It is said that being slim in old age is worth a lot of money. Is it true that the thinner the better?

This is the 4397th article of Da Yi Xiao Hu

Last week, a very thin old man came to the clinic with pain in many parts of his body. Osteoporosis pain was considered at the time, and a bone density test was performed. The results showed severe osteoporosis, and the degree of osteoporosis was more severe than that of his peers. Inquiring about the medical history, the patient walked slowly, reacted slowly, and fell easily in the past two years. I explained to the patient and his family that the old man had sarcopenia and osteoporosis. The patient and his family said that they often heard of osteoporosis, but this was the first time they heard of sarcopenia. Is this related to osteoporosis?

What is sarcopenia?

Many people are not familiar with sarcopenia. It is clinically called "skeletal muscle aging" or "sarcopenia", which refers to the decline in skeletal muscle mass and muscle strength caused by aging. It is an aging syndrome in which muscle mass, strength and function decline with age, and is caused by continuous loss of skeletal muscle mass, strength and function.

What are the symptoms?

1. Walk slowly on flat ground.

Generally, a healthy adult around 30 years old walks at a speed of about 1.1 to 1.5 meters per second, but patients with sarcopenia have reduced thigh muscle strength, resulting in a walking speed of less than 0.8 meters per second.

2. Weight loss

If you are not trying to lose weight, but lose 5% of your body weight within 6 months, it should be taken seriously.

3. Decreased hand grip strength

Muscle loss makes it difficult to pick up things and reduces hand grip strength, such as being unable to lift a kettle to pour water, unscrew a bottle cap, or wring out a towel.

4. Impaired mobility

Some people even have difficulty standing up because their thigh muscles cannot support the weight of their entire body. They have to rely on others to support them or use handrails to stand up. They cannot go up and down stairs because they cannot support themselves on one foot.

5. Prone to repeated falls

He will fall even when walking on flat ground, and it is uncontrollable. He falls more than twice in a year. At this stage, his sarcopenia is already quite serious.

What are the dangers of sarcopenia?

Sarcopenia increases the risk of falls and fractures, reduces the patient's ability to live daily, and is associated with heart disease, respiratory disease, and cognitive impairment; it can lead to motor dysfunction, decreased quality of life, loss of independent living ability, or long-term need for care from others, and increased risk of death. Sarcopenia increases the risk of hospitalization, increases the cost of care during hospitalization, and increases hospitalization costs.

Is there a relationship between sarcopenia and osteoporosis?

Studies have found that muscle mass is an important factor affecting bone density, bone strength and the incidence of osteoporosis.

Sarcopenia and osteoporosis are closely related degenerative diseases. A decrease in muscle mass will lead to and accelerate the development of osteoporosis, while a decrease in bone strength will also lead to atrophy of muscle morphology and functional degeneration. Some scholars refer to sarcopenia and osteoporosis as "metabolic syndrome" or "activity disorder syndrome". Studies have found that compared with non-sarcopenic patients, sarcopenic patients have a nearly 4 times higher risk of suffering from osteoporosis.

How to prevent and treat?

Currently, there are no clinical drugs for sarcopenia. The 2014 Consensus on Sarcopenia points out that some clinical drugs such as anabolic hormones, active vitamin D, and growth hormone may benefit muscles. According to the Expert Consensus on Nutritional Support for Elderly Patients in China - Nutritional Support for Sarcopenia, vitamin D should be supplemented daily at 700 to 1000 IU to maintain serum 25(OH)D>50 nmol/L, improve skeletal muscle function, and reduce the risk of fractures in the elderly. Supplementation of calcium and vitamin D is an important measure to prevent and treat skeletal muscle system diseases.

Strengthening nutrition and avoiding a vegan diet, increasing protein and vitamin intake can prevent and alleviate muscle loss.

Keep exercising and take appropriate resistance training to improve muscle strength. The American College of Sports Medicine (ACSM) recommends that to improve muscle strength and endurance, complete 2-3 strength training sessions per week, with at least 8-12 maximum repetitions per set each time. People who start strength training at the age of 50-60 and weak individuals can use a slightly lower load, with a maximum repetition of 10-15 times. It is recommended to go out and exercise, and exercise for at least half an hour a day.

Changes in the intestinal microecology affect skeletal muscle function through multiple pathways, and regulation of the intestinal flora is also a new direction for the treatment of sarcopenia.

Physical therapy such as hydrotherapy, whole body vibration and functional electrical stimulation can help improve muscle recovery.

Author: Department of Orthopedics, Tianjin Third Central Hospital

Guo ShuzhangChief Physician