SARCOPENIA – CURRENT KNOWLEDGE AND CLINICAL CHALLENGES

Mateusz Kacalak; Zofia Nowakowska; Julia Szklarska-Komenda; Maciej Komenda; Wiktoria Dybizbańska; Aleksandra Marek; Agnieszka Burzej; Krzysztof Jamroch; Karolina Dziki; Katarzyna Garncarz

doi:10.31435/ijitss.1(49).2026.4557

Authors

Mateusz Kacalak The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology in Łódź, Łódź, Poland https://orcid.org/0009-0006-3386-0906
Zofia Nowakowska Upper Silesian Medical Center of the Medical University of Silesia in Katowice, Katowice, Poland https://orcid.org/0009-0000-8030-7341
Julia Szklarska-Komenda 105th Military Hospital SP ZOZ in Żary, Żary, Poland https://orcid.org/0009-0000-9914-4917
Maciej Komenda 105th Military Hospital SP ZOZ in Żary, Żary, Poland https://orcid.org/0009-0009-7327-417X
Wiktoria Dybizbańska Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Kraków, Kraków, Poland https://orcid.org/0009-0000-9899-7272
Aleksandra Marek Central Teaching Hospital of the Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0002-3391-5082
Agnieszka Burzej 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0003-0066-3197
Krzysztof Jamroch 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0003-2562-1276
Karolina Dziki 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0005-1720-3810
Katarzyna Garncarz 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0001-7554-2715

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4557

Keywords:

Sarcopenia, Aging, Muscle Loss, Geriatrics, Prevention, Diagnosis, Physical Activity

Abstract

Introduction: Sarcopenia, defined as the progressive loss of muscle mass and strength, is one of the primary threats to the functional independence of older adults. With global population aging and an increasing burden of chronic diseases, the clinical relevance of this condition continues to grow. Despite rising awareness, sarcopenia remains underdiagnosed and undertreated, leading to a decline in quality of life, a higher risk of falls, hospitalizations, complications, and increased mortality.

Aim of the Study: The aim of this study is to provide a comprehensive review of current knowledge on sarcopenia, including its definition, pathophysiology, epidemiology, risk factors, diagnostic criteria, and therapeutic and preventive strategies.

Methodology: A literature search was conducted using PubMed, Google Scholar, and ScienceDirect for publications from 2005 to 2025. The review included peer-reviewed studies, clinical trials, systematic reviews, and international guidelines (EWGSOP2, ICFSR, GLIS) related to the definition, diagnosis, and management of sarcopenia. Only peer-reviewed articles published in English were included, while non-peer-reviewed materials, conference abstracts, and case reports without broader applicability were excluded.

Conclusions: Sarcopenia is a complex and increasingly prevalent condition that requires early diagnosis and a comprehensive, multidisciplinary approach. Effective management relies primarily on resistance training, adequate protein intake, and correction of nutritional deficiencies, while pharmacological options remain limited. Particular attention should be directed to secondary sarcopenia, and routine screening in at-risk populations is essential to reduce functional decline and adverse health outcomes.

References

Yuan, S., & Larsson, S. C. (2023). Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism, 144, 155533. https://doi.org/10.1016/j.metabol.2023.155533

Cruz-Jentoft, A. J., Bahat, G., Bauer, J., et al. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16–31. https://doi.org/10.1093/ageing/afy169

Dent, E., Morley, J. E., Bauer, J. M., et al. (2018). International clinical practice guidelines for sarcopenia (ICFSR): Screening, diagnosis, and management. The Journal of Nutrition, Health and Aging, 22(10), 1148–1161. https://doi.org/10.1007/s12603-018-1139-9

Kirk, B., Cawthon, P. M., Arai, H., et al. (2024). The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS). Age and Ageing, 53(3). https://doi.org/10.1093/ageing/afae052

Morawin, B., Tylutka, A., Bielewicz, F., & Zembron-Lacny, A. (2023). Diagnostics of inflammaging in relation to sarcopenia. Frontiers in Public Health, 11, 1162385. https://doi.org/10.3389/fpubh.2023.1162385

Anker, S. D., Morley, J. E., & von Haehling, S. (2016). Welcome to the ICD-10 code for sarcopenia. Journal of Cachexia, Sarcopenia and Muscle, 7(4), 512–514. https://doi.org/10.1002/jcsm.12147

Sanchez-Tocino, M. L., Cigarran, S., Urena, P., et al. (2024). Definition and evolution of the concept of sarcopenia. Nefrologia (English Edition), 44(3), 323–330. https://doi.org/10.1016/j.nefroe.2023.08.007

