Sarcopenia 101: What You Need to Know About Muscle Loss

Dr. James - Orthopaedic Surgeon in Singapore

Medically reviewed by Dr. James Tan

As we go through our lives, our bodies experience countless changes. Some of these changes are obvious while others can fly under the radar. One of the most noteworthy changes that our bodies undergo is the gradual loss of muscle mass and strength. This age-related loss of muscle mass is a condition called sarcopenia.

Sarcopenia is a common issue that can have a serious impact on your overall health and quality of life. To stay healthy and happy as you age, knowing the common causes, effects, and most importantly, what you can do to prevent and manage sarcopenia is essential.

Sarcopenia can affect your mobility, independence, and even your likelihood of dealing with other illnesses. That is why it is so crucial to take charge of your muscle health. Ready to get on the path to effective pain management and relief? Let’s dive into the fundamentals of this often-overlooked yet common aspect of ageing.

What Is Sarcopenia?

Sarcopenia is the gradual loss of muscle mass, strength, and function. It is a problem that usually affects older adults. It is such a common issue that healthcare professionals consider it a typical part of the ageing process. However, as common as it may be, sarcopenia can greatly lower your quality of life. Because it seriously affects your ability to do normal daily tasks, it can affect your ability to live and operate independently. Indeed, this is one of the key health issues that can create a need for long-term care.

Sarcopenia impacts your musculoskeletal system and is a major factor in increased frailty, falls, and fractures. This issue can leave you in the hospital and even require surgery, which puts you at risk of complications that can cause permanent or even fatal issues.

On top of being an often-seen condition in older adults, sarcopenia can also affect people with a high BMI in a condition called sarcopenic obesity. Older adults who are obese have a particularly high risk of developing this condition.

What Causes Sarcopenia?

Sarcopenia has a range of potential causes. To help you reduce muscle loss are you age, there are a few key causes that you should keep in mind:

  • Ageing: As we get older, muscle fibres shrink and die off faster than they can be replaced. This leads to widespread muscle loss over time. Age-related hormone changes like declining testosterone and growth hormone levels also contribute.
  • Inactivity: When muscles aren’t used routinely with exercise and activity, they begin to atrophy and get smaller. If you have a sedentary lifestyle, you increase your odds of developing sarcopenia.
  • Poor nutrition: Not getting enough protein, calories, and nutrients (especially vitamin D and antioxidants) makes it harder for your body to maintain and grow muscle. Having a poor diet speeds up muscle wasting.
  • Illnesses: Certain diseases and medical conditions can lead to sarcopenia. These include cancer, heart disease, diabetes, kidney disease, lung disease, and rheumatoid arthritis. If you have any of these conditions, it is important to talk to your doctor about preventing muscle loss.
  • Inflammation: Higher levels of inflammatory markers in the body are associated with sarcopenia. This sort of inflammation can be caused by smoking, obesity, autoimmune diseases, cardiovascular disease, diabetes, and a range of other issues that can lead to muscle loss.
  • Nerve and motor unit changes: The loss and dysfunction of motor units, which stimulate muscle movement, affect muscle coordination and contraction. This loss is a normal part of ageing but can be slowed down by staying mentally and physically active as well as leading a generally healthy lifestyle.
  • Mitochondrial dysfunction: Declining mitochondria (the energy source for your cells) reduces muscle cell health and function over time. Maintaining a healthy diet and lifestyle can also slow down this ageing side effect.

What Are the Symptoms of Sarcopenia?

Muscle weakness is a telltale sarcopenia symptom. While a lack of strength is not something that you would typically notice all at once, you will become more aware of it over time. If you are physically active, not only will it prevent muscle loss, but it will make it easier for you to notice your loss of strength. Keep reading for a complete list of common warning signs.

How Do I Know If I Have Sarcopenia?

To stay aware of your health and be proactive in managing sarcopenia, here are a few common warning signs to look out for:

  • Loss of endurance
  • Difficulty with everyday tasks
  • Slow walking
  • Trouble climbing stairs
  • Poor balance and falls
  • Decreased muscle size

Who Is At Risk for Sarcopenia?

