Sunrise in Sarcopenia Land
Miles Witham is Professor of Trials for Older People at Newcastle University, and is deputy editor of Age and Ageing. He tweets at @OlderTrialsProf
Back in 2010, when the first edition of the European Working Group on Sarcopenia (EWGSOP) guidelines were published in Age and Ageing, sarcopenia was a niche research area, of interest mostly to epidemiologists and muscle physiologists. Since then, research activity in sarcopenia has mushroomed, and the concept has started to enter clinical practice. A measure of the impact of the first guideline is that it has been cited over 3300 times (a record for Age and Ageing) and it is in the top 5% of articles ever published in terms of citation across all media, measured by Altmetric.
Sarcopenia research has progressed a lot in the last eight years. We now have better data on the prevalence and consequences of sarcopenia, and a better understanding of how different cutoffs for diagnosis affect these parameters. Although we are nowhere near a full understanding of the pathology of sarcopenia, sufficient knowledge has accrued to drive some early-phase clinical trials, both from industry and from the academic sector.
In October this year, Age and Ageing published the revised EWGSOP guidance, accompanied by an editorial – “A new dawn in Sarcopenia” (hence the title of this blog!). UK geriatricians were once again closely involved in generating the guidance, with Professor Avan Sayer on the writing group and Professor Finbarr Martin on the reference group. Professor Alfonso Cruz-Jentoft, the chair of the guideline group, launched the guidance at the EUGMS meeting in Berlin in October, and is speaking at the BGS autumn meeting Sarcopenia and Frailty Research SiG session here in London on November 16th. The diagnostic criteria have been simplified, thresholds for diagnosis changed, and more emphasis placed on muscle strength as the key diagnostic criterion. Helpful advice is given on how best to measure muscle mass, and new guidance on the research subclassification of sarcopenia (primary vs secondary, acute vs chronic) is given.
So how will this help us as clinicians who care for older people? Firstly, the new guidance will continue to raise the profile of sarcopenia, which is a condition that so many of our patients are faced with. The simplified guidance should make it easier to diagnose the condition in clinical practice, although locally appropriate algorithms will still be needed.
However, the acid test (as with so many diagnoses) is: will making a diagnosis of sarcopenia change my management? Is it worth the time, cost and effort? At the moment, there are few interventions that are proven to make a difference for people with sarcopenia, although several nutrition and drug interventions are under test. The one intervention that we know works is resistance training. As shown by our recent SiG survey, few people with sarcopenia receive this intervention though – even though we know that such training also improves frailty. So making the diagnosis of sarcopenia is probably a necessary, but not sufficient step towards translating this evidence into patient benefit. The complementary step is the design and delivery of resistance training programmes that can be delivered at scale for older people.
Within the BGS Sarcopenia and Frailty Research SiG, we are working on these issues – bringing existing resistance training programmes that exist around the country together to find what works best in practical terms, encouraging a thriving network for further research and trials, and acting as a forum for benchmarking current practice and sharing practical initiatives on embedding the diagnosis of sarcopenia in clinical practice. The new EWGSOP guidance is another helpful step towards the goal of understanding, diagnosing and treating this important condition, but further progress will depend as much on the contributions of clinicians at the front-line of practice as on professional researchers. Come and join us!