Sarcopenia: Current evidence, advances in assessment, clinical implementation and future directions

Sarcopenia is the progressive loss of muscle strength and mass that is commonly, though not exclusively, associated with increasing age. It has been well established to be associated with increased risk of adverse health outcomes and is a growing public health challenge. Reported prevalence varies widely by setting and diagnostic criteria, complicating surveillance and cross-study comparisons. The recent development of the conceptual definition of sarcopenia by the Global Leadership Initiative in Sarcopenia marks a critical step towards harmonisation. There have been significant advances in our understanding of the pathophysiological basis, biomarkers, assessment, diagnosis and interventions in sarcopenia. Novel biomarkers (including creatinine–cystatin C indices, myokines and composite multi-marker panels) and artificial intelligence-enabled radiomics from computed tomography, magnetic resonance imaging and ultrasound show promise for scalable, opportunistic case-finding, but currently remain research tools requiring large-scale validation and cost-effectiveness assessments. Management remains grounded in resistance exercise and nutrition, although there is ongoing debate on the optimal type of protein as well as the most effective timing of protein intake in relation to exercise and the amount required. Pharmacological and regenerative approaches are under active investigation but have yet to deliver proven, generalisable clinical benefits. Translation into practice hinges on standardised definitions, validated assessment tools and integrated care pathways that embed sarcopenia screening into chronic disease management and public health programmes. Singapore’s first national sarcopenia consortium aims to accelerate translation into clinical practice and community care by advancing mechanistic research, validating novel biomarkers and developing scalable interventions to enhance muscle health and promote healthy ageing.