Transforming the definition and diagnosis of sarcopenia

Sarcopenia is a condition where muscle strength and size fall below critical thresholds as a person ages.

This can lead to a range of major adverse health outcomes including impaired mobility, falls, prolonged hospital stay and loss of independence.

Identifying the problem

Diagnosing sarcopenia is an essential first step in offering prevention or treatment but variable definitions and measurement techniques have held back progress. Our national survey of sarcopenia diagnosis showed that only 9% of hospital services for older people routinely measure and diagnose sarcopenia [1]. Measuring muscle size and differences in diagnostic criteria were cited as key barriers. We have used epidemiological insights to develop new, practical definitions of sarcopenia and embed diagnosis in clinical practice as described below.

New approaches to definition and diagnosis

We created the first set of life course normal values for hand grip strength by combining data from nearly 50,000 men and women taking part in 12 British general population studies aged 4-90 years [2]. We used these data to propose cut-points for weak grip strength, similar to the approach used to diagnose osteoporosis. These cut-points have been adopted by the European Working Group on Sarcopenia in Older People in their revised diagnostic criteria – the most commonly used approach to defining and diagnosing sarcopenia worldwide [3]. Our normal values have influenced policy, informing the World Health Organisation’s Baseline Report for the Decade of Healthy Ageing 2021−2030 and UK work on trajectories and patterns of strength from the NIHR Policy Research Unit on Older People and Frailty.

Changing practice in the clinic

We have introduced the diagnosis of sarcopenia into routine clinical practice through embedding hand grip strength measurement and the revised sarcopenia diagnostic criteria into local geriatric medicine, orthopaedic hip fracture, vascular surgery and lung cancer services. This has been standardised through our pioneering new electronic health record – SarcScreen. Our findings have also provided guidance (the Newcastle protocol) on how to assess and interpret the time to rise from a chair five times as a simple measure of lower limb muscle strength.
These advances have simplified and clarified the diagnosis of sarcopenia and provided a pathway to widespread diagnosis and appropriate treatment in national and international clinical practice.

Linked Publications
[1] Offord NJ et al. J Frailty Sarcopenia Falls 2019;4:71-77
[2] Dodds RM et al. PLoS One 2014;9:e113637.
[3] Cruz-Jentoft AJ et al. Age Ageing 2019;48:16-31.