Sarcopenia most often affects people who are age 60 and older. The rates go up with age so it is fair to say that your odds of getting it increase by the year. Statistically, it is an ailment that affects both genders equally. While genetic risk has been researched, studies on impacted ethnicities and other key risk factors have had inconsistent results.

Generally speaking, when it comes to risk factors, the main things that we know are that risk factors increase with each year of life, and the rates increase in those with chronic illness as well as those with an unhealthy lifestyle.

What Are Sarcopenia Risk Factors?

The main cause of sarcopenia is normal ageing. You start gradually losing muscle in your 30s or 40s. This accelerates between 65 and 80. Rates vary, but you can lose up to 8% of muscle per decade. Everyone loses muscle over time, but it’s faster with sarcopenia.

While ageing is the key factor, common other sarcopenia risk factors include the following:

  • Lack of physical activity
  • Obesity
  • Chronic diseases like COPD, kidney disease, diabetes, cancer, and HIV
  • Rheumatoid arthritis
  • Insulin resistance
  • Low hormone levels
  • Poor nutrition or insufficient protein
  • Decreased ability to convert protein to energy
  • Fewer nerve cells signalling muscles to move
  • Sedentary lifestyle
  • Poor nutrition
  • Hormonal changes

Is Sarcopenia Common?

Since we know that many people are undiagnosed and untreated, it is impossible to say exactly how many cases of sarcopenia there are around the planet. As an educated guess, most experts agree that the number of cases ranges somewhere from 5% to 13% of people over the age of 60. If we are talking about people over the age of 80, healthcare professionals believe that anywhere from 11% to 50% of people are affected by it.

Is Sarcopenia a Disease?

Sarcopenia is not classified as a disease in Singapore or most other countries. Instead, it is seen as an age-related condition that is defined by the loss of muscle and weakness in muscles.

It is worth noting that disease classifications can differ between countries. In Singapore, as in many places, sarcopenia is a health issue that is common and widely treated, but not officially categorised as a disease.

What Is the Difference Between Sarcopenia and Muscular Atrophy?

Sarcopenia is age-related muscle wasting (muscle atrophy). Sarcopenia and muscular atrophy both involve muscle loss but the way that this happens is different in each case. With sarcopenia, you have fewer muscle fibres. If you are dealing with muscular atrophy, your muscle tissues have smaller fibres but the same number. In other words, you don’t lose muscle fibres with muscle atrophy in the way that you do with sarcopenia.

What Is the Difference Between Sarcopenia and Osteoporosis?

Sarcopenia and osteoporosis are two common age-related conditions that affect different parts of the body but have some similarities.

As you now know, sarcopenia is the gradual loss of muscle mass and strength that happens as we age. It is caused by factors like lack of exercise and decreased hormone levels. Sarcopenia causes weaker muscles, reduced mobility, a higher risk of falls and fractures, and greater overall frailty. While its impacts are most noticeable later in life, sarcopenia can start as early as age 30.

On the other hand, osteoporosis involves a progressive weakening of your bones and causes an increased risk of fracture. Osteoporosis is often worsened by hormone changes as well as calcium and vitamin D deficiencies. When you have osteoporosis, your bones become less dense and more porous, which makes them fragile. This can lead to broken bones, especially in your hips, spine, and wrist. While it’s a more common issue for older women because of the hormonal changes that come with menopause, it can occur in men and younger adults. Lifestyle changes like proper nutrition and exercise can help, along with bone-strengthening medications in more serious cases. Check out these 10 daily exercises to improve your lifestyle.

Though sarcopenia and osteoporosis affect different parts of your body, they both involve loss of function and are linked to ageing. They share risk factors like lack of exercise, poor nutrition, and hormonal influences. Maintaining your strength, staying active, eating a nutrient-rich diet, and monitoring your hormone levels help to prevent both conditions.

How Is Sarcopenia Diagnosed?

