Sarcopenia: Diagnosis & Outpatient Management

How to identify in clinic

• SARC-F questionnaire — 5-item screening (strength, walking, rising, climbing, falls)
• Score ≥4 = probable sarcopenia — proceed to confirmation
• Grip strength (handgrip dynamometer): <27 kg male, <16 kg female = low
• Chair stand test: >15 seconds for 5 stands = impaired
• Gait speed: <0.8 m/s = slow (suggests severe sarcopenia)
• EWGSOP2 criteria: low strength + low muscle quantity or quality

What to look for

• Difficulty rising from chair without arms
• Reduced walking speed
• History of recurrent falls
• Unintentional weight loss with preserved fat mass
• Temporal wasting, thin extremities

Non-pharmacologic (primary treatment)

• Resistance/strength training — the single most effective intervention
• Progressive resistance exercise 2–3× per week
• Protein intake 1.0–1.2 g/kg/day (higher than standard recommendations)
• Leucine-rich protein sources (dairy, eggs, meat, soy)
• Protein distributed across meals, not concentrated in one meal
• Vitamin D supplementation if deficient (target >30 ng/mL)

Medications

• No FDA-approved pharmacotherapy for sarcopenia
• Vitamin D 1000–2000 IU daily
• Oral nutritional supplements if malnourished
• Treat reversible causes: hypothyroidism, hypogonadism, corticosteroid use

Avoid

• Prolonged bed rest or inactivity — accelerates muscle loss
• Caloric restriction diets in older adults
• Unnecessary corticosteroids

When to refer

• PT — resistance training program design and supervision
• Dietitian — if protein intake is inadequate or weight loss is concurrent
• Endocrinology — if hypogonadism or unexplained muscle wasting

Documentation must include

• Screening tool used and result
• Confirmation measures (grip, chair stand, gait speed)
• Nutritional assessment
• Exercise prescription or PT referral
• Vitamin D level and supplementation