How Compounding Pharmacists Can Ameliorate Age-Related Muscle Loss and Slow Down Sarcopenia

How Compounding Pharmacists Can Ameliorate Age-Related Muscle Loss and Slow Down Sarcopenia

sarcopeniaA 68-year-old visited the emergency room seeking treatment for an arm wound caused by a fall. He said he felt fine, but lost his balance as he walked up the stairs, which is commonly seen in the ER in older patients. Five months later he was back. His leg seemed to collapse as he walked across the living room, causing another fall and a head injury from hitting a table. This time physicians assessed his muscle strength and diagnosed sarcopenia.

Sarcopenia is prevalent among aging adults who may ignore the symptoms as an expected part of getting older. Compounding pharmacists can make an important difference by screening their elderly patients to catch sarcopenia before they land in the ER and by providing topical pain relief to enable muscle-strengthening exercise.

Prevalence and Impact of Sarcopenia

Sarcopenia has always been defined as progressive age-related muscle loss, but more current diagnostic standards include measures of muscle strength and a decline in walking speed. Earlier data estimated that 20 percent of people over 60 and nearly half of all adults older than 75 have sarcopenia. However, estimates established in 2014 place prevalence at 5 percent to 10 percent of people over 65.1

Sarcopenia is an independent risk factor for physical disability independent of obesity, health behaviors, and socioeconomic status.

  • Muscle mass declines at the rate of 1 percent to 2 percent yearly, but strength also declines at the rate of 1.5 percent yearly after the age of 50, increasing to 3 percent after 602
  • Complex causes include normal aging decline, inactivity, low levels of hormones, nutritional deficiencies, neuromuscular disorders and disease states such as liver disease, COPD, and congestive heart failure.

Compounding Pharmacists Can Help Remediate Sarcopenia

One of the most significant qualities of sarcopenia is this: In most adults, it’s preventable and reversible. In spite of intensive research, pharmaceutical interventions haven’t been developed to treat sarcopenia. However, it’s important to be sure patients with osteoarthritis receive proper medical treatment because it may increase their risk of sarcopenia.

The key intervention for sarcopenia is an exercise regimen. Daily physical activity is an important determinant of muscle anabolism. It only takes 14 days of inactivity to induce anabolic resistance, which is the reduced sensitivity of muscle to the anabolic effect of protein and exercise.3 However, patients with sarcopenia need more than normal daily activity. Their activity regimen must include resistance training to improve muscle protein synthesis, increase strength and enhance mobility.

How pharmacists can take the lead:

Most patients don’t know about sarcopenia, so they’re not likely ask about symptoms perceived as the natural effects of aging. Physicians also expect age-related muscle weakness, so they may not consider sarcopenia until symptoms advance. Meanwhile, undiagnosed sarcopenia keeps progressing until someone—the pharmacist—steps in to ask the right questions and catch it in its early stages.

  • Assess all of your elderly patients for sarcopenia. Use a simple 5-question assessment—SARC-F—which is recommended for everyone 60 or older.4
  • Refer to their doctor if the assessment raises red flags. Motivate the patient to keep appointments by emphasizing that treatment prevents progression.

When you encounter patients who are already diagnosed with sarcopenia, ask what treatment plan they’re following.

  • If they’re not exercising, explain it’s the best treatment. Emphasize the importance of implementing a safe exercise plan under the supervision of their physician or a physical therapist.
  • If they are exercising, ask if they’re hindered by pain. Patients with sarcopenia often report they’re in pain, which subsequently interferes with activity. Self-reported pain may predict muscle decline and risk of falls.5

The next step is reaching out to talk about safe topical treatments that will relieve pain so that they can do the one thing the remediates or prevents sarcopenia—exercise.

  • Explain how topical treatments target specific areas of pain without systemic side effects.
  • Discuss non-opioid medications such as gabapentin, ketoprofen, baclofen, diclofenac, and clonidine. Schedule a medication review to be sure they’re not at risk for adverse interactions.
  • Some patients may get all the relief they need from lidocaine, menthol, and capsaicin.
  • Don’t forget to mention the ease of a patch and the benefits of using an emollient delivery base.

