Sarcopenia: Symptoms, Causes & Treatment

Written by: Editorial Team

Medically reviewed by: Dr. Mounika Jetti - General Physician and Diabetologist

Overview | Prevalence | Types | Symptoms | Causes | Risk Factors | Complications | Diagnosis | Treatment | Prevention | Sarcopenia vs Atrophy | FAQs | When to consult a Doctor

Sarcopenia definition

Sarcopenia is a musculoskeletal disorder characterized by the progressive decline in muscle mass, strength, and function, often associated with ageing. As muscles get weaker over time, people may find it harder to do everyday tasks, move around, and be more likely to fall and break bones. The symptoms include muscle weakness, reduced endurance, and a noticeable decrease in muscle size. Individuals may also experience difficulty with balance, frequent falls, and a general decline in physical performance

The causes of sarcopenia are multifactorial, including ageing, changes in hormones, physical inactivity, poor nutrition, and chronic inflammation. Medical conditions such as diabetes, heart disease, and neurological disorders can also have an effect on it. The condition can lead to complications such as frailty, falls, fractures, disability, and a decreased ability to recover from surgery or illness.

Sarcopenia is best managed by a multidisciplinary team including a general physician, geriatrician (a physician who specializes in the care and treatment of elderly patients), physiotherapists, dietitians, and sometimes endocrinologists or exercise specialists.

Sarcopenia affects around 10 %–16 % of the elderly population worldwide, although estimates vary based on the diagnostic criteria and study population. The reported prevalence ranges from roughly 10 % to 27 % in adults aged ≥60 years in many studies, with higher rates seen in specific regions or settings and when different consensus definitions are used. Overall, sarcopenia is a common condition in older adults globally, and its prevalence increases with age and in certain patient groups.

In India, the prevalence of sarcopenia varies widely across populations and diagnostic criteria. Studies done in communities show that about 10% of the general population and 14.2% of people over 60 are affected. For some older Indian groups, estimates say that the prevalence could be anywhere from 14% to almost 40%. 

Sarcopenia is classified based on its underlying causes, including aging and additional factors such as inactivity or disease. The sarcopenia classifications are:

• Primary (age-related) sarcopenia
• Secondary sarcopenia
• Activity-related sarcopenia
• Disease-related sarcopenia

This form of sarcopenia is largely attributed to the natural ageing process, in which muscle mass, strength, and function decline over time without an underlying medical condition. It commonly occurs in older adults, with muscle loss gradually increasing as they age. Hormonal changes, decreased physical activity, and changes in muscle metabolism contribute significantly to this type.

This type of sarcopenia is caused by identifiable external factors, including diseases or lifestyle choices that exacerbate muscle loss. It is further divided into:

Activity-related sarcopenia

This is a condition where there is a loss of muscle mass, strength, and function, mainly due to low physical activity or prolonged inactivity. This form is more common in individuals with limited mobility, like those recovering from surgery or dealing with chronic conditions.

Disease-related sarcopenia

Disease-related sarcopenia is the loss of muscle mass, strength, and function that occurs due to underlying medical conditions, rather than just aging or inactivity. Chronic diseases, such as organ failure, cancer, inflammatory disease conditions, or endocrine disorders, contribute to muscle wasting. These conditions affect muscle metabolism, inflammation, and nutritional intake, making the body more susceptible to muscle loss.

Sarcopenia is a progressive condition that results in various symptoms that significantly impact mobility, balance, and daily functioning. The following are the symptoms of sarcopenia:

• Muscle Weakness 
• Slower Walking 
• Muscle Loss 
• Increased Risk of Falls
• Reduced stamina
• Poor balance

Muscle Weakness: As sarcopenia gets worse, people notice that their muscles are getting weaker, especially in their arms and legs. Everyday activities like lifting things or climbing stairs become more challenging. The muscle loss leads to a noticeable decrease in strength, making physical exertion more challenging. Over time, this weakness may affect one's ability to perform basic movements.

Slower Walking: A slower walking speed is one of the main signs of sarcopenia. People have a harder time walking at their normal pace as their muscle mass decreases, which often makes it hard for them to keep up with others. This slower movement is due to weak muscles and reduced coordination, making walking difficult and less effective. This symptom can increase the risk of falling, particularly in older adults.

Muscle Loss: Muscle loss or atrophy is a common sign of sarcopenia. As muscles shrink, they generally get smaller, particularly in the arms, legs, and core. This can make the body look thinner or weaker. Less muscle mass makes it harder for the body to perform physical tasks, so it has to rely more on other systems for movement.