Coletta, G., & Phillips, S. M. (2023). An elusive consensus definition of sarcopenia impedes research and clinical treatment: A narrative review. Ageing Research Reviews, 86, 101883. https://doi.org/10.1016/j.arr.2023.101883

Beaudart, C., Alcazar, J., Aprahamian, I., et al. (2025). Health outcomes of sarcopenia: A consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS). Aging Clinical and Experimental Research, 37(1), 100. https://doi.org/10.1007/s40520-025-02995-9

Sayer, A. A., & Cruz-Jentoft, A. J. (2022). Sarcopenia definition, diagnosis and treatment: Consensus is growing. Age and Ageing, 51(10), afac220. https://doi.org/10.1093/ageing/afac220

Chen, R., Xu, J., Wang, Y., et al. (2023). Prevalence of sarcopenia and its association with clinical outcomes in heart failure: An updated meta-analysis and systematic review. Clinical Cardiology, 46(3), 260–268. https://doi.org/10.1002/clc.23970

de Sire, A., Calafiore, D., Curci, C., et al. (2024). Osteosarcopenia and risk of falls: A concise review. International Journal of Bone Fragility, 4(2), 63–66. https://doi.org/10.57582/IJBF.240402.063

Wen, Q., Chen, X., Luo, S., et al. (2024). Association between sarcopenia grade and fall history among older adults in West China: A retrospective study. BMJ Open, 14(2), e080426. https://doi.org/10.1136/bmjopen-2023-080426

Liu, P., Hao, Q., Hai, S., et al. (2017). Sarcopenia as a predictor of all-cause mortality among community-dwelling older people: A systematic review and meta-analysis. Maturitas, 103, 16–22. https://doi.org/10.1016/j.maturitas.2017.04.007

Cho, M. R., Lee, S., & Song, S. K. (2022). A review of sarcopenia: Pathophysiology, diagnosis, treatment and future direction. Journal of Korean Medical Science, 37(18), e146. https://doi.org/10.3346/jkms.2022.37.e146

Shafiee, G., Keshtkar, A., Soltani, A., et al. (2017). Prevalence of sarcopenia in the world: A systematic review and meta-analysis of general population studies. Journal of Diabetes & Metabolic Disorders, 16, 21. https://doi.org/10.1186/s40200-017-0302-x

Walston, J. D. (2012). Sarcopenia in older adults. Current Opinion in Rheumatology, 24(6), 623–627. https://doi.org/10.1097/BOR.0b013e328358d59b

García-Prat, L., Sousa-Victor, P., & Muñoz-Cánoves, P. (2013). Functional dysregulation of stem cells during aging: A focus on skeletal muscle stem cells. The FEBS Journal, 280(17), 4051–4062. https://doi.org/10.1111/febs.12221

Li, Y. P., Chen, Y., John, J., et al. (2005). TNF-α acts via p38 MAPK to stimulate expression of the ubiquitin ligase atrogin-1/MAFbx in skeletal muscle. The FASEB Journal, 19(3), 362–370. https://doi.org/10.1096/fj.04-2364com

Sandri, M. (2008). Signaling in muscle atrophy and hypertrophy. Physiology, 23, 160–170. https://doi.org/10.1152/physiol.00041.2007

Glass, D. J. (2003). Signaling pathways that mediate skeletal muscle hypertrophy and atrophy. Nature Cell Biology, 5(2), 87–90. https://doi.org/10.1038/ncb0203-87

Zamboni, M., Mazzali, G., Fantin, F., et al. (2008). Sarcopenic obesity: A new category of obesity in the elderly. Nutrition, Metabolism and Cardiovascular Diseases, 18(5), 388–395. https://doi.org/10.1016/j.numecd.2007.10.002

Joseph, A. M., Adhihetty, P. J., Buford, T. W., et al. (2012). The impact of aging on mitochondrial function and biogenesis pathways in skeletal muscle of sedentary high- and low-functioning elderly individuals. Aging Cell, 11(5), 801–809. https://doi.org/10.1111/j.1474-9726.2012.00844.x

Ceglia, L. (2008). Vitamin D and skeletal muscle tissue and function. Molecular Aspects of Medicine, 29(6), 407–414. https://doi.org/10.1016/j.mam.2008.07.002

Mitchell, W. K., Williams, J., Atherton, P., et al. (2012). Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength: A quantitative review. Frontiers in Physiology, 3, 260. https://doi.org/10.3389/fphys.2012.00260

Ferrucci, L., & Fabbri, E. (2018). Inflammageing: Chronic inflammation in ageing, cardiovascular disease, and frailty. Nature Reviews Cardiology, 15(9), 505–522. https://doi.org/10.1038/s41569-018-0064-2