Dietary Considerations and Supplements to Recommend

Treatment for sarcopenia takes a two-pronged approach—exercise and diet—which includes protein to increase muscle mass and vitamin D to improve muscle function.  Be sure to keep these supplements in stock to facilitate sales.

Protein: Protein is the one nutrient consistently recommended for sarcopenia. Getting enough protein boosts muscle protein synthesis, but a few guidelines should be followed to see optimal results:

  • For dietary protein, patients should get 25 to 30 grams at each meal to ensure consuming a regular amount over the course of the day. Studies show this regimen improves muscle protein synthesis.6
  • Supplemental protein is a good choice for elderly patients who may not get enough protein in their diet. Recommend protein powders with branched-chain amino acids; leucine-enriched whey powder may be especially beneficial.
  • Total daily protein needs should be determined by their doctor or registered dietician.

Vitamin D: It’s estimated that 20 percent to 100 percent of elderly people are vitamin D deficient. Supplementation with 2,000 IU (50 mcg) of vitamin D is recommended for older adults.7

Other Supplements: Ursolic acid, which is naturally found in apple peels, and tomatidine from green tomatoes may reduce age-related loss of muscle strength and mass.8 A 2014 study reported that omega-3 fatty acid supplements may counteract sarcopenia, but they should be taken in earlier stages.9

Services for Older Adults Extend Life While Building Business

Compounding pharmacists are presented with the unique opportunity to help their older patients prevent a disease that accelerates disability and death the longer it goes undiagnosed. While maintaining health is always the number one goal, don’t lose sight of the fact that this is a significant market. The U.S. Census estimates that the population of people over 65 will more than double from 35 million in 2000 to 86.6 million in 2050. Now is the time to reach out with a proactive plan and establish your pharmacy as the place to go for elder care.

Pharmaceutica North America is a leading provider of bulk active pharmaceuticals and compounding kits that meet the needs of your patients with sarcopenia. Please contact us to talk about transdermal creams, diclofenac, lidocaine and other high-quality products that help you become a leader in your field.

Show 9 footnotes

  1. “Prevalence, Incidence, and Clinical Impact of Sarcopenia: Facts, Numbers, and Epidemiology—Update 2014,” http://www.jcsm.info/documents/1404/Prevalence,%20incidence,%20and%20clinical%20impact%20of%20sarcopenia%20%20facts,%20numbers,%20and%20epidemiology-update%202014.htm
  2. “Sarcopenia: What Every NP Needs to Know,” 2015, http://www.medscape.com/viewarticle/851737_1
  3. “Alterations in Human Muscle Protein Metabolism with Aging: Protein and Exercise as Countermeasures to Offset Sarcopenia,” March 2014, http://www.ncbi.nlm.nih.gov/pubmed/24105883
  4. “Alterations in Human Muscle Protein Metabolism with Aging: Protein and Exercise as Countermeasures to Offset Sarcopenia,” March 2014, http://www.ncbi.nlm.nih.gov/pubmed/24105883
  5. “Prospective Study of Self-Reported Pain, Radiographic Osteoarthritis, Sarcopenia Progression, and Falls Risk in Community-Dwelling Older Adults,” January 2012, http://onlinelibrary.wiley.com/doi/10.1002/acr.20545/pdf
  6. Dietary Protein Recommendations and the Prevention of Sarcopenia, January 2010, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760315/
  7. “Vitamin D,” November 2014, http://lpi.oregonstate.edu/mic/vitamins/vitamin-D
  8. “Identification and Small Molecule Inhibition of an Activating Transcription Factor 4 (ATF4)-Dependent Pathway to Age-Related Skeletal Muscle Weakness and Atrophy,” October 2015, http://www.jbc.org/content/290/42/25497
  9. “Omega-3 Fatty Acids and Protein Metabolism: Enhancement of Anabolic Interventions for Sarcopenia,” March 2014, http://www.ncbi.nlm.nih.gov/pubmed/24500439
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