Sarcopenia: The Age-Related Muscle Loss You Shouldn’t Ignore

Understand how sarcopenia affects your strength, mobility, and independence and what you can do about it.

Losing muscle as we age may seem like a natural part of life and to some extent, it is. But when that decline becomes more than just “getting older,” it can have a profound impact on mobility, independence, and quality of life. This condition is known as sarcopenia, and while it's common, it's also often underdiagnosed, misunderstood, and undertreated. Most importantly, although muscle is viewed as a mobility organ, it serves important roles in overall body metabolism, So losing it, also affects the body metabolism.

By the time we reach our 60s and 70s, sarcopenia can silently progress to the point where daily tasks like climbing stairs, lifting groceries, or even rising from a chair become difficult. The good news? Sarcopenia can be recognised early, managed effectively, and in many cases, even reversed.

What Is Sarcopenia?

Sarcopenia is defined as the progressive loss of skeletal muscle mass, strength, and function related to ageing¹. Unlike short-term muscle fatigue or weakness due to illness or injury, sarcopenia is chronic and systemic. It doesn’t just shrink muscle size, it weakens the very structures responsible for balance, endurance, and postural control.

By age 70, up to 30% of muscle mass may be lost if left unaddressed². The consequences go far beyond weakness. Sarcopenia is strongly linked to:

Increased risk of falls and fractures

Longer hospital stays after surgery

Reduced metabolic health and insulin sensitivity, and hence diabetes & prediabetes and thus cardiovascular diseases.

Higher all-cause mortality in older adults

What Causes Sarcopenia?

While ageing is the key driver, several compounding factors can accelerate muscle loss:

Inactivity or a sedentary lifestyle

Low protein intake or poor nutrition

Chronic inflammation from diseases like diabetes or arthritis

Hormonal changes, particularly reduced testosterone/estrogen and growth hormone

Acute illness or surgery, especially with prolonged bed rest

Neurological conditions such as stroke or Parkinson’s disease

Osteoarthritis or Rheumatoid Arthritis

Osteoporosis

Fractures

Pre & Post Joint Replacements (TKR, THR)

Fractures and Post-traumatic recovery

Orthopaedic Surgeries

Spine Surgeries

Sarcopenia

Diabetes

Fatty liver diseases

Thyroid disorders

Neurologic conditions

Hypertension

Obesity

PCOS

Menopause

Cardiovascular diseases

It's also more likely to affect people with:

Early Warning Signs to Watch For

Sarcopenia can begin subtly. Be alert to signs like:

Trouble rising from a chair without using your arms

Slower walking pace or shortened stride

Difficulty walking up steps or stairs

Frequent tripping, imbalance, or fear of falling

Unexplained weight loss, especially in the limbs

Weak grip strength or difficulty opening jars

These signs often appear before visible changes in muscle mass. That’s why screening is essential particularly for adults over 60, postmenopausal women, or individuals recovering from surgeries.

How Is Sarcopenia Diagnosed?

While advanced imaging tools like MRI can precisely measure muscle volume, several simple and validated tests are commonly used in clinical or outpatient settings to assess sarcopenia risk.

SARC-F Questionnaire

This 5-item self-reported screening tool is widely used and includes:

Strength – Difficulty lifting/carrying 10 lbs (approx. 4.5 kg)
Assistance with walking
Rising from a chair
Climbing stairs
Falls in the past year

Scores ≥4 suggest a risk of sarcopenia and warrant further clinical assessment³.

Grip Strength Test Using a Dynamometer

Grip strength is a strong predictor of overall muscle function. In this test, the patient squeezes a handheld device called a dynamometer, which measures force in kilograms.

Low grip strength (e.g., <27 kg for men and <16 kg for women) is one of the earliest signs of muscle decline.

It reflects both upper body strength and general frailty risk.

Gait Speed Measurement

This assesses how fast a person walks over a short distance, typically 4 metres.

A gait speed below 0.8 metres per second is associated with a higher risk of falls, disability, and hospitalisation.

It’s a practical, non-invasive marker of functional decline and can be done in clinics or at home under supervision.

Muscle Mass Index from DEXA or BIA

These tests evaluate body composition, specifically, the amount of lean muscle mass:

DEXA scan (Dual-energy X-ray Absorptiometry): A precise imaging test that measures bone density and muscle mass.

BIA (Bioelectrical Impedance Analysis): A portable device that estimates muscle mass using electrical current flow.

A low appendicular skeletal muscle mass index (adjusted for height) is a diagnostic criterion for sarcopenia in most clinical guidelines.

How to Manage and Reverse Sarcopenia?

The key to managing sarcopenia lies in early intervention, and the approach must be multimodal, combining physical activity, nutrition, and clinical monitoring.

1. Resistance Training

Progressive resistance exercise is the gold standard. It stimulates muscle protein synthesis and improves neuromuscular activation. Effective programmes typically include:

2–3 sessions per week

Exercises using body weight, resistance bands, or light weights

Focus on large muscle groups: thighs, back, arms

Even frail older adults have shown significant strength gains after just 8–12 weeks of structured strength training⁴.

2. Protein-Rich Nutrition

Older adults often under consume protein. Experts recommend:

0.8–1.2 g/kg/day of high-quality protein

Distribute protein intake evenly across meals

Include leucine-rich sources like eggs, dairy, lentils, and tofu

Specific supplements that support muscle regeneration and prevents muscle breakdown

3. Supplementary Interventions

Under medical guidance, supplementation may help:

Vitamin D for muscle metabolism

Creatine to enhance the resistance training response

Omega-3 fatty acids to counter inflammation

Supplements with HMB, Carnosine, Astaxanthin, Magnesium helps muscle relax and improve energy

4. Address Underlying Conditions

If sarcopenia is secondary to surgery, arthritis, or malnutrition, managing the root cause is essential. Post-orthopaedic rehab, physiotherapy, and tailored dietary plans can help patients regain lost muscle.

Why Sarcopenia Shouldn’t Be Ignored?

Unlike bone loss, which is routinely screened for, muscle loss often goes unnoticed — until a fall or fracture occurs. In reality, sarcopenia and osteoporosis often co-exist, forming a vicious cycle that increases fragility and dependence.

Recognising the signs early and starting a focused plan of action can delay or reverse muscle decline. It’s never too late or too early to care for your muscles.

References

Frequently Asked Questions (FAQ)

1. At what age should I start thinking about sarcopenia?

Sarcopenia can begin as early as 40, but most noticeable changes occur after 60. It’s wise to build strength early and screen regularly after age 50 especially if you’re sedentary, recovering from surgery, or managing chronic illnesses.

2. Can sarcopenia be reversed?

Yes, especially in its early stages. With regular resistance training, protein-rich meals, and lifestyle changes, older adults can rebuild lost muscle. Even those with joint issues or frailty can benefit from tailored physiotherapy plans.

3. How is sarcopenia different from regular ageing?

While some muscle decline is expected with age, sarcopenia involves accelerated, abnormal loss that interferes with everyday activities. It is considered a muscle disease by the WHO and requires active intervention.

4. Does sarcopenia affect only older adults?

Primarily, but not exclusively. People recovering from surgery, those with chronic illnesses, or malnourished individuals regardless of age can experience sarcopenia-like muscle loss if preventive measures are not taken.

5. What exercises are safest to start with?

Begin with bodyweight exercises like chair squats, wall push-ups, and resistance band training. A physiotherapist can help design a plan suited to your age, strength level, and mobility status.