Muscle and Bone Mass Loss in the Elderly Population: Diagnosis and Treatment
Aging is the result of different functional changes leading to a substantial reduction of all human capabilities. A variety of anatomical and physiological changes occur with advancing age. These changes are more evident in the elderly population.
Loss of muscle mass (sarcopenia) and loss of bone mass (osteopenia or osteoporosis) with advancing age, when untreated, represent a major public health problem for the elderly population and may result in loss of independence in later life. Untreated age-related sarcopenia and osteopenia/osteoporosis, increases the risk for falls and fractures, making older individuals more susceptible to the development of mobility limitations or severe disabilities that ultimately affect their capacity for independence.
In this review, we will discuss the muscle and bone mass loss in the elderly population and the Treatment of both issues.
Aging causes a variety of anatomical and physiological changes. Knowledge of age-related anatomical and physiological changes allows for the understanding of the pathophysiological differences between the elderly and the rest of the adult population. Muscle mass loss is one of the multiple age-related physical changes involving a condition known as sarcopenia, which has been associated with the loss of physical activity. Another disorder related to aging is a bone mass loss, known as osteopenia, which can further progress to osteoporosis. Both conditions are multifactorial, but genetics, nutrition, and lifestyle have been shown to be associated with these disorders. The extent of loss in both of these conditions can be measured with a technique called Dual-energy x-ray absorptiometry (DXA). The gold standard for measuring bone material properties in clinical practice is axial DXA measurement from the femur and spine. There are multiple treatments for both of these conditions including the use of hormones and balanced nutrition; however, exercise is the most recommended therapeutic approach for both disorders.
Muscle Mass Loss
There are various methods to measure sarcopenia and osteopenia, but dual X-ray absorptiometry (DXA) is considered the most accurate. Muscle mass can be assessed in an accurate manner by dual X-ray absorptiometry (DXA) with a very low dose of radiation (1–2 micro-Sieverts). However, there are still challenges to overcome using this method to consistently diagnose sarcopenia and osteopenia or osteoporosis.
Treatment of Muscle Mass Loss
1. Testosterone
In the elderly, the testosterone concentrations decrease with age. Lower testosterone concentrations are associated with lower fat-free mass, lower appendicular skeletal muscle mass, and lower force on the knee extension in hypogonadal men versus healthy controls. The prevalence of hypogonadism is 20% in men over 60 years and up to 50% in men over 80 years. In a controlled, double-blinded, randomized clinical trial by Wittert et al., the administration of 80 mg of oral testosterone every 12 hours for 12 months, increased lean body mass by 2% while fat mass decreased in 69 hypogonadal subjects. Testosterone increases muscle protein synthesis, but its effects on muscle are modulated by several factors, including genetic, nutritional, and exercise history.
Hence, having a lifestyle that is working towards making more testosterone will help reduce muscle mass loss.
2. Estrogen
It has been suggested that the transition to menopause, and the subsequent decrease in estrogen, may play a role in the loss of muscle mass. There is a positive correlation between lean body mass and estrogen levels. Additionally, estrogen may have a direct effect on muscle mass, as the cell membranes of skeletal muscle contain beta estrogen receptors. The mechanisms by which the decrease in Estrogen levels may have a negative effect on muscle mass remains not well understood.
3. Human growth hormone (HGH)
Treatment with HGH is very effective in promoting bone and muscle growth and has been approved by the FDA for a number of indications. HGH replacement therapy increases muscle mass and strength in young adults with hypopituitarism. In middle age, HGH has an anabolic effect. In adults over 50 years with HGH deficiency that started in adulthood, treatment increases the strength of the thigh in both sexes.
4. Nutrition
Reducing food intake in the elderly has consequences that could be important for muscle mass and strength. Reduction of energy intake corresponding to lower levels of energy consumption leads to weight loss and ultimately, to muscle mass loss. A number of interventions have been studied, ranging from the provision of nutritional support to supplementation with specific nutrients. The nutrients that have been most consistently linked to sarcopenia and frailty in the elderly are vitamin D, protein, and a series of antioxidants and nutrients, including carotenoids, selenium, and vitamins E and C.
5. Proteins
Proteins are considered a key nutrient in the elderly. They provide the necessary energy source for muscle protein production as absorbed amino acids have a stimulating effect on muscle protein synthesis after feeding. There is evidence that the synthetic response to amino acid intake can be mitigated in the elderly, particularly when consumption is low and when protein is consumed with carbohydrates. Protein intake should be carefully increased in the elderly to maintain nitrogen balance and protection against muscle loss. Protein and amino acid supplements have the potential to slow down the development of sarcopenia.
