(Osteo)Sarcopenia & Sarcopenic Obesity

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Background

Sarcopenia is a geriatric syndrome with progressive loss of mass, quality and function of skeletal muscles associated with aging. Its prevalence may reach 30% for people over 60 in European populations. Sarcopenia is a multifactorial process: some factors lead to the development of sarcopenia and its associated negative effect on physical function. The loss of skeletal muscle fibers secondary to the reduced number of motor neurons appears to contribute significantly to the disorder, which may further include reduced levels of hormones (particularly GH, IGF-1, MGF, and testosterone), lack of protein and calories of the diet, oxidative stress, inflammatory processes etc. Sarcopenia requires a rehabilitation program to improve physical performance but also nutritional interventions: protein supplementation combined with exercise, leucine-enriched amino acids and vitamin D supplementation, as adjunctive therapy.

In older persons, the combination of osteopenia/osteoporosis and sarcopenia - known as osteosarcopenia - has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. Osteosarcopenic patients have very particular clinical, biochemical, diagnostic, and functional characteristics that could be identified in clinical practice.

In this Research Topic, a clinical definition of osteosarcopenia aiming to describe the clinical, functional, and biochemical features that are unique to these patients will be presented.

Sarcopenic Obesity (SO) describes the condition in which obesity co-exists with sarcopenia. There is a lack of studies with outcome interventions to counteract sarcopenic obesity. However, there are recommendations for sarcopenia and / or weight loss.

Potential subjects include the following:
• The use of imaging combined with functional assessments for the diagnosis of osteosarcopenia.
• The translational aspects of sarcopenia and osteoporosis research and highlight expected outcomes from different interventions for both conditions.
• New therapies targeting both muscle and bone.
• Studies which address how to increase muscle mass in a situation of energy deficit.
• Studies which address weight loss, which is effective in reducing fat mass but address skeletal muscle mass loss.
• Studies which address protein loss and exercise programs containing strength and aerobic exercise in combination with dietary weight loss program may possibly have positive effects on sarcopenic obesity. Particularly those focused on higher protein intake.
• Studies with outcome interventions to counteract sarcopenic obesity including strength exercise combined with proper diet.

What makes our RT special is that the new holistic concept called Osteosarcopenia school will be presented. Preventive measures and therapeutic interventions that can benefit both muscle and bone simultaneously will be analyzed. This new concept is based on counselling and education of patients as part of a rehabilitation program. It includes a specific pathway to stop the vicious cycle, not only of social isolation, but also of falls and fractures in this population, which can lead to disability. Rehabilitation uses interventions such as counselling and re-education on how to prevent falls. According to the concept, the focus is mainly shifted on muscle strengthening, balance improvement, and reducing causes of instability (i.e. neurogenic, iatrogenic etc.). To this end, specific exercise programs combined with a review of drugs is essential in these patients. Re–education includes interventions targeting an increase in the functionality of subjects through social reintegration and improvement in activities of daily living.

Keywords: Sarcopenic Obesity, sarcopenia, osteoporosis, osteopenia, Osteosarcopenia

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