Sarcopenia: Symptoms, Causes & Treatment

Sarcopenia is a musculoskeletal condition that causes a gradual loss of muscle mass, strength, and physical performance. It can lead to symptoms like muscle weakness, poor balance, and difficulty performing everyday tasks.

It is more common after age 50, when muscle fibers naturally become smaller and fewer. At the same time, hormone levels like estrogen and testosterone may decline, and many people become less physically active.

To help rebuild and maintain muscle, it’s important to avoid a sedentary lifestyle and stay physically active with activities like strength training and walking. A diet rich in protein, vitamins, and minerals can also help, with an emphasis on lean meats, milk and dairy products, and plant-based options like soy, lentils, and quinoa.

Main symptoms

The main symptoms of sarcopenia are:

• Muscle weakness;

• Loss of balance;

• Increased risk of falls and fractures;

• Loss of endurance;

• Decreased muscle mass.

In addition, a person with sarcopenia may have trouble walking and may need support from another person, a cane, or a wheelchair.

Sarcopenia in older adults

Sarcopenia can gradually affect an older adult’s daily life, leading to problems such as poor balance, difficulty walking, and challenges with everyday tasks like grocery shopping or housework. Over time, it can also make basic activities, such as bathing or getting out of bed, more difficult.

Some people may also develop more body aches. This can be related not only to wear and tear on bones and joints, but also to having less muscle to help stabilize the joints.

Confirming a diagnosis

Sarcopenia is diagnosed by a primary care provider or geriatrician based on symptoms, health history, age, and a physical exam to assess muscle strength.

To confirm the diagnosis of sarcopenia, the provider may order tests such as magnetic resonance imaging (MRI), computed tomography (CT), dual-energy X-ray absorptiometry (DXA), or bioelectrical impedance. These tests assess muscle quantity, density, or quality.​

Possible causes

The main causes of sarcopenia are:

• Natural aging of the body;

• Sedentary lifestyle;

• Obesity;

• Low protein intake;

• Insulin resistance or diabetes;

• Chronic diseases, such as COPD, HIV, cancer, kidney disease, or heart failure.

In addition, lower levels of hormones like estrogen and testosterone may also contribute to muscle loss and the development of sarcopenia.

Treatment options

Treatment for sarcopenia in someone who already has muscle loss should be guided by a primary care provider or geriatrician. The goal is to support muscle recovery and prevent symptoms from getting worse.

The main treatments for sarcopenia are:

• Strength training with physical activity and physical therapy;

• Home adaptations to make daily and leisure activities easier;

• Adjusting medications that may reduce appetite or contribute to muscle loss;

• Treating and controlling conditions that may worsen an older adult’s physical performance, such as diabetes, intestinal changes, or appetite changes;

• A protein-rich diet and, for a frail older adult, a higher-calorie diet guided by a registered dietitian;

• Medications and hormones, such as hormone replacement therapy or testosterone, only in specific cases when medically necessary and under medical supervision.

A doctor or registered dietitian may recommend certain supplements or nutrition drinks to help minimize muscle loss and support muscle building. Examples include oral nutrition supplements like Ensure or BOOST, tube-feeding formulas like Nutren (when clinically appropriate), and dietary supplements such as HMB and creatine.

Is there a cure?

Sarcopenia has no cure. However, it may be possible to slow muscle loss and reduce symptoms with the treatments recommended by a healthcare provider.

This is because sarcopenia is part of the natural aging process, but it can be prevented or delayed.

Prevention measures

To help prevent sarcopenia, it is very important to adopt habits such as:

• Doing physical activity, including strength and resistance training, such as weight training and Pilates, for example, and aerobic exercise, such as walking and running, to support circulation and overall physical performance;

• Eating a high-protein diet, including meats, eggs, and dairy products, to support muscle growth, along with carbohydrates, fats, and enough calories for energy, in the right amounts and preferably guided by a registered dietitian;

• Avoiding smoking, as cigarettes can reduce appetite, impair circulation, and damage the body’s cells. According to the CDC, cigarette smoking harms blood vessels by causing them to thicken and narrow, which disrupts healthy circulation;

• Drinking about 2 liters (8 cups) of water per day to stay hydrated and support circulation, bowel regularity, taste, and overall cell health;

• Avoiding excessive alcohol intake, because it can contribute to dehydration and may impair the function of organs such as the liver, brain, and heart.

 According to the World Health Organization (WHO), adults aged 65 and older should aim for at least 150 minutes of moderate-intensity physical activity per week and include muscle-strengthening activities on 2 or more days per week, with balance-focused activity on 3 or more days per week for those with poor mobility.

It is also important to keep follow-up visits with a primary care provider or geriatrician to identify and treat conditions that can worsen lean mass loss, such as diabetes, hypothyroidism, and stomach or intestinal conditions, as well as immune-related conditions.