Greising, S. M., Baltgalvis, K. A., Lowe, D. A., & Warren, G. L. (2009). Hormone therapy and skeletal muscle strength: A meta-analysis. The Journals of Gerontology Series A, 64(10), 1071–1081. https://doi.org/10.1093/gerona/glp082

Morley, J. E., Perry, H. M., Kaiser, F. E., et al. (1993). Effects of testosterone replacement therapy in old hypogonadal males: A preliminary study. Journal of the American Geriatrics Society, 41(2), 149–152. https://doi.org/10.1111/j.1532-5415.1993.tb02049.x

Welch, A. A. (2014). Nutritional influences on age-related skeletal muscle loss. Proceedings of the Nutrition Society, 73(1), 16–33. https://doi.org/10.1017/S0029665113003698

Kortebein, P., Ferrando, A., Lombeida, J., et al. (2007). Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA, 297(16), 1769–1774. https://doi.org/10.1001/jama.297.16.1772-b

Wilkinson, D. J., Piasecki, M., & Atherton, P. J. (2018). The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Research Reviews, 47, 123–132. https://doi.org/10.1016/j.arr.2018.07.005

Benz, E., Trajanoska, K., Lahousse, L., et al. (2019). Sarcopenia in COPD: A systematic review and meta-analysis. European Respiratory Review, 28(154), 190049. https://doi.org/10.1183/16000617.0049-2019

Thoma, A., & Lightfoot, A. P. (2018). NF-κB and inflammatory cytokine signalling: Role in skeletal muscle atrophy. In Muscle Atrophy (pp. 267–279). https://doi.org/10.1007/978-981-13-1435-3_12

Buckinx, F., Landi, F., Cesari, M., et al. (2018). Pitfalls in the measurement of muscle mass: A need for a reference standard. Journal of Cachexia, Sarcopenia and Muscle, 9(2), 269–278. https://doi.org/10.1002/jcsm.12268

Kim, T. N., & Choi, K. M. (2014). The implications of sarcopenia and sarcopenic obesity on cardiometabolic disease. Journal of Cellular Biochemistry, 116(7), 1171–1178. https://doi.org/10.1002/jcb.25077

Malmstrom, T. K., & Morley, J. E. (2013). SARC-F: A simple questionnaire to rapidly diagnose sarcopenia. Journal of the American Medical Directors Association, 14(8), 531–532. https://doi.org/10.1016/j.jamda.2013.05.018

Barbosa-Silva, T. G., Menezes, A. M. B., Bielemann, R. M., et al. (2016). Enhancing SARC-F: Improving its performance for screening sarcopenia. Journal of the American Medical Directors Association, 17(12), 1136–1141. https://doi.org/10.1016/j.jamda.2016.08.004

Carmeli, E. (2020). Sarcopenia in older adults. In Background and management of muscular atrophy (pp. 273–288). https://doi.org/10.5772/intechopen.93418

Liao, C. D., Tsauo, J. Y., Wu, Y. T., et al. (2017). Effects of resistance exercise combined with protein supplementation on body composition and physical function in older adults: A systematic review and meta-analysis. The American Journal of Clinical Nutrition, 106(4), 1078–1091. https://doi.org/10.3945/ajcn.116.143594

Fragala, M. S., Cadore, E. L., Dorgo, S., et al. (2019). Resistance training for older adults: Position statement from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 33(8), 2019–2052. https://doi.org/10.1519/JSC.0000000000003230

Sherrington, C., Michaleff, Z. A., Fairhall, N., et al. (2017). Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine, 51(24), 1750–1758. https://doi.org/10.1136/bjsports-2016-096547

Bauer, J., Biolo, G., Cederholm, T., et al. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association, 14(8), 542–559. https://doi.org/10.1016/j.jamda.2013.05.021

Deutz, N. E., Bauer, J. M., Barazzoni, R., et al. (2014). Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clinical Nutrition, 33(6), 929–936. https://doi.org/10.1016/j.clnu.2014.04.007

Gielen, E., O’Neill, T. W., Pye, S. R., et al. (2015). Endocrine determinants of incident sarcopenia in middle-aged and elderly European men. Journal of Cachexia, Sarcopenia and Muscle, 6(3), 242–252. https://doi.org/10.1002/jcsm.12030

Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., et al. (2010). Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: A randomized, double-blind, placebo-controlled study. The Journal of Clinical Endocrinology & Metabolism, 95(2), 639–650. https://doi.org/10.1210/jc.2009-1251

Khoo, T. K. (2010). Adverse events associated with testosterone administration. The New England Journal of Medicine, 363(19), 1865–1867. https://doi.org/10.1056/NEJMc1009326