If you think that you may have sarcopenia, it is essential to book a doctor’s appointment. Your healthcare professional can diagnose sarcopenia with an exam and information on your medical background.

A questionnaire called SARC-F is a common method for quickly and accurately detecting sarcopenia. This questionnaire covers the following:

  • S – Strength
  • A – Assistance walking 
  • R – Rising from a chair
  • C – Climbing stairs
  • F – Falls

This test for sarcopenia will help your doctor understand how you’re dealing with everyday activities to get a sense of your strength level.

What Tests Diagnose Sarcopenia?

While the SARC-F questionnaire works well in some cases, there are a range of other sarcopenia tests, such as the following:

  • Muscle strength tests
  • Handgrip test: Handgrip strength reflects overall muscle strength.
  • Chair-stand test: Measures leg muscle strength, especially quadriceps. The test looks to see if you can stand from a chair in 30 seconds without using your arms.
  • Walking speed test: Times walking four metres at normal speed.
  • Short Physical Performance Battery (SPPB): Times chair stand, balance, and walking speed.
  • Timed up and go test (TUG): Times getting up from a chair, walking three metres away and back, and sitting back down.

Your doctor will choose the right type of exam based on your medical history.

Testing for Sarcopenia: Imaging for Muscle Mass

In addition to physical exams and questionnaires, your doctor may want to take a closer look at your muscle mass by using image scans such as MRIs and CT scans. The following are some of the imaging techniques used:

  • Dual-Energy X-ray Absorptiometry (DXA): These are commonly used to check bone density, but they can also offer your doctor insights into your muscle mass
  • Computed Tomography (CT) Scan: This option gives detailed cross-sectional images of your body. This will for precise measurements of muscle mass in specific regions.
  • Magnetic Resonance Imaging (MRI): This scan can see the volume of muscles, similar to CT scans, and gives measurements of your muscle mass.
  • Ultrasound Imaging: This measures muscle thickness and can look at a cross-sectional area.
  • Bioelectrical Impedance Analysis (BIA): Opting for this exam type will allow your doctor to estimate muscle mass based on the electrical conductivity of different body tissues.
  • 3D Body Scanners: Your doctor can create a 3D model of your body, which is useful in estimating muscle mass and tracking changes over time.

The right type of imaging scan for you will depend on a wide range of factors that your doctor will determine based on your current health and medical history.

Sarcopenia Treatment: How is Sarcopenia Treated?

Treating sarcopenia successfully is often based on making key lifestyle changes. At the core of the treatment are exercise and a healthy diet. When it comes to physical activity, progressive resistance strength training such as deadlifts and squats are some of the effective ways to boost your strength and reverse muscle loss. Along with a consistent exercise routine, maintaining a healthy diet is key. In particular, it is important to get enough protein from your food or start taking supplements if recommended by your doctor.

While certain cases may require additional treatment, this foundation of a healthy diet and exercise is the right approach for everyone dealing with this and other age-related conditions.

What is the Treatment for Sarcopenia?

Rather than looking for a single effective sarcopenia treatment, it is best to take a holistic approach. Lifestyle changes, like improving your diet and exercising more, are the key to success. While each competency is important, they are far more effective when done together.

Is Sarcopenia Reversible Once It Develops?

While it may not be entirely reversible, you can slow down the progression and keep your muscles healthy with a good sarcopenia treatment plan, along with regular exercise and good nutrition.

How Can I Prevent Sarcopenia?

While you can’t entirely prevent sarcopenia, as it is a normal part of ageing, you can slow progression by doing some of the following:

  • Healthy food choices: Eat quality protein.
  • Exercise: Stay active with resistance training.
  • Regular medical care: Report any health changes.

How Can I Build Muscle As I Age?

