Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States.
Bone. 2017 Dec;105:276-286. doi: 10.1016/j.bone.2017.09.008. Epub 2017 Sep 18.
Sarcopenia is defined as an age associated decline in skeletal muscle mass. The pathophysiology of sarcopenia is multifactorial, with decreased caloric intake, muscle fiber denervation, intracellular oxidative stress, hormonal decline, and enhanced myostatin signaling all thought to contribute. Prevalence rates are as high as 29% and 33% in elderly community dwelling and long-term care populations, respectively, with advanced age, low body mass index, and low physical activity as significant risk factors. Sarcopenia shares many characteristics with other disease states typically associated with risk of fall and fracture, including osteoporosis, frailty, and obesity. There is no current universally accepted definition of sarcopenia. Diagnosing sarcopenia with contemporary operational definitions requires assessments of muscle mass, muscle strength, and physical performance. Screening is recommended for both elderly patients and those with conditions that noticeably reduce physical function. Sarcopenia is highly prevalent in orthopedic patient populations and correlates with higher hospital costs and rates of falling, fracture, and mortality. As no muscle building agents are currently approved in the United States, resistance training and nutritional supplementation are the primary methods for treating sarcopenia. Trials with various agents, including selective androgen receptor modulators and myostatin inhibitors, show promise as future treatment options. Increased awareness of sarcopenia is of great importance to begin reaching consensus on diagnosis and to contribute to finding a cure for this condition.
肌肉减少症是一种与年龄相关的骨骼肌量减少。肌肉减少症的病理生理学是多因素的,包括热量摄入减少、肌肉纤维去神经支配、细胞内氧化应激、激素下降以及增强肌肉生长抑制素信号等,都被认为与之相关。在分别居住在社区和长期护理机构的老年人群中,其患病率高达 29%和 33%,高龄、低体重指数和低体力活动是显著的危险因素。肌肉减少症与其他通常与跌倒和骨折风险相关的疾病状态有许多共同特征,包括骨质疏松症、虚弱和肥胖症。目前,肌肉减少症没有一个被普遍接受的定义。使用当代操作性定义来诊断肌肉减少症需要评估肌肉量、肌肉力量和身体表现。建议对老年患者和那些明显降低身体功能的患者进行筛查。肌肉减少症在骨科患者人群中非常普遍,与更高的住院费用以及跌倒、骨折和死亡率相关。由于目前在美国没有批准任何增加肌肉的药物,因此阻力训练和营养补充是治疗肌肉减少症的主要方法。各种药物的试验,包括选择性雄激素受体调节剂和肌肉生长抑制素抑制剂,都显示出作为未来治疗选择的前景。提高对肌肉减少症的认识非常重要,有助于就诊断达成共识,并为治疗这种疾病做出贡献。