Arthritis und Rheuma 2018; 38(02): 87-92
DOI: 10.1055/s-0038-1649286
Geronto-Orthopädie
Schattauer GmbH

Sarkopenie

Pathophysiologie und TherapieSarcopeniaPathophysiology and therapy
W. Kemmler
1   Institut für Medizinische Physik, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen
,
F. Jakob
2   Orthopädisches Zentrum für Muskuloskeletale Forschung, Experimentelle und Klinische Osteologie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg
,
C. Sieber
3   Institut für Biomedizin des Alterns, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg
› Institutsangaben
Weitere Informationen

Publikationsverlauf



Publikationsdatum:
27. April 2018 (online)

Zusammenfassung

Sarkopenie ist eine altersassoziierte Erkrankung, deren Prävalenz mit der zunehmenden Lebenserwartung ansteigt. Der Verlust an Muskelmasse und Funktion geht mit einer erhöhten Mortalität und mit einem hohen Risiko der Behinderung und der Hospitalisierung einher. Die Angaben über die Häufigkeit in selbstständig lebenden Populationen sind sehr inkonsistent. Wichtige Risikofaktoren sind genetische/epigenetische Faktoren, Immobilisation, Fehlund Mangelernährung, Hormonmangelzustände, chronische Entzündung und ein Anstieg der inhibitorischen Faktoren der Geweberegeneration. Trotz hoher Forschungsintensität und intensiver Diskussion in Konsensus-Konferenzen über die diagnostischen Kriterien besteht noch keine einheitliche Definition der Sarkopenie. Eine ganze Reihe von Interventionsstrategien werden klinisch getestet. Trainings-Regimes, Ernährungsprogramme, Hormonersatztherapien und pharmakologische Ansätze mit anabolen Prinzipien wie SARMs, Ghrelin/Wachstumshormon und Myostatin-Antagonisten sind in der klinischen Evaluationsphase. Aus den wenigen bereits publizierten Studienergebnissen wird deutlich, dass Trainingsprogramme und Medikamente ein hohes Potenzial haben. Nicht wenige Studien zeigen aber über die Verbesserungen der Surrogatparameter hinaus keine eindrucksvollen Funktionsverbesserungen. Zukünftige Strategien müssen multimodale Interventionen zum Inhalt haben und im Design verbessert werden.

Summary

Sarcopenia is an aging-associated syndrome with increasing prevalence in aging societies. Loss of muscle mass and function is associated with enhanced mortality, and conveys a high risk of disability and hospitalization. Data about its prevalence in free living populations are inconsistent. There are important risk factors such as genetics/epigenetics, immobilisation, malnutrition and anorexia, hormone deficiencies, chronic inflammation and raising levels of inhibitors of tissue regeneration. In spite of intensive research activities and discussions in consensus conferences we do not yet have a generally accepted definition of sarcopenia. Many intervention strategies are being evaluated in clinical trials, including exercise regimens, nutrition programs, hormone replacement and pharmacological strategies involving anabolic principles such as SARMs, Ghrelin/growth hormone and myostatin antagonists. Available data suggest that exercise strategies and pharmacological approaches have a high potential. However a relevant number of studies also does not demonstrate impressive functional outcomes beyond significant improvement of surrogate parameters. Future strategies will have to involve multimodal interventions and improved study designs.

