Pharmacological Interventions to Improve Muscle Mass, Muscle Strength and Physical Performance in Older People: An Umbrella Review of Systematic Reviews and Meta-analyses
- 368 Downloads
Sarcopenia, defined as the pathological decline in muscle mass, muscle strength and physical performance with aging, has become one of the geriatric giants because of its increasing prevalence and devastating health effects. The Belgian Society of Gerontology and Geriatrics (BSGG) is currently developing evidence-based guidelines for the prevention and therapy of sarcopenia for use in broad clinical practice. This systematic review summarizes the results of the Working Group on Pharmacology.
Our objective was to provide an evidence-based overview of the possible pharmacological interventions for sarcopenia with a focus on interventions that have already been studied in systematic reviews or meta-analyses.
We conducted a systematic umbrella review. Using the electronic databases PubMed and Web of Science, we identified systematic reviews and meta-analyses that assessed the effect of pharmacological interventions on criteria for sarcopenia in subjects aged ≥ 65 years. Study selection, quality assessment and data extraction were performed by two independent reviewers.
We identified seven systematic reviews or meta-analyses, encompassing ten pharmacological interventions: vitamin D, combined estrogen–progesterone, dehydroepiandrosterone, growth hormone, growth hormone-releasing hormone, combined testosterone–growth hormone, insulin-like growth factor-1, pioglitazone, testosterone and angiotensin-converting enzyme inhibitors. Importantly, very few systematic reviews or meta-analyses clearly mentioned baseline sarcopenia status. Therefore, our recommendations are generalised to older people, without specifying whether the muscle effect is more effective in healthy, pre-sarcopenic or sarcopenic older people. Vitamin D had a significant effect on muscle strength and physical performance, especially in women with low baseline values (< 25 nmol/l). Adverse events were rare. Testosterone had a strong effect on muscle mass and a modest to minimal effect on muscle strength and physical performance, respectively, when supplementing men with low serum levels (< 200–300 ng/dl). The adverse events were rare and mild. Insufficient evidence was available to recommend other pharmacological interventions.
Only vitamin D, especially in older women, and testosterone in older men with clinical muscle weakness and low testosterone serum levels can be justified in daily clinical practice to improve muscle mass, muscle strength and/or physical performance.
The Sarcopenia Guideline Development Group of the BSGG includes the following members: Bautmans I, Beaudart C, Beckwée D, Beyer I, Bruyère O, De Breucker S, De Cock A-M, Delaere A, de Saint-Hubert M, De Spiegeleer A, Gielen E, Perkisas S, Vandewoude M.
Compliance with Ethical Standards
No sources of funding were used to conduct this study or prepare this manuscript.
Conflict of interest
Anton De Spiegeleer, David Beckwée, Ivan Bautmans and Mirko Petrovic have no conflicts of interest that are directly relevant to the content of this review.
- 18.Ceglia L, Niramitmahapanya S, Morais MD, Rivas DA, Harris SS, Bischoff-Ferrari H, et al. A randomized study on the effect of vitamin D-3 supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab. 2013;98(12):E1927–35.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Avenell A, Mak JCS, O’Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014;(4):CD000227.Google Scholar
- 24.Takiar R, Lutsey PL, Zhao D, Guallar E, Schneider ALC, Grams ME, et al. The associations of 25-hydroxyvitamin D levels, vitamin D binding protein gene polymorphisms, and race with risk of incident fracture-related hospitalization: Twenty-year follow-up in a bi-ethnic cohort (the ARIC Study). Bone. 2015;78:94–101.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Veldhuis JD, Patrie JT, Frick K, Weltman JY, Weltman A. Sustained growth hormone (GH) and insulin-like growth factor I responses to prolonged high-dose twice-daily GH-releasing hormone stimulation in middle-aged and older men. J Clin Endocrinol Metab. 2004;89(12):6325–30.CrossRefPubMedGoogle Scholar
- 36.Traish AM, Haider A, Haider KS, Doros G, Saad F. Long-term testosterone therapy improves cardiometabolic function and reduces risk of cardiovascular disease in men with hypogonadism: a real-life observational registry study setting comparing treated and untreated (control) groups. J Cardiovasc Pharmacol Ther. 2017;22(5):414–33.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Spira D, Walston J, Buchmann N, Nikolov J, Demuth I, Steinhagen-Thiessen E, et al. Angiotensin-converting enzyme inhibitors and parameters of sarcopenia: relation to muscle mass, strength and function: data from the Berlin Aging Study-II (BASE-II). Drugs Aging. 2016;33(11):829–37.CrossRefPubMedGoogle Scholar
- 46.Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MDL, Adams JE, Oldham JA, et al. 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. J Clin Endocrinol Metab. 2010;95:639–50.CrossRefPubMedGoogle Scholar