Increased Risk of Falls: As muscle strength and balance decline, the risk of falls increases significantly. Reduced muscle strength and impaired coordination make it difficult to maintain stability while standing or walking. Even small missteps can result in falls, and recovery becomes harder due to weakened muscles, making daily activities riskier for those with sarcopenia.

Reduced stamina: People with sarcopenia often have less energy and get tired more easily. Less muscle mass makes it unable to do activities like walking or climbing stairs for long periods of time. This lack of energy affects both physical and mental health, making it harder to do things.

Poor balance: Sarcopenia causes muscle loss and weaker postural control, making it harder to maintain balance while doing things like walking or standing. This makes it more likely that people will fall and makes it harder to do things that need coordination, like driving or working out.

Sarcopenia arises due to a combination of factors that affect muscle mass, strength, and function over time. The following are the causes of sarcopenia:

• Aging 
• Hormonal changes
• Chronic inflammation 
• Neuromuscular / nerve-cell decline

Aging: As ageing occurs, muscle fibers undergo changes, and there is a decline in growth hormone, leading to muscle loss. Maintaining muscle mass and strength becomes more difficult as the body's capacity to repair and regenerate muscle tissue declines. Frailty and decreased physical performance result from this gradual deterioration in muscle function.

Hormonal changes: Muscle growth and repair depend on hormones. Sarcopenia develops as a result of a natural decline in muscle mass and strength brought on by a decrease in hormone levels with age. Daily tasks become more challenging as a result of this loss of muscle function, which impacts overall physical abilities. Reduced muscle strength also raises the risk of falls and mobility issues in older people.

Chronic inflammation: Chronic inflammation is most commonly seen in conditions like rheumatoid arthritis, which causes muscle breakdown. Inflammatory cytokines interfere with muscle repair processes, contributing to muscle loss and weakness over time.

Neuromuscular / nerve-cell decline: Diseases like Parkinson's or Alzheimer's can impact the nervous system, affecting the signals between nerves and muscles. This disrupts normal muscle function, leading to muscle weakness and atrophy. 

Sarcopenia can be more likely to develop in people with certain health conditions and lifestyle habits that lead to gradual muscle loss and weakness over time. These include:

• Older age
• Physical inactivity
• Poor nutrition
• Obesity
• Comorbidities 
• Insulin resistance
• Low BMI
• Smoking
• Depression 
• Frailty and prior falls
• Socioeconomic factors

Older age: Due to changes in muscle fibres, hormonal decline, and decreased physical activity, muscle mass naturally declines with age. Over time, this decline intensifies, raising the risk of sarcopenia in older adults. Additionally, the process of muscle regeneration slows down, which exacerbates frailty and general muscle loss.

Physical inactivity: Lack of physical activity or prolonged periods of immobility, such as during illness or recovery, can lead to muscle loss. Muscles atrophy when people don't use them or take care of them regularly.

Poor nutrition: Inadequate intake of essential nutrients, such as protein, can result in muscle degradation. Malnutrition or low-calorie diets impair the body's ability to maintain and build muscle tissue, making sarcopenia more likely.

Obesity: While obesity may seem unrelated to muscle loss, excess body fat often contributes to reduced physical activity and increased inflammation. This can make muscles break down faster. The extra weight also puts more stress on the muscles, increasing the risk of muscle weakness and imbalance.

Comorbidities: Conditions such as diabetes, heart disease, and cancer can lead to muscle wasting due to inflammation, poor circulation, and reduced physical activity. These diseases often lead to increased protein breakdown and decreased muscle protein synthesis.

Insulin resistance: Muscle protein synthesis is restricted by insulin resistance, which is frequently observed in people with type 2 diabetes or metabolic syndrome. It makes it more difficult for the body to acquire and maintain muscle mass. Insulin resistance raises the risk of sarcopenia and encourages muscle atrophy over time.

Low BMI: Lack of adequate muscle mass and total body weight is frequently indicated by a low body mass index (BMI). People with low BMI are more likely to lose muscle, particularly if their nutritional intake is insufficient. Additionally, a low BMI is associated with greater frailty and difficulty retaining muscle strength.

Smoking: Smoking accelerates muscle loss by promoting inflammation and impairing blood flow to muscles. Chemicals in cigarettes also reduce protein synthesis, which is important for muscle repair and growth. Smokers are more likely to experience muscle weakness and decreased mobility as a result.