It is essential to maintain and work to build muscles as you get older. This will go a long way in preventing sarcopenia, as well as other age-related conditions. Here are some of the key things to do to slow down the ageing process:

  • Increase Your Protein Intake: Protein is the building block of muscles and having a protein-rich diet is essential for building muscles.
    • In Singapore, the current recommended daily protein intake for adults is 0.8 grams per kilogram of body weight. For older adults, the recommended intake is between 1.2 and 2.0 grams per kilogram of body weight to account for higher needs.
  • Eat A Balanced Diet: Focusing on eating a variety of fruits, vegetables, healthy fats, and important micronutrients like selenium and magnesium. Pay attention to your levels of Vitamin C, vitamin D, vitamin B6, zinc, and calcium as they are crucial to supporting your muscle health.
  • Do a Pre-workout Warm-Up and Stretches: Do light jogging, stretches, and other warm-up exercises for at least ten minutes before strenuous exercise. This helps prevent sports injuries like sprains, muscle cramps, tears, and fractures.
  • Use Resistance Bands: Training with elastic resistance bands is smart and effective to improve your muscle strength in the elderly.
  • Body Weight Exercises: You can build muscle without any equipment by doing workouts, push-ups and squats that use your body weight to help build and maintain muscles.
  • Exercise Machines: Ellipticals, bikes (such as those in spinning classes), rowing machines, and lat pulldown machines are great ways to get started with gaining muscles without having to learn elaborate routines.
  • Lifting Light to Moderate Weights: Work with a personal trainer or physical therapist to find the appropriate exercises and weights to get started. Focus on starting with lighter weights slowly and carefully to build strength.
  • Slow and Steady Increase Of Exercise Intensity: Start with lighter weights and ten reps, slowly increasing weight and reps over time. Take rest between sets and after workouts.
  • Getting Plenty of Rest And Sleep: Rest allows your body to recover from exercise-induced stress adequate sleep is also essential for muscle protein metabolism and anabolic hormone release.

Sarcopenia and Muscle Loss: How Does It Impact Your Overall Health?

Sarcopenia can significantly impact your overall health in a wide range of ways. While each case is different, there are a few possible sarcopenia side effects that you can expect:

  • Reduced strength and mobility: A loss of muscle mass affects your physical strength and mobility. This can make it hard to do daily activities like walking, climbing stairs, or getting up from a chair. When these everyday things become hard, you have an increased risk of falls and fractures.
  • Increased frailty: Sarcopenia is a major contributor to physical frailty, which is characterised by weakness, fatigue, and vulnerability to stressors like infections or injuries. Frailty puts older adults at high risk for hospitalisation, disability, and death.
  • Higher risk of chronic diseases: Sarcopenia is linked to having a higher risk of type 2 diabetes, heart disease, obesity, osteoporosis, and certain cancers. The loss of muscle is believed to contribute to the development of insulin resistance.
  • Impaired balance and coordination: With reduced muscle strength in your core and lower body, your balance and coordination can be seriously impaired. This puts you at risk for falls.
  • Loss of independence: Severe muscle loss can make it impossible for people to independently manage daily self-care activities like bathing, dressing, and cooking.
  • Increased inflammation: A loss of muscle is associated with a rise in inflammatory cytokines. This chronic inflammation may promote the development of atherosclerosis, insulin resistance, and other age-related diseases.

Across the board, sarcopenia has a significant impact on people’s health by reducing physical capability, increasing susceptibility to other diseases, and taking away independence.

What Is It Like to Live with Sarcopenia?

The particular effects of sarcopenia depend a great deal on your age as the risk increases as you get old. That said, it also depends on your health and lifestyle.

It can greatly impact the quality of life. Lifestyle changes may reverse effects. Without them, muscles will continue to weaken. Over time full-time care may be needed for daily living.

Finding a Sarcopenia Specialist in Singapore

Do you think that you may have sarcopenia? Don’t just ignore the symptoms! Getting on the right treatment plan will make a real difference in your daily quality of life. To get started on the path to recovery, send us an email at hello@quantumortho.com.sg, call +65 6235 8781, or chat

with us on WhatsApp at +65 8028 4572. 

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Dr. James - Orthopaedic Surgeon in Singapore

About the Author

Dr James Tan is a skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.

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