Musculoskeletal Endocrinology Research Group, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK -
Academic Metabolic Bone Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK -
Minerva Endocrinol (Torino). 2021 Dec;46(4):453-468. doi: 10.23736/S2724-6507.20.03198-3. Epub 2020 Dec 17.
Sarcopenia describes low muscle mass and strength associated with ageing, whilst reduced physical performance indicates the severity of the condition. It can happen independently of other medical conditions and can be a key feature of the frailty phenotype. Frailty is a syndrome of increased vulnerability to incomplete resolution of homeostasis, following a stressor event. Researchers have described the implications of hypothalamic pituitary dysregulation in the pathogenesis of both entities. This review summarizes the recent evidence in this area as well as other endocrine factors such as insulin resistance and vitamin D status and outlines current research priorities. We conducted searches to PubMed and Embase databases for articles, reviews and studies reporting new data on the interaction between hormones of the endocrine system and frailty and/ or sarcopenia in the last 5 years. Interventional studies, cohort studies, case-control studies and animal studies were included. Clinical trials register was also searched to identify ongoing relevant studies. Studies have given us insights into the complex relationships between factors such as anabolic hormones, glucocorticoids and vitamin D on muscle strength and performance and their involvement in ageing phenotypes. However, robust randomized controlled trials are needed to consolidate existing evidence in humans and inform clinical practice. Current evidence supports hormone replacement in patients with confirmed deficiencies, to optimize health and prevent complications. Hormone replacement has limited use for age-related conditions. Current interest is focused on muscle/bone/fat interactions and health outcomes in "sarcopenic obesity." A life-course approach to improving 'health-span' is advocated. Lifestyle factors such as nutrition and physical activity have important interactions with body composition, physical function and metabolic outcomes. Large-scale clinical trials will determine the efficacy and long-term safety of hormone supplementation in the management of sarcopenia and frailty.
肌肉减少症描述了与衰老相关的低肌肉质量和力量，而身体机能下降则表明病情的严重程度。它可以独立于其他疾病发生，并且可以是脆弱表型的一个关键特征。脆弱是一种综合征，指在应激事件后，身体对体内平衡不完全恢复的易感性增加。研究人员描述了下丘脑-垂体功能障碍在这两种疾病发病机制中的作用。这篇综述总结了该领域的最新证据，以及其他内分泌因素，如胰岛素抵抗和维生素 D 状态，并概述了当前的研究重点。我们在 PubMed 和 Embase 数据库中进行了检索，以查找在过去 5 年内报告内分泌系统激素与脆弱和/或肌肉减少症之间相互作用的新数据的文章、综述和研究。纳入了干预性研究、队列研究、病例对照研究和动物研究。还对临床试验注册进行了检索，以确定正在进行的相关研究。研究使我们深入了解了合成代谢激素、糖皮质激素和维生素 D 等因素与肌肉力量和性能之间的复杂关系，以及它们与衰老表型的关系。然而，需要进行强有力的随机对照试验来巩固现有的人类证据，并为临床实践提供信息。目前的证据支持在确诊缺乏的患者中补充激素，以优化健康状况并预防并发症。激素替代疗法对与年龄相关的疾病的应用有限。目前的研究兴趣集中在肌肉/骨骼/脂肪相互作用和“肌肉减少性肥胖”的健康结果上。提倡采用一种改善“健康寿命”的生命过程方法。生活方式因素，如营养和身体活动，与身体成分、身体功能和代谢结果有重要的相互作用。大型临床试验将确定激素补充在肌肉减少症和脆弱管理中的疗效和长期安全性。