Depression: Depression frequently results in decreased appetite and physical activity, both of which cause muscle loss. Long-term inactivity brought on by the psychological and emotional difficulties of depression can raise the risk of sarcopenia. Muscle atrophy may be made worse by depression's impact on the body's hormonal balance.

Frailty and prior falls: Frailty, which is often caused by weak muscles and loss of strength, increases the risk of future falls. People who have fallen in the past are more likely to get sarcopenia because of the injuries, less mobility, and physical decline that come with falling over and over again. Frailty and muscle weakness create a cycle that makes recovery more difficult.

Socioeconomic factors: These factors increase the risk of developing by limiting access to proper nutrition, health care, and physical activity. Limited income may lead to poor protein intake and malnutrition, while reduced access to medical care may delay treatment of underlying diseases.

Frequently Asked Questions (FAQs) on Sarcopenia

No, sarcopenia does not directly cause osteoporosis. But both conditions occur together, especially in older people, because they share risk factors such as ageing, physical inactivity, and hormonal changes. Sarcopenia causes muscle loss, while osteoporosis causes bones to get thinner. Sarcopenia doesn't cause osteoporosis, but the two can make it more likely to fall and break bones.

Sarcopenia often develops slowly, so the early signs may be mild and easy to overlook. Common early indicators include muscle weakness, trouble doing everyday things such as lifting or climbing stairs, and getting tired more quickly. Individuals may also notice a decrease in walking speed and balance issues, which increase the risk of falls. Another early sign is a loss of muscle mass, especially in the arms and legs. This is often seen as muscles that are getting thinner or smaller.

The primary cause of sarcopenia is ageing, which leads to hormonal changes, decreased physical activity, and alterations in muscle metabolism. Other factors include poor nutrition, chronic diseases such as diabetes and cardiovascular disease, and inflammation, all of which contribute to muscle loss.

Sarcopenia can affect mobility and independence mainly by reducing muscle strength and physical performance, which are important for routine activities. As muscle mass decreases, simple movements like walking, climbing stairs, standing up from a chair, or carrying objects become more difficult. Reduced balance and slower walking speed also increase the risk of falls and fractures, which can further limit movement.

Over time, people may become less able to perform daily self-care activities such as bathing, dressing, cooking, and shopping without assistance. This can lead to increased dependence on family members or caregivers. In more advanced cases, sarcopenia can result in loss of independence, reduced quality of life, and a higher risk of hospitalization due to falls or complications related to immobility.

A balanced diet with high protein is essential for preventing sarcopenia, as it supports muscle growth and repair. Lean meats, eggs, fish, legumes, and dairy products are rich in protein. Vitamin D, calcium, and omega-3 fatty acids help maintain muscle and bone health. Maintaining hydration and consuming a variety of nutrient-dense foods helps overall health and muscle function.

Sarcopenia primarily affects the musculoskeletal system, specifically skeletal muscles involved in movement, strength, and physical function. It results in a progressive decline in muscle mass and strength that impairs mobility and daily activities in older adults.

The prognosis of sarcopenia differs according to its severity and the rapidity of its management. It can progress more slowly with proper measures, like regular exercise, a healthy diet, and appropriate care of any underlying health issues. If left untreated, it may lead to frailty, increased risk of falls, disability, and reduced quality of life.

The difference between Cachexia and Sarcopenia depends on their underlying cause and pattern. Sarcopenia develops gradually with ageing and decreased activity, resulting in the loss of muscle mass and strength. Cachexia happens with long-term illnesses like cancer or heart failure. Unlike sarcopenia, cachexia is not reversible and requires management of the underlying illness.

Consult a doctor for sarcopenia if there is a noticeable decline in muscle strength, difficulty in performing daily activities, or frequent falls. Signs that indicate a need for medical assistance are:

• Progressive muscle weakness or loss of strength
• Difficulty in walking, climbing stairs, or getting up from a chair
• Frequent falls or loss of balance
• Unexplained weight loss or visible muscle wasting
• Fatigue and reduced physical endurance

If individuals have any of these symptoms, they should consult a sarcopenia doctor for proper evaluation and management of sarcopenia. Doctors such as geriatricians, orthopaedic specialists, or rehabilitation physicians may recommend tests to assess muscle mass and strength and guide appropriate sarcopenia treatment. Seek urgent medical care if there are repeated falls, sudden weakness, or inability to move, as these may increase the risk of serious injury or complications.