6. Strength training
One of the most effective ways to combat the loss of muscle mass is by stimulating hypertrophy and increasing muscle strength by incorporating strength training. After 6 months of strength training 3 times per week, the maximum lean body mass increases by 1.0 ± 0.5 kg in older adults.
Strength training maintains muscle mass and performance more efficiently than other types of exercise.
Treatments for Bone Mass Loss
1. Adequate Nutrition
Changes in lifestyles, such as having an adequate diet, can exert a profound effect on the progression of osteopenia. For example, increasing the intake of calcium and vitamin D to the daily recommended levels can promote musculoskeletal health. The National Osteoporosis Foundation (NOF) recommends adults under age 50 to have an intake of 1,000 mg of calcium and 400–800 IU of vitamin D daily and adults age 50 and older to have an intake of 1,200 mg of calcium and 800–1,000 IU of vitamin D daily. Products that are high in calcium are low-fat and non-fat milk, yogurt, and cheese. Vitamin D can be obtained through careful exposure to sunlight, dietary supplements, and food nutrients.
2. Exercise
Specifically, weight training and walking are beneficial for increasing bone density in middle-aged and older people. Regular weight-bearing and muscle-strengthening exercises can reduce the risk of falls and fractures. This type of exercise can increase bone density as well as strength by micro-architectural bone arrangement.
3. Reduce alcohol and tobacco consumption
Consuming high quantities of alcohol and smoking is detrimental to musculoskeletal health. Excessive alcohol intake is considered detrimental to bone health. More than two drinks per day for women and more than three drinks per day for men have been shown to increase the risk of falling. The use of tobacco products is damaging to musculoskeletal health. Orthopedic perioperative complications of smoking include impaired healing, increased infection, delayed and/or impaired fracture union and arthrodesis, and inferior arthroplasty outcomes. The National Osteoporosis Foundation recommends that people participate in tobacco cessation programs.
4. Medications
Calcitonin
Calcitonin is a naturally occurring hormone that helps regulate calcium levels in your body and is involved in the process of bone-building. It can be administered by injection or nasal spray. Calcitonin treatment decreases the rate of bone thinning and relieves pain that occurs when the bones in the spine (vertebrae) break and collapse on top of each other (spinal compression fracture). It may be prescribed to women who are more than 5 years beyond menopause and who do not tolerate bisphosphonate medicines and in men with osteoporosis who have normal levels of the male sex hormone testosterone or whose osteoporosis does not get better with testosterone treatment.
Physical Medicine and Rehabilitation (PM&R)
It is known that physical medicine and rehabilitation can reduce disability, improve physical function, and lower the risk of subsequent falls in patients with osteoporosis. Moderate to vigorous physical activity is associated with a hip fracture risk reduction of 45% and 38% respectively, among men and women.
The risk of falling is suggested to be generally reduced among physically active people, with potential increased risk in the most inactive people. Rehabilitation along with exercise is recognized as a means to increment musculoskeletal function, such as activities involved in daily living. Psychosocial factors also strongly affect the functional ability of patients with osteoporosis who have already suffered fractures. Therefore, psychological support and therapy can improve the well-being and quality of life of these patients.
Conclusion
Aging causes a variety of anatomical and physiological changes. Skeletal muscle physiology is one of the most affected by the aging process. Loss of muscle and bone mass results in a poor quality of life and impaired mobility. Although multifactorial, the loss of functionality and body movement acts as a major factor driving loss of muscle and bone mass.
As discussed above there are multiple ways to solve both of the issues however, in my opinion, If one keeps track of his nutrition, exercises on a regular basis, and takes some essential nutrients, the probability of decreased bone or muscle mass will decrease drastically. This also applies to folks who will be transitioning in the respected senior citizen group over the course of the next 10,20 or 30 years.
That is where GFWA comes into the picture, here we understand your schedule, your preferences, your weaknesses, etc and based on your goals, craft a new Diet and Workout plan separately for each one of you and keep track of your progress, so that we make sure that you are making progress, every single week.
Besides making you healthy, we also give you a blueprint of a healthy lifestyle, so that once the program is over, you are independent of the trainer.
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Aadil Qayoom is a Health Coach, Fitness Model, and founder at the MAVEN Know more on Instagram or Website