Severe sarcopenia with loss of grip strength

Specialty: Geriatrics.

• senile muscle wasting
• loss of muscle mass and function
• muscular insufficiency in the elderly
• senile myopenia

Why it occurs

• Decrease in myofibrillar protein synthesis and muscle anabolic resistance associated with the cellular aging process
• Chronic sedentary lifestyle due to prolonged immobility or prolonged bed rest after acute hospital admissions
• Daily intake of proteins of dietary origin lower than the requirements of the elderly (less than 1.2 g/kg/day) associated with senile anorexia
• Muscle resistance to insulin action and mitochondrial dysfunction in type II fast-twitch skeletal muscle fibers
• Denervation and loss of alpha motor units in the spinal cord due to peripheral neuropathies or degenerative pathology of the motor neuron

Initial workup

Measurement of handgrip strength using a calibrated hand dynamometer (alarm values: less than 27 kg in men and 16 kg in women); quantification of appendicular muscle mass by total body dual-energy physical functional assessment using the SPPB battery (Short Physical Performance Battery); serum determination of albumin, prealbumin, creatine kinase (CK), 25-hydroxyvitamin D levels and hormonal profile (total testosterone, TSH).

Standard management

• Cholecalciferol — Vitamin D3, 1000 IU to 2000 IU orally per day, indicated in cases of serum levels below 30 ng/ml to optimize the function of vitamin D receptors at the muscle and bone level
• Protein supplementation enriched with essential amino acids — especially leucine, or beta-hydroxy-beta-methylbutyrate [HMB] 3 grams orally per day divided into two doses, indispensable associated with a resistance strength physical exercise program
• Strictly avoid the prolonged prescription of systemic corticosteroids that induce atrophy of muscle fibers.