Experts in ageing concerned at neglect of ‘silent’ muscle-wasting disease impacting millions of Australians

Pharma News: The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) is calling on all primary healthcare providers to recognise the crucial role they play in stopping the onset of the muscle wasting disease sarcopenia in vulnerable patients before it is too late.

Sarcopenia is estimated to affect up to 1 in 5 Australians over the age of 60 years. Despite its health impact, sarcopenia is a relatively new concept in the medical sphere, with it only being added to Australia’s list of formal diseases in 2019.

Professor Robin Daly, Immediate-Past President of the Australian and New Zealand Society of Sarcopenia and Frailty Research and Chair in Exercise and Ageing at Deakin University is concerned sarcopenia is not being given serious consideration in primary healthcare.

Commenting on recent consumer research by the ANZSSFR, Professor Daly said “The research by the ANZSSFR shows that consumers hold a strong recognition of the role of the primary healthcare provider in diagnosing sarcopenia. We need to start really considering the importance of skeletal muscle to our health and wellbeing. It’s difficult to recognise signs and symptoms in patients, especially patients in their fifties, because most people in that age group walk into your office and they look physically capable. Unless they take their shirt off or perform a test to measure strength, you can’t really see or evaluate the status of their muscle. However, we know that muscle deterioration has already begun as early as age forty.”

Sarcopenia is a disease defined as a progressive loss of skeletal muscle mass, strength and function associated with ageing. Many experience both physical and metabolic problems given the pinnacle role skeletal muscle mass plays in the body. It is often an unrecognised disease and those who are affected sometimes mistakenly dismiss symptoms as a normal part of ageing. They often do not speak with their healthcare provider about the weakness or frailty they are experiencing.

Professor Andrea Maier, President of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) and Professor of Medicine at the University of Melbourne said “With the ageing process lots of activities happen in the body that lead to a decline in muscle mass. Factors that contribute to this are physical inactivity and a very important one is acute disease. Older Australians who are admitted to hospital can experience a significant decrease in muscle mass because they are sedentary while they are recovering. Older adults with sarcopenia have a 60% likelihood of falls and 70% higher chance of fractures. So eventually, if muscles of older adults are weak, they will lose independence.”

Sarcopenia has been shown in multiple studies to be associated with a risk of adverse outcomes including falls, fractures and frailty. While ensuring patients maintain a healthy skeletal muscle mass, it is also important to consider the intricate role that muscle and bone play together in the body. When this intricate partnership between muscle and bone is impaired, it is known as osteosarcopenia (a syndrome that comprises two musculoskeletal conditions associated with ageing – osteoporosis and sarcopenia). An estimated 66% of Australians over 50 years of age reportedly have osteoporosis or osteopenia. In Australia, more than 140,000 osteoporotic fractures occur every year, and the average cost of osteopenia-associated fractures is estimated at $2.75 billion per year.

For falls prevention, healthcare providers are urged to look for the warning signs of sarcopenia. This comes with the recent update to the National Aged Care Mandatory Quality Indicator Program (QI Program) on July 1^st, 2021 which now requires all residential aged care providers to collect and report on two additional quality indicators for their residents, one of which is ‘Falls and major injury’.

To identify patients at risk of sarcopenia, Professor Daly recommends the ‘5 Times Chair Stand Test’. This test is used to assess functional lower limb muscle strength, transitional movements, balance and falls risk in older adults. Based on how quickly a patient can complete the ‘5 Times Chair Stand Test’ it will give primary healthcare providers a good indication of how at-risk a person is of developing sarcopenia, or if they are already experiencing impaired muscle function.

To treat patients with sarcopenia and help older adults live their best life, a foundation of good nutrition combined with physical activity intervention, such as resistance exercise, is recommended.

Professor Maier recommends prescribing older adults with sarcopenia a high-protein, HMB^* and vitamin D enriched oral nutritional supplement as they have been clinically shown to be an effective strategy to improve nutritional status, muscle mass, strength, and recovery.

*HMB (β-Hydroxy β-methylbutyrate)