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Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia

¹Laboratory of Clinical Epidemiology, Geriatric Department, Italian National Institute of Research and Care on Aging, 50125 Florence; and ²Department of Medicine and Aging, Geriatric Clinic, University of Chieti, 66013 Chieti, Italy; ³Department of Health Sciences, University of Jyvaskyla, 40351 Jyvaskyla, Finland; ⁴Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda 20892; and ⁵Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland 21224-6825

Submitted 11 March 2003 ; accepted in final form 28 June 2003

Sarcopenia, the reduction of muscle mass and strength that occurs with aging, is widely considered one of the major causes of disability in older persons. Surprisingly, criteria that may help a clinician to identify persons with impaired muscle function are still lacking. Using data from a large representative sample of the general population, we examined how muscle function and calf muscle area change with aging and affect mobility in men and women free of neurological conditions. We tested several putative indicators of sarcopenia, including knee extension isometric torque, handgrip, lower extremity muscle power, and calf muscle area. For each indicator, sarcopenia was considered to be present when the measure was >2 SDs below the mean. For all four measures, the prevalence of sarcopenia increased with age, both in men and women. The age-associated gradient in prevalence was maximum for muscle power and minimum for calf-muscle area. However, lower extremity muscle power was no better than knee-extension torque or handgrip in the early identification of poor mobility, defined either as walking speed <0.8 m/s or inability to walk at least 1 km without difficulty and without developing symptoms. Optimal cutoff values that can be used in the clinical practice to identify older persons with poor mobility were developed. The findings of the study lay the basis for a cost-effective, clinical marker of sarcopenia based on a measure of isometric handgrip strength. Our findings should be verified in a longitudinal study.

elderly; muscle power; strength

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