Current and Future Pharmacologic Treatment of Sarcopenia

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Testosterone

Testosterone levels gradually decline in elderly men at a rate of 1% per year. Hypogonadism occurs in approximately 20% of men older than 60 years and 50% of men older than 80 years.2 Epidemiologic studies support a relationship between low levels of testosterone in elderly men and loss of muscle mass, strength, and function.3, 4

Currently, supraphysiologic doses of testosterone are known to dramatically increase muscle mass and strength in young subjects performing resistance training. However,

Cardiovascular drugs angiotensin II-converting enzyme inhibitors

Angiotensin II-converting enzyme (ACE) inhibitors improve the vital prognostic of patients with congestive heart failure, and can also reduce their functional decline. This beneficial effect is attributable to the cardiovascular actions but may also be related to the direct effect of ACE inhibitors on the skeletal muscle tissue.15, 102, 103, 104, 105 The activation of the renin-angiotensin-aldosterone system may be involved in the progress of sarcopenia, and growing evidence from basic and

Cytokine Inhibitors

The age-related inflammation process is supposed to play a crucial role in the development of sarcopenia through increasing myofibrillar protein degradation and decreasing protein synthesis. Anti-inflammatory drugs may delay its onset and progression. New drugs are currently being tested, mainly in the context of cachexia. Cytokine inhibitors, such as thalidomide, increase weight and lean tissue anabolism in patients with AIDS.156 In a model of cardiac cachexia, anti-TNF treatment attenuated

Creatine

Creatine supplementation increases energy storage through increasing intramuscular phosphocreatin.171 It may enable increased physical working capacity and resistance training, which stimulate muscle mass synthesis.172 The benefit of creatine on exercise performances has been reported repeatedly in young adults, and creatine was recently proposed to be a potential medication for the prevention and management of sarcopenia.1 However, few clinical trials in older people of creatine

Summary

Sarcopenia is a major cause of frailty and disability in older persons.193, 194 Relevant new pharmacologic drugs for sarcopenia will have a dramatic impact on improving the health and quality of life for elderly patients, reducing the associated comorbidity and disability and stabilizing rising health care costs. However, further clinical research on their effects on muscle physiology is needed before these new rising therapeutic can be recommended. The long-term safety and side effects must be

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