Progress to Preventing and Curing weak bones and muscle loss in the elderly

Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults.

Curing and preventing osteoporosis (severe bone loss and weakness) and sarcopenia (muscle loss and weakness) would dramatically improve the health and life of most people over the age of 60.

How common is osteoporosis [age related severe bone loss and weakness]

Worldwide, osteoporosis (weak bones) causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Osteoporosis is estimated to affect 200 million women worldwide – approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90. Osteoporosis affects an estimated 75 million people in Europe, USA and Japan. Worldwide, 1 in 3 women over 50 will experience osteoporotic fractures, as will 1 in 5 men.

There are diets and calcium supplements to reduce the amount of bone loss and weakening of bones. There are newer drugs in the pipeline to regrow bone and stop osteoporosis.

There are promising bone building drugs.

The experimental drug, romosozumab, frees the body’s ability to stimulate bone production by blocking biochemical signals that naturally inhibit bone formation. It is 1.5 times to 3 times better than current drugs at regrowing bone.

There is a drug called anti-sclerostin antibody. Now in its earliest clinical trials (the first long-term study in people), the drug, McClung says, “does not inhibit bone resorption, it activates bone formation, so it is a true bone-building drug.” In rats and monkeys it has not only restored the amount of bone but also its structure, architecture and strength, thus literally curing osteoporosis in a few months.

Meanwhile a team at Columbia University has discovered that the serotonin produced in the gut prevents bone formation, and that an “investigational” drug called LP533401, developed for irritable bowel syndrome, inhibits serotonin synthesis and thereby both prevented osteoporosis from developing and cured existing osteoporosis over a six-week trial in mice and rats.

How prevalent sarcopenia [age related severe muscle loss] is in the population and how dangerous is it ?

The term sarcopenia was originally created to refer age-related loss of muscle mass with consequent loss of strength. There are now four international definitions of sarcopenia (Cruz-Jentoft et al., 2010; Muscaritoli et al., 2010; Morley et al., 2011). In essence they all agree, requiring a measure of walking capability [either low gait speed or a limited endurance (distance) in a 6-min walk], together with an appendicular lean mass of less than 2 Standard Deviations of a sex and ethnically corrected normal level for individuals 20–30 years old. Sarcopenia is a prevalent health problem among the elderly. On average, 5–13 and 11–50% of people aged 60−70 years and over 80 years, respectively suffer sarcopenia with higher prevalences (68%) been reported in nursing home residents over 70 years.

Sarcopenia needs to be differentiated from cachexia, which is a combination of both muscle and fat loss and is usually attributable to an excess of catabolic cytokines associated with a disease process. Sarcopenia is a prime component of the frailty syndrome, and both sarcopenia and frailty are associated with increased disability, falls, hospitalization, nursing home admission, and mortality.

New drugs such as allopurinol or losartan, all of them approved by the Food and Drugs Administration (FDA) and actually prescribed for the treatment of other diseases, could be useful in preventing loss of muscle mass in the described susceptible populations yet new pharmacological targets are needed.

New therapies in clinical development include myostatin and the selective androgen receptor modulators (SARMs).[18] Nonsteriodal SARMs are of particular interest, given they exhibit significant selectivity between the anabolic effects of testosterone on muscle, but with little to no evidence of androgenic effects (such as prostate stimulation in men).[18]

MT-102, the first-in-class anabolic catabolic transforming agent (ACTA), has recently been tested in a Phase-II clinical study for treating cachexia in late-stage cancer patients. The study data show significant increases in body weight in patients treated with 10 mg of MT-102 twice daily over the study period of 16 weeks compared to significant decrease in body weight in patients receiving placebo treatment. In preclinical models, MT-102 has also shown benefits in reversing sarcopenia in elderly animals. Future clinical studies will investigate sarcopenia as potential second indication for MT-102.

Sarcopenia Statistics

There is over 50 percent loss of muscle mass by 90 years.

Roughly 45 percent of the U.S. population is sarcopenic
A 10 percent reduction in the sarcopenic population would save $1.1 billion
Healthcare expenditures due to sarcopenia cost roughly $900 per person per year
Lifestyle exercise programs cost about $200 per person per year
No race or ethnicity is protected from sarcopenia
In the United States, an estimated 53 percent of men and 43 percent of women over 80 are sarcopenic.

Experts say sarcopenia affects about 10 percent of those over 60, with higher rates as age advances. One study estimated that disability caused by sarcopenia accounted for $18.5 billion in direct medical costs in 2000, equivalent to 1.5 percent of the nation’s health-care spending that year.

An 80-year-old might have 30 percent less muscle mass than a 20-year-old. And strength declines even more than mass. Weight-lifting records for 60-year-old men are 30 percent lower than for 30-year-olds; for women the drop-off is 50 percent.

Lean muscle mass generally contributes up to ~50 percent of total body weight in young adults but declines with aging to be 25 percent at 75–80 years old

Moreover, a study that has tracked 3,000 people for 50 years found that about 20 of them, now in their 80s, have not lost muscle mass.

People who are physically inactive can lose as much as 3 to 5 percent of their muscle mass per decade after age 30

From 20 to 80 years of age, there is an ≈30 percent reduction in muscle mass and a decline in cross-sectional area of ≈20 percent.

Human muscle undergoes constant changes. After about age 50, muscle mass decreases at an annual rate of 1 to 2 percent. Muscle strength declines by 1.5% between ages 50 and 60 and by 3% thereafter.

1 in 4 adults either engage in a low level of activity (i.e. moderately active during usual daily activities and completely inactive during leisure-time) or are never active at all.

Jack Lelanne lived until he was 96 and maintained muscle and fitness into his 80s

Jack Lelanne was an example showing that maintaining muscle mass, strength and bone health is possible for people well into their 80s and even 90s.

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