Rethinking sarcopenia and frailty of the elderly

Sarcopenia, or 'frailty of the elderly', is a condition of low muscle mass which is prevalent in older adults and post-menopausal women, leading to falls or worsening after falls. Age-related muscle thinning contributes to falls and fractures. Fractures lead to downward spiral toward the loss of independence in the elderly and ultimately, increased health care expenditures of approximately 4 billion pounds a year. The diagnosis of sarcopenia is based on muscle mass, muscle strength, and physical performance. Sarcopenia is caused by imbalance between the anabolic and catabolic processes on the protein production pathway, as well as a decrease in satellite cells. Denervation, inflammation, hormonal changes, and mitochondrial decline further complicate the issue. Is it time that physicians begin to rethink the diagnosis of sarcopenia or frailty as a process that begins in mid-life? In women, it begins in menopause and ends with falls, fractures, or immobility due to weakness. Physicians often question which came first; frailty causing the fall or the fall worsening frailty, which leads to challenges in treatment. Sarcopenia treatment involves resistance training, appropriate diet and being proactive about the diagnosis. These low-risk lifestyle interventions should be recommended during mid-life well woman visits. Physicians can influence the outcomes of sarcopenia simply by providing an exercise prescription, supplement, and diet recommendation in early menopause. This article aims to change the thinking around sarcopenia from an 'end stage' diagnosis to a mid-life discussion around disease prevention and maintenance of health and muscle.