Sarcopenia: early prevention or overdiagnosis?
Haase B C ,Broderson J B ,Bulow J ,13 January 2022 ,Sarcopenia: early prevention or overdiagnosis? ,BMJ ,https://doi.org/10.1136/bmj-2019-052592.
Clinical context—Sarcopenia is defined as age related loss of muscle mass and function and is associated with increased morbidity and mortality. With rising numbers of older people, interest in the condition and possible treatments is expected to rise
Diagnostic change—Sarcopenia was first described in 1989 as the phenomenon of decreasing lean body mass with older age. The idea of sarcopenia as a disease was raised in 1997. From 2010 to 2014, six consensus definitions changed the focus to assessments of physical function. In 2016, sarcopenia was assigned the code M62.84 in the International Classification of Diseases (ICD-10-CM)
Rationale for change—Sarcopenia specialists’ groups argued that an ICD-10 diagnosis would raise awareness and recognition of the condition, encourage funders and sponsors to allocate research resources, and support development of new therapies
Leap of faith—Early detection and treatment of sarcopenia will reduce morbidity and mortality and improve quality of life
Effect on prevalence—Based on the most used definition of sarcopenia, prevalence is estimated at 5-13% among people aged 60-70 years, and 11-50% among people aged >80 years. Worldwide prevalence by 2050 could be up to two billion
Evidence of overdiagnosis—Current literature, including studies on screening for sarcopenia, has not explicitly considered the risk of overdiagnosis. For now, overdiagnosis is inevitable since treatment does not differ from general health recommendations
Harms from overdiagnosis—No studies have investigated how people are affected by being diagnosed with sarcopenia. Indirect evidence shows that being labelled with a diagnosis that implies increased risk of morbidity and mortality imposes a psychological burden
Limitations of evidence—A diagnosis of sarcopenia has not been shown to improve prognosis. Sarcopenia treatment has not been shown to have better outcomes than general recommendations for physical exercise and diet. Moreover, the current diagnostic cut-off points, including sex and regional adjustments, are arbitrary and non-validated. It is not possible to distinguish between normal and pathological age related loss of muscle mass
As the global population ages, science and societies look for initiatives to handle the societal and individual problems that follow. One such initiative is the diagnosis of sarcopenia, the phenomenon of age related loss of muscle mass and function. Around two billion people aged 60 years or older are expected to be diagnosed with sarcopenia by 2050.1 Yet despite important research, uncertainties about the clinical value of diagnosis remain. We examine how modern medicine has established the diagnosis of sarcopenia without sufficient supporting evidence and ask whether it will lead to better prevention and treatment or to overdiagnosis.