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Sarcopenia

Nature Reviews Disease Primers volume 10, Article number: 68 (2024) Cite this article

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Abstract

Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality. Although prevalence estimates vary because sarcopenia has been defined in different ways, even using a conservative approach, the prevalence is between 5% and 10% in the general population. A life course framework has been proposed for understanding not only the occurrence of sarcopenia in later life but also influences operating at earlier life stages with potentially important implications for preventive strategies. Harnessing progress in understanding the hallmarks of ageing has been key to understanding sarcopenia pathophysiology. Considerable convergence in approaches to diagnosis of sarcopenia has occurred over the last 10 years, with a growing emphasis on the central importance of muscle strength. Resistance exercise is currently the mainstay of treatment; however, it is not suitable for all. Hence, adjunctive and alternative treatments to improve quality of life are needed. An internationally agreed approach to definition and diagnosis will enable a step change in the field and is likely to be available in the near future through the Global Leadership Initiative in Sarcopenia.

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Fig. 1: Key milestones in the development of a sarcopenia definition.
Fig. 2: Grip strength by age, sex and UN world region.
Fig. 3: The overall structure of skeletal muscle tissue.
Fig. 4: Differences between slow-twitch and fast-twitch myofibres.
Fig. 5: Algorithm for management of sarcopenia.

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Acknowledgements

The authors thank H. Atkinson (Patient and Public Involvement and Engagement Manager for the Ageing, Sarcopenia and Multimorbidity Theme within the National Institute for Health and Care Research Newcastle Biomedical Research Centre) and the 11 people who shared their experiences of sarcopenia for contributing to the patient experience box. A.A.S., R.C. and M.D.W. acknowledge support from the National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (reference NIHR203309). R.C. also receives support as part of a generous donation made by the McArdle family to Newcastle University for research that will benefit the lives of older people in the UK. R.A.F. acknowledges support from the US Department of Agriculture, under agreement no. 58-1950-4-003.

Author information

Authors and Affiliations

  1. AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

    Avan A. Sayer, Rachel Cooper & Miles D. Witham

  2. NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

    Avan A. Sayer, Rachel Cooper & Miles D. Witham

  3. National Center for Geriatrics and Gerontology, Obu, Japan

    Hidenori Arai

  4. California Pacific Medical Center, Research Institute, San Francisco, CA, USA

    Peggy M. Cawthon

  5. University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA

    Peggy M. Cawthon

  6. Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon

    Marie-Josiane Ntsama Essomba

  7. Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA

    Roger A. Fielding

  8. Department of Anatomy, Physiology and Human Biology, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia

    Miranda D. Grounds

  9. Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain

    Alfonso J. Cruz-Jentoft

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  1. Avan A. Sayer
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  2. Rachel Cooper
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  3. Hidenori Arai
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  4. Peggy M. Cawthon
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  5. Marie-Josiane Ntsama Essomba
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  6. Roger A. Fielding
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  9. Alfonso J. Cruz-Jentoft
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Contributions

Introduction (R.A.F. and R.C.), Epidemiology (P.M.C., H.A., M.-J.N.E. and R.C.), Mechanisms (M.D.G.), Diagnosis, screening and prevention (A.J.C.-J., H.A. and M.-J.N.E.), Management (M.D.W., H.A. and M.-J.N.E.), Quality of life (R.C.), Outlook (A.A.S.), overview of the Primer (A.A.S. and R.C.).

Corresponding author

Correspondence to Avan A. Sayer.

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Competing interests

A.A.S. reports research grant funding from the National Institute for Health and Care Research UK, UK Research and Innovation, a research collaboration agreement with Regeneron Pharmaceuticals and a previous Pfizer Investigator Initiated Research Grant. R.C. reports research grant funding from the National Institute for Health and Care Research UK and UK Research and Innovation. H.A. has no funding or other conflicts of interest to disclose. P.M.C. is a consultant to and owns stock in Myocorps. M.-J.N.E. has no funding or other conflicts of interest to disclose. R.A.F. reports grants from the National Institutes of Health and USDA Agricultural Research Service; grants and personal fees from Axcella Health, Juvicell, Inside Tracker and Biophytis; and personal fees from Amazentis, Nestle, Pfizer, Rejuvenate Biomed, Embion and Hevolution Foundation, outside the submitted work. M.G. has no funding or other conflicts of interest to disclose. M.D.W. reports research grant funding from the National Institute for Health and Care Research UK and UK Research and Innovation. A.J.C.-J. has no funding to disclose. A.J.C.-J. has received honoraria for lectures or for organizing independent educational events from Abbott Nutrition, Danone-Nutricia, Nestlé Health Science and Fresenius-Kabi, and consulting fees from Akros Pharma, Chugai Pharmaceutical, Rejuvenate Biomed, Reneo Pharmaceutical and Toray Industries.

Peer review

Peer review information

Nature Reviews Disease Primers thanks S. von Haehling; N. Martinez-Velilla, who co-reviewed with A. Cedeno-Veloz; D. Scott; and H. Wakabayashi, for their contribution to the peer review of this work.

Additional information

Informed consent

The authors affirm that all contributors to the patient experience box provided informed consent for publication of their experiences.

Disclaimer The views expressed in this publication are those of the authors and do not necessarily reflect the views of the National Institute for Health and Care Research, the Department of Health and Social Care, the McArdle family or the US Department of Agriculture.

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Sayer, A.A., Cooper, R., Arai, H. et al. Sarcopenia. Nat Rev Dis Primers 10, 68 (2024). https://doi.org/10.1038/s41572-024-00550-w

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