Sarcopenia treatment and chiropractic care

An unmet clinical need, sarcopenia treatment can be addressed by doctors of chiropractic

SARCOPENIA IS A SURPRISINGLY COMMON CONDITION that puts older adults at increased risk for falls, fractures, head injuries, mobility impairments, loss of independence, decreased quality of life and co-morbidities.(1) Uncontrolled sarcopenia even increases the likelihood of death by nearly 2-1/2 times.(2) Despite this, sarcopenia is one of the most overlooked and undertreated conditions in primary health care practices,(3) with sarcopenia treatment creating a significant unmet clinical need that chiropractors may fill.

Sarcopenia and consequences

Sarcopenia is characterized by the progressive and generalized loss of skeletal muscle mass and strength with risk of adverse outcomes such as physical disability, poor quality of life and death.(4)

The consequences of sarcopenia are sobering. Older adults experiencing sarcopenia are up to five times more likely to develop physical disabilities.5 Excessive muscle loss, one of the hallmarks of the condition, not only increases the likelihood of impairment but elevates the risk of hip fractures by 60%, independent of bone density.(5)

Sarcopenia also increases the onset of co-morbidities including CAD, type 2 diabetes, obesity, kidney disease, arthritis, respiratory disease, thrombophlebitis, depression and cognitive disorders(1) — all of which increase the risk of mortality. Sarcopenia is even financially taxing, increasing the medical expenses of those experiencing it and adding approximately $18 billion a year to total U.S. health care costs, a figure that even exceeds osteoporosis.(6)

Prevalence

Sarcopenia is a common clinical condition, existing across numerous age groups and settings, including 33% in adults 65 and over in community health settings, 50% in individuals over age 80, 50-70% in frail individuals, and 76% in acutely hospitalized older patients.(6,7,8,9)

In contrast to osteoporosis, which people readily recognize, sarcopenia is not a condition the public is generally aware of. Despite this, when educated about it, 71% of older adults indicate they’d modify their nutrition and exercise habits to mitigate it.(10)

Filling an unmet clinical need

Chiropractors are ideally suited for sarcopenia treatment to provide patients with the education and leadership they need to mitigate this destructive condition, as:

• Compared to other health care professionals, chiropractors are better suited philosophically and educationally to serve the needs of individuals at risk for or experiencing sarcopenia. Sarcopenia is a musculoskeletal disease rooted in poor lifestyle choices, and who is better prepared to mentor patients about healthier choices and apply sarcopenia treatment than chiropractors, whose training and practice behaviors are steeped in this tradition.

• Estimates indicate as many as 14% of older adults seek chiropractic care.(11) Consequently, if you have older individuals in your practice, you’re already seeing patients with sarcopenia. By virtue of the fact that chiropractors see patients more frequently, they are in line to educate and mentor patients about sarcopenia.

• Although the visual appearance of sarcopenia may not be apparent until the sixth or seventh decade, the genesis of the condition occurs much earlier, often traceable to the fifth or fourth decade or prior to that. Consequentially, sarcopenia is as much a middle-aged problem as a geriatric condition. Providers like DCs, who treat thousands of middle-aged patients and who are advocates of nutrition, exercise and a healthy lifestyle, are ideally placed to be influencers at a time when it can make a significant difference in reducing risk of this disease.

• Doing so may improve patient outcomes. The combination of passive and active care (passive care consisting of spinal manipulative therapy and active care, nutrition and exercise) may prove to be an effective way to treat sarcopenia.

Exercise and nutritional interventions are known to be effective with sarcopenia treatment. But a recent research study evaluating the effect of spinal manipulative therapy (SMT) on muscle mass may have opened the door to other intriguing possibilities.

In this study(12) it was found that the thickness of lumbar multifidus muscle was increased after a trial of three spinal manipulative therapies. This is significant in that muscle mass is a foundational issue of sarcopenia. This is not to imply that SMT is a cure for sarcopenia, as further investigation is needed to validate a causal relationship here. But the combination of passive and active care as provided by chiropractors may prove to be a highly efficacious form of treatment for sarcopenia.

With their unique training, skills, philosophy and commitment to educating their patients, chiropractors are well suited to fill the unmet clinical need that currently exists with sarcopenia. They have only to embrace the opportunity.

JOSEPH A. MILLER, DC, MSCN, MA, BA, BS, possesses 30 years of experience in the chiropractic profession, where he has been a well-respected practitioner, teacher, researcher, author and speaker. As CEO of Prime of Life Nutrition, he maintains a clinical nutrition practice assisting older adults with sarcopenia, becoming a thought leader on the subject. He is available for speaking engagements and personal consultations and can be contacted at jmiller@nycc.edu.

References

1 Miller JA. Sarcopenia: A review of the validity and usefulness of five commonly employed screening tests for early detection in clinical practice. Journal of contemporary chiropractic 2021; Vol. 4: 72-78.

2 Landi F, Liperotti R, Russo A. Sarcopenia as a risk factor for falls in elderly individuals. Clinical Nutrition 2012; 31(5):652-658.

3 Cruz-jentoft AJ, Bahat G, Bauer JM et al. Sarcopenia: Revised European consensus definition and diagnosis. Age and Aging. 2018; 0:1-16.

4 Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People. Age and aging 2010; 39(4):412-423.

5 Janssen I. Influence of sarcopenia on development of physical disability. Cardiovascular Health study. 2006; 54:56-62.

6 Brown JC, Harhay MN. Sarcopenia: Mortality among a population-based sample of community dwelling older adults. Journal Cachexia Sarcopenia & Muscle 2016; 7(3): 290-298.

7 Iannuzzi-Sucich M, Prestwood KM, Kenny AM et al. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy older men and women. J. Geront. 2002; 57(12):M772-M777.

8 Robinson SM, Reginster JY, Rizzoli L et al. Does nutrition play a role in the prevention and management of sarcopenia. Clinical Nutrition 2018; 37(4): 1121-1132.

9 Bianchi L, Abete P, Bellelli G et al. Prevalence and clinical correlates of sarcopenia identified according to EWGSOP2 definition and diagnostic algorihm in hospitalized older people. GLISTEN Study. J. Geront. 2017; 72, 11:1575-1581.

10 Van Ancumm JM, Alcazar J, Meskers C. Impact of using updated EWGSOP2 definition in diagnosing sarcopenia. A clinical perspective. Arch. Geront. 2020; 90:1041-1047.

11 Weigel P, Hockenberg JM et al. Longitudinal study of chiropratic use among older adults in U.S. Chiroo. Osteopat. 2010; 18:34

12 Koppenhaver SL, Fritz JM, Hebert J. et al. Association between changes in abdominal and lumbar multifidus muscle thickness and clinical improvement after spinal manipulation. J. Ortho. & Spinal Therapy. 2011; 41(6):389-399.