follow-up was bigger. In a trial of 180 adults aged 70 and older, everyone got nutrition support and light exercise, and half also got the drug. Bimagrumab increased lean mass and cut fat. But physical function improved just as much in the placebo group, and Novartis recommended not moving forward with it for sarcopenia. The reviews are blunt about where that leaves things: no drug is approved, and none should be prescribed for sarcopenia, testosterone included.
What do weight-loss drugs do to muscle?
It’s an open question in older adults. A 24-month cohort study of older adults with type 2 diabetes found semaglutide lowered both BMI and muscle mass compared with controls, with larger losses at higher doses. A review in the journal Diabetes adds that researchers haven’t exhaustively studied these drugs in older adults with sarcopenic obesity, and that antibodies like trevogrumab and garetosmab are in trials.
Bimagrumab itself found a second job there: a phase 2 study is testing it alongside semaglutide in people with obesity, aiming to keep muscle while the fat comes off. Anyone taking one of these medications has a good reason to ask the prescriber about strength training and protein.
The bottom line
The best-supported treatment is still the one Fiatarone tested in 1990: lifting, with enough protein. The drug that got furthest didn’t beat it.
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