4. Falls
• 30% of the elderly 65+ years fall at least once a year
• Increased risk to fall again
• 1% of falls hip fracture
• 10% of falls fracture
• Increased mortalityProf. dr. A.B. Maie
14. Beenakker et al., Ageing Res Rev, 2010
meta-regression lines with 95% confidence
band (adjusted to 50% female)
General population
20 40 60 80 100
0
10
20
30
40
50
60
Age (years)
Gripstrength(kg)
Prof. dr. A.B. Maie
25. - Sarcopenia predicts physical, psychological and social outcome, interrelated
with organ systems.
Prof. dr. A.B. Maie
26. Muscle strength and age
General population
20 40 60 80 100
0
10
20
30
40
50
60
Age (years)
Gripstrength(kg)
Beenakker et al., Age Res Rev 2010
?
Prof. dr. A.B. Maie
27. Code
Formula Cut-off point Cohort used as reference population Reference†
Sarcopenia present Men Women
A ALM/height2 > 2 SD below RP 7.26 kg/m2 5.45 kg/m2 Rosetta Study (1986-1992) non-Hispanic
white men and women aged 18-40 years
Baumgartner
1998
B ALM/height2 Under 20th percentile 7.25 kg/m2 5.67 kg/m2 Health ABC Study (1997/1998), 2976 men
and women 70-79 years old black and white,
Pittsburgh, Pennsylvania and Memphis,
Tenessee
Delmonico
2007
C ALM/height2 > 2 SD below RP 6.19 kg/m2 4.73 kg/m2 NHANES survey (1999 - 2004) white men
and women aged 20 years
Kelly 2009
D ALM with height
and fat mass
Under 20th percentile NA NA NA Delmonico
2007
E Skeletal lean
mass/body mass
* 100%
>2 SD below RP is class II
sarcopenia
1-2 SD below RP is class I
sarcopenia
31%
37%
22%
28%
NHANES III (1988-1994), 6414 men and
women aged 18-39 years non-Hispanic
white, non-Hispanic black and
Mexican-American
Janssen 2002
F Skeletal lean
mass/ height2
ROC analysis 8.50
10.75 kg/m2
5.75
6.75 kg/m2
NHANES III (1988-1994), 60 years plus,
non-Hispanic white, black and Mexican-
American
Janssen 2004
G Optimal cutpoint
for grip strength,
walking slower
than 0.8 m/s
Below optimal cutpoint 30.3 kg 19.3 kg InCHIANTI (1998-2000), 1030 subjects aged
20 - 102 years, ,
Lauretani
2003
Used definitions
Bijlsma et al. 2012, Age
Prof. dr. A.B. Maie
29. Code
Formula Cut-off point Cohort used as reference population Reference†
Sarcopenia present Men Women
A ALM/height2 > 2 SD below RP 7.26 kg/m2 5.45 kg/m2 Rosetta Study (1986-1992) non-Hispanic
white men and women aged 18-40 years
Baumgartner
1998
B ALM/height2 Under 20th percentile 7.25 kg/m2 5.67 kg/m2 Health ABC Study (1997/1998), 2976 men
and women 70-79 years old black and white,
Pittsburgh, Pennsylvania and Memphis,
Tenessee
Delmonico
2007
C ALM/height2 > 2 SD below RP 6.19 kg/m2 4.73 kg/m2 NHANES survey (1999 - 2004) white men
and women aged 20 years
Kelly 2009
D ALM with height
and fat mass
Under 20th percentile NA NA NA Delmonico
2007
E Skeletal lean
mass/body mass
* 100%
>2 SD below RP is class II
sarcopenia
1-2 SD below RP is class I
sarcopenia
31%
37%
22%
28%
NHANES III (1988-1994), 6414 men and
women aged 18-39 years non-Hispanic
white, non-Hispanic black and
Mexican-American
Janssen 2002
F Skeletal lean
mass/ height2
ROC analysis 8.50
10.75 kg/m2
5.75
6.75 kg/m2
NHANES III (1988-1994), 60 years plus,
non-Hispanic white, black and Mexican-
American
Janssen 2004
G Optimal cutpoint
for grip strength,
walking slower
than 0.8 m/s
Below optimal cutpoint 30.3 kg 19.3 kg InCHIANTI (1998-2000), 1030 subjects aged
20 - 102 years, ,
Lauretani
2003
Used definitions-no concordance
Bijlsma et al. 2012, Age
Prof. dr. A.B. Maie
31. “Sarcopenia with limited mobility” is defined as a person with
muscle loss whose walking speed is equal to or less than 1
m/s or who walks less than 400 m during a 6-minute walk, and
who has a lean appendicular mass corrected for height
squared of 2 standard deviations or more below the mean of
healthy persons between 20 and 30 years of age of the same
ethnic group.
Morley et al. JAMDA 2011
International consensus
Prof. dr. A.B. Maie
32. • Rockwood: 2 items of cognitive decline or disabilities
in activities of daily living or urinary incontinence
• Fried: 3 items of exhaustion, weight loss, slow gait
speed, low handgrip strength, low physical activity
• low handgrip strength (women <17.5 kg; men <30
kg)
• Gait speed less than 1.0 m/s
Frailty definitions
Prof. dr. A.B. Maie
34. - Sarcopenia predicts physical, psychological and social outcome, interrelated
with other organ systems.
- Sarcopenia has become a syndrome / disease. No clear definition yet.
Prof. dr. A.B. Maie
35. • resistance, endurance,
balance training
• Prevent inactivity!
• Diet, amino acids, vitamins
• Prevent catabolic state!
• Phase II trails (Wnt
signalling, hormons etc)
Sarcopenia interventions
Prof. dr. A.B. Maie
36. 16 weeks
3 x /week
Sipila et al., 1994 Am Physiol Soc
Prof. dr. A.B. Maie
37. Leg press after intervention
Peterson, Age Res Rev 2010
Prof. dr. A.B. Maie
45. old onset
monkeys
young onset
monkeys
Caloric restriction - lifespan
30% decrease ad libitum feeding without malnutrition (mech via oxidative damage,
mitochondrial function)
Mattison et al., Nature 2012Prof. dr. A.B. Maie
46. Caloric restriction - healthspan
30% decrease ad libitum feeding without malnutrition (mech via oxidative damage,
mitochondrial function)
young onset
monkeys
CVD, DM,
cancer
Mattison et al., Nature 2012Prof. dr. A.B. Maie
51. Elimination of
senescent cells
Aging stopped
Biological
young
Biological
old
Baker et al.,Nature, 2011
Target: senescent cells
Prof. dr. A.B. Maie
52. Regeneration capacity muscle / heart
pre + + + - - -
post + + + + - -
Influence of factor x en y in blood
Loffredo et al., Cell 2013, Conboy et al., Nature 2007Prof. dr. A.B. Maie
53. - Sarcopenia predicts physical, psychological and social outcome, interrelated
with other organ systems.
- Sarcopenia has become a disease. No clear definition yet.
-Prevent decline of muscle mass in early stages and increase muscle mass
by targeted intervention. Drug therapy will be available next years.Prof. dr. A.B. Maie