 
  • Literatur

  • 1 Ali S, Garcia JM. Sarcopenia, cachexia and aging: diagnosis, mechanisms and therapeutic options - a mini-review. Gerontology 2014; 60: 294-305.
  • 2 Balachandran A, Krawczyk SN, Potiaumpai M, Signorile JF. (2014). High-speed circuit training vs hypertrophy training to improve physical function in sarcopenic obese adults: a randomized controlled trial. Exp Gerontol 2014; 60: 64-71.
  • 3 Bano G, Trevisan C, Carraro S. et al. Inflammation and sarcopenia: A systematic review and metaanalysis. Maturitas 2017; 96: 10-15.
  • 4 Baumgartner RN, Waters DL, Gallagher D. et al. Predictors of skeletal muscle mass in elderly men and women. Mech Ageing Dev 1999; 107: 123-136.
  • 5 Beaudart C, Zaaria M, Pasleau F. et al. Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis. PLoS One 2017; 12: e0169548.
  • 6 Behm DG, Muehlbauer T, Kibele A, Granacher U. Effects of Strength Training Using Unstable Surfaces on Strength, Power and Balance Performance Across the Lifespan: A Systematic Review and Meta-analysis. Sports Med 2015; 45: 1645-1669.
  • 7 Borde R, Hortobagyi T, Granacher U. Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med 2015; 45: 1693-1720.
  • 8 Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013; 16: 105-114.
  • 9 Campins L, Camps M, Riera A. et al. Oral Drugs Related with Muscle Wasting and Sarcopenia. A Review. Pharmacology 2016; 99: 1-8.
  • 10 Cawthon PM, Blackwell TL, Cauley J. et al. Evaluation of the Usefulness of Consensus Definitions of Sarcopenia in Older Men: Results from the Observational Osteoporotic Fractures in Men Cohort Study. J Am Geriatr Soc 2015; 63: 2247-2259.
  • 11 Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease: molecular mechanisms and promising therapies. Nat Rev Drug Discov 2015; 14: 58-74.
  • 12 Cruz-Jentoft AJ, Baeyens JP, Bauer JM. et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412-423.
  • 13 Cruz-Jentoft AJ, Landi F, Schneider SM. et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014; 43: 748-759.
  • 14 Curtis E, Litwic A, Cooper C, Dennison E. Determinants of Muscle and Bone Aging. J Cell Physiol 2015; 230: 2618-2625.
  • 15 Drey M, Krieger B, Sieber CC. et al. Motoneuron loss is associated with sarcopenia. J Am Med Dir Assoc 2014; 15: 435-439.
  • 16 Fielding RA, Vellas B, Evans WJ. et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011; 12: 249-256.
  • 17 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156.
  • 18 Goisser S, Kemmler W, Porzel S. et al. Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review. Clin Interv Aging 2015; 10: 1267-1282.
  • 19 Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002; 50: 889-896.
  • 20 Kemmler W, Kohl M, von Stengel S. Long-term effects of exercise in postmenopausal women: 16-year results of the Erlangen Fitness and Osteo-porosis Prevention Study (EFOPS). Menopause 2017; 24: 45-51.
  • 21 Kemmler W, Teschler M, Weissenfels A. et al. Whole-body Electromyostimulation to Fight Sarcopenic Obesity in Community-Dwelling Older Women at Risk. Results of the Randomized Controlled FORMOsA-Sarcopenic Obesity Study. Osteo Int 2016; 27: 3261-3270.
  • 22 Kemmler W, von Stengel S. Exercise frequency, health risk factors, and diseases of the elderly. Arch Phys Med Rehabil 2013; 94: 2046-2053.
  • 23 Kemmler W, von Stengel S, Engelke K. et al. Prevalence of sarcopenic obesity in Germany using established definitions: Baseline data of the FORMOsA study. Osteoporos Int 2016; 27: 275-281.
  • 24 Kim HK, Suzuki T, Saito K. et al. Effects of exercise and amino acid supplementation on body composition and physical function in communitydwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc 2012; 60: 16-23.
  • 25 Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev 2010; 09: 226-237.
  • 26 Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc 2011; 43: 249-258.
  • 27 Phu S, Boersma D, Duque G. Exercise and Sarcopenia. J Clin Densitom 2015; 18: 488-492.
  • 28 Raymond MJ, Bramley-Tzerefos RE, Jeffs KJ. et al. Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Arch Phys Med Rehabil 2013; 94: 1458-1472.
  • 29 Reginster JY, Cooper C, Rizzoli R. et al. Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia. Aging Clin Exp Res 2016; 28: 47-58.
  • 30 Rütten A., Abu-Omar K, Meierjürgen R. et al. Was bewegt die Nicht-Beweger?. Präv Gesundheitsf 2009; 04: 245-250.
  • 31 Sieber CC. [Sarcopenia]. Ther Umsch 2014; 71: 171-176.
  • 32 Sieber CC. Frailty - From concept to clinical practice. Exp Gerontol 2017; 87: 160-167.
  • 33 Stewart VH, Saunders DH, Greig CA. Responsiveness of muscle size and strength to physical training in very elderly people: a systematic review. Scand J Med Sci Sports 2014; 24: e1-e10.
  • 34 Studenski SA, Peters KW, Alley DE. et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 2014; 69: 547-558.
  • 35 Tschopp M, Sattelmayer MK, Hilfiker R. Is power training or conventional resistance training better for function in elderly persons? A meta-analysis. Age Ageing 2011; 40: 549-556.
  • 36 Zamboni M, Mazzali G, Fantin F. et al. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 2008; 18: 388-395.