Dalton, J. T., Barnette, K. G., Bohl, C. E., et al. (2011). The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: Results of a double-blind, placebo-controlled phase II trial. Journal of Cachexia, Sarcopenia and Muscle, 2(3), 153–161. https://doi.org/10.1007/s13539-011-0034-6

Rooks, D., Swan, T., Goswami, B., et al. (2020). Bimagrumab vs optimized standard of care for treatment of sarcopenia in older adults: A randomized clinical trial. JAMA Network Open, 3(10), e2020836. https://doi.org/10.1001/jamanetworkopen.2020.20836

Stockton, K. A., Mengersen, K., Paratz, J. D., Kandiah, D., & Bennell, K. L. (2011). Effect of vitamin D supplementation on muscle strength: A systematic review and meta-analysis. Osteoporosis International, 22(3), 859–871. https://doi.org/10.1007/s00198-010-1407-y

Candow, D. G., & Chilibeck, P. D. (2008). Timing of creatine or protein supplementation and resistance training in the elderly. Applied Physiology, Nutrition, and Metabolism, 33(1), 184–190. https://doi.org/10.1139/H07-139

Onder, G., Penninx, B. W. J. H., Balkrishnan, R., Fried, L. P., Chaves, P. H. M., Williamson, J. D., et al. (2002). Relation between use of angiotensin-converting enzyme inhibitors and muscle strength and physical function in older women: An observational study. The Lancet, 359(9310), 926–930. https://doi.org/10.1016/S0140-6736(02)08024-8

Peterson, M. D., Rhea, M. R., Sen, A., & Gordon, P. M. (2010). Resistance exercise for muscular strength in older adults: A meta-analysis. Ageing Research Reviews, 9(3), 226–237. https://doi.org/10.1016/j.arr.2010.03.004

Liu, C. J., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, (3), CD002759. https://doi.org/10.1002/14651858.CD002759.pub2

Steffl, M., Bohannon, R. W., Sontakova, L., et al. (2017). Relationship between sarcopenia and physical activity in older people: A systematic review and meta-analysis. Clinical Interventions in Aging, 12, 835–845. https://doi.org/10.2147/CIA.S132940

Bischoff-Ferrari, H. A., Dawson-Hughes, B., Staehelin, H. B., et al. (2009). Fall prevention with supplemental and active forms of vitamin D: A meta-analysis of randomized controlled trials. BMJ, 339, b3692. https://doi.org/10.1136/bmj.b3692

Landi, F., Calvani, R., Tosato, M., et al. (2015). Sarcopenia as the biological substrate of physical frailty. Clinics in Geriatric Medicine, 31(3), 367–374. https://doi.org/10.1016/j.cger.2015.04.005

Woo, J., Leung, J., & Morley, J. E. (2014). Validating the SARC-F: A suitable community screening tool for sarcopenia? Journal of the American Medical Directors Association, 15(9), 630–634. https://doi.org/10.1016/j.jamda.2014.04.021

Tieland, M., Trouwborst, I., & Clark, B. C. (2018). Skeletal muscle performance and ageing. Journal of Cachexia, Sarcopenia and Muscle, 9(1), 3–19. https://doi.org/10.1002/jcsm.12238

Baracos, V. E., Martin, L., Korc, M., Guttridge, D. C., & Fearon, K. C. H. (2018). Cancer-associated cachexia. Nature Reviews Disease Primers, 4, 17105. https://doi.org/10.1038/nrdp.2017.105

Shachar, S. S., Williams, G. R., Muss, H. B., & Nishijima, T. F. (2016). Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. European Journal of Cancer, 57, 58–67. https://doi.org/10.1016/j.ejca.2015.12.030

Collimate, A., Marzetti, E., Calvani, R., et al. (2016). Sarcopenia in heart failure: Mechanisms and therapeutic strategies. Journal of Geriatric Cardiology, 13(7), 615–624. https://doi.org/10.11909/j.issn.1671-5411.2016.07.004

Fülster, S., Tacke, M., Sandek, A., et al. (2013). Muscle wasting in patients with chronic heart failure: Results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). European Heart Journal, 34(7), 512–519. https://doi.org/10.1093/eurheartj/ehs381

Bernard, S., LeBlanc, P., Whittom, F., et al. (1998). Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 158(2), 629–634. https://doi.org/10.1164/ajrccm.158.2.9711023

Isoyama, N., Qureshi, A. R., Avesani, C. M., et al. (2014). Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clinical Journal of the American Society of Nephrology, 9(10), 1720–1728. https://doi.org/10.2215/CJN.10261013

Cai, Y., Feng, F., Wei, Q., et al. (2021). Sarcopenia in patients with Parkinson's disease: A systematic review and meta-analysis. Frontiers in Neurology, 12, 598035. https://doi.org/10.3389/fneur